甲状腺癌评估体系

(MACIS) FACTORSSCOREdistantMetastasis:Didthetumorspreadtootherpartsofthebodyoutsideoftheregionoftheneck?yes=3no=0Ageatthetimethetumorwasfoundlessthan39years=3.1over40=0.08xageInvasion:Didthesurgeonseethatthetumorhadextendedbeyondthethyroidintootherregionsoftheneck?yes=1no=0inCompleteresection:Weretherepartsofthetumorthatthesurgeonwasunabletoremove(forexampleapartthatwasattachedtothewindpipe)?yes=1no=0Sizeoftumor(measuredbythepathologist)0.3xsizeincmOncethescoreforeachfactoriscalculated,theyareaddeduptogetatotalMAICSscoreandthistotalpredictsthelikelihoodthatthepatientwilllive20yearsfromthetimethetumorwasdiscovered.Fortunatelymostpatientsfallintothelowriskcategory(MAICSscorelessthan6.0)andarecuredofthecanceratthetimeofsurgery.20-yearsurvivalrateaccordingtoMAICSscoreMAICSScore<6.06.0-6.997.0-7.99>8.020yrSurvival99%89%56%24%

STAGEAGE<45AGE>45LocalRecurrenceDistantRecurrenceMortalityIAnyTAnyNM0T1N0M05.5%2.8%1.8%IIAnyTAnyNMlT2N0M0T3N0M07%7%11.6%III-T4N0M0AnyTAnyNMl27%13.5%37.8%IV-AnyTAnyNMl10%100%90%(AMES)LOWRISK1.8%MortalityRateHIGHRISK

46%MortalityRateMenunder41andWomenunder51withoutdistantmetastasesAllpatientswithdistantmetastasesIntra-thyroidalpapillaryIntra-thyroidalpapillarycancer(papillarycancerconfinedpresentonlywithinthethyroidgland)ORfollicularcancertumorwithminorcapsularinvolvement(thetumorslightlyextendsintothecapsulewhichsurroundsit)ANDPrimarytumorlessthan5cmindiameterANDNodistantmetastasesAllmenover41andwomenover51with:Allmenover41andwomenover51with:Extra-thyroidalpapillarycancer(extendsbeyondthethyroidgland)ORfollicularcancertumorwithmajorcapsularinvolvement(thetumorextendssignificantlyintothecapsulewhichsurroundsit)AND/ORPrimarycanceris5cmindiameterorlarger,regar1、AGES系统(1987,Hay提出，MayoClinic)A(age)0.05x年龄(>40岁)G(grade)组织学分级(Broders分级)0(G=l),1(G=2),3/4(G=3)E(extrathyroid)(包膜外受侵)无侵犯(E=0)，有侵犯(E=l)，远处转移(E=3)S(size):0.2x肿瘤大小(厘米，最大径线)20年生存率：<3.99=99%4.99=80%5.99=67%>6=13%包膜微小浸润型滤泡状癌；原发肿瘤直径＜5cm高危： 远处转移（无论年龄多大）年老（男＞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5＞cm20年生存率：低危=99%高危=61%3、MACIS系统（适用于乳头状甲状腺癌）（1993,Hay提出，MayoClinic）预后评分A=3.1（年龄＜40岁）或0.08x年龄（年龄240岁）S=0.03x肿瘤大小（厘米，最大径线）+1（肿瘤未完全切除）UICC评分（国际抗癌联盟评分）AMES（Lahey医学中心评分，美国麻省）EORTC（欧洲肿瘤研究与治疗组织评分）CCS（美国芝加哥大学评分，其长期随访病例数超过2000例）UAB-MDACC（美国阿拉巴马大学评