甲状腺肿瘤的分期和预后得分策略.doc

MAICSThe MAICS method was developed by the Mayo Clinic based on careful evaluation of a large group of patients. It is probably the most reliable staging method available and therefore most accurately predicts a patients outcome compared to other methods. It was developed to determine the prognosis of patients with papillary thyroid cancer. MAICS is an abbreviation for the factors taken into account to predict survival: (distant) Metastasis or spread of the cancer to areas outside the neck, Age of the patient at the time the tumor was discovered, Invasion of the cancerous tumor into surrounding areas of the neck as seen by the naked eye, (in)Completeness of surgical resection (or removal) of the tumor, and Size of the tumor. FACTORSSCOREdistant Metastasis: Did the tumor spread to other parts of the body outside of the region of the neck?yes = 3no = 0Age at the time the tumor was foundless than 39 years = 3.1over 40 = 0.08 x ageInvasion:Did the surgeon see that the tumor had extended beyond the thyroid into other regions of the neck?yes = 1no = 0inComplete resection: Were there parts of the tumor that the surgeon was unable to remove (for example a part that was attached to the windpipe)?yes = 1no = 0Size of tumor (measured by the pathologist)0.3 x size in cmMACIS系统(适用于乳头状甲状腺癌)得分= 3.1 (年龄40 岁) 或0.08 年龄 (年龄40 岁) + 0.3分 肿瘤大小(厘米，最大径线) + 1 (肿瘤未完全切除) + 1 (局部侵犯) + 3 (远处转移)Once the score for each factor is calculated, they are added up to get a total MAICS score and this total predicts the likelihood that the patient will live 20 years from the time the tumor was discovered. Fortunately most patients fall into the low risk category (MAICS score less than 6.0) and are cured of the cancer at the time of surgery.20-year survival rate according to MAICS scoreMAICS Score 8.020 yr Survival99%89%56%24%AMESAnther popular staging method is the AMES method, developed by the Lahey Clinic. Like the TNM method, it is applicable to both papillary and follicular thyroid cancers. This method takes into account the Age of the patient when the tumor was discovered, Metastases of the tumor to different sites other than neck lymph nodes, the Extent of primary tumor and, the Size of the tumor (if it is larger than 5 cm, or about 2 inches).LOW RISK1.8% Mortality RateHIGH RISK46% Mortality RateMen under 41 and Women under 51without distant metastasesAll patients with distant metastasesAll men over 41 and women over 51 with:Intra-thyroidal papillary cancer (papillary cancer confined present only within the thyroid gland) OR follicular cancer tumor with minor capsular involvement (the tumor slightly extends into the capsule which surrounds it) ANDPrimary tumor less than 5 cm in diameter ANDNo distant metastases All men over 41 and women over 51 with:Extra-thyroidal papillary cancer (extends beyond the thyroid gland) OR follicular cancer tumor with major capsular involvement (the tumor extends significantly into the capsule which surrounds it) AND/ORPrimary cancer is 5 cm in diameter or larger, regarAMES系统(适用于乳头状和滤泡状甲状腺癌)低危：年轻(男 40岁,女 50岁)：无远处转移；年老(男 40岁, 女50岁)：腺内乳头状癌；包膜微小浸润型滤泡状癌；原发肿瘤直径40岁, 女50岁)：甲状腺外浸润型乳头状癌；包膜广泛浸润型滤泡状癌；原发肿瘤直径5cm20年生存率: 低危 = 99%； 高危 = 61%TNMThe TNM method is the most universally used staging method and applies to both papillary and follicular thyroid cancers. It was introduced in 1987 by the International Union Against Cancer and adopted by the American Joint Commission on Cancer.T: Tumor size (in cm). T=1 if the tumor is less than 1cm; T = 2 if it is 1-4 cm; T=3 if it is greater than 4 cm; and T=4 if the tumor extends beyond the thyroid gland.N: Node metastasis - presence or absence of lymph node metastases (meaning has the cancer spread to the lymph nodes in the neck). If the cancer has spread to the lymph nodes, N = 1; if none of the lymph nodes were affected, N = 0M: distant Metastases (meaning has the cancer spread beyond the neck to other areas of the body like the lung or bone) - if there is distant metastases, M = 1, if the cancer has not spread outside of the neck region, M = 0Based on these three categories, the cancer is assigned a Stage of 1, 2 ,3 or 4. Stage 1 is the least advanced form of cancer with the best prognosis, and Stage 4 is the most advanced category. The table below shows the likelihood of a local recurrence (or recurrence of thyroid cancer in the neck region), distant recurrence (recurrence of cancer in other areas of the body), and mortality (death)