Patients and families of patients with papillary thyroid cancer often ask how long they can live after surgery. Actually, doctors do not tell fortune. However, we can give a definite answer, that is, don’t worry because patients with papillary thyroid cancer have a very good prognosis. The reason why we say so is based on clinical studies from some international medical institutions with rich experience in the treatment of papillary thyroid cancer. There are various prognostic scoring systems for papillary thyroid cancer that are used to assess the malignancy of the disease on the one hand, and to guide the scope and size of surgery on the other. These scoring systems include the MACIS score, the AGES score and the AMES score. Xiaohui Wang, Department of General Surgery, Xuanwu Hospital, Capital Medical University
MACIS score is a scoring system obtained by Mayo Medical Center (one of the most famous medical centers in the United States) based on statistical analysis of large number of cases, which is another improvement on the famous AGES scoring system, and its considered to be the most accurate scoring system for papillary thyroid cancer at present.
Calculation of MACIS score.
M: whether there is distant (liver, lung) metastasis
Yes: +3 points
No: +0 points
A: Age
Less than 39 years old = 3.1 points
Greater than 40 years old = 0.08*years (points)
C: Whether the tumor was completely removed
No: +1 point
Yes: +0 points
I: Whether it invades extra-thyroidal tissue
Yes: +1 point
No: +0 points
S: Tumor size (diameter)
0.3*Tumor diameter (cm)
20-year survival rate:Score <6: 20-year survival rate is 99%; 6-6.99: 20-year survival rate is 89%; 7-7.99 : 20-year survival rate is 56%; ≥8: 20-year survival rate is 24%
Example: A patient with papillary thyroid cancer who underwent total thyroidectomy with cervical lymph node dissection.
No distant metastases, score 0.
Age 60 years, recorded as 4.8 points (0.08* 60).
Surgery has completely removed the tumor, recorded 0 points.
Tumor invasion of extra-thyroidal tissues, such as the anterior cervical girdle muscle, was recorded as 1 point.
The tumor size is 2 cm, recorded as 0.6 points (0.3*2);
Therefore, the total MACIS score of this patient is:0+4.8+0+1+0.6=6.45 points, and the 20-year survival rate is 89%, which is a medium-low risk patient.
Calculation of the AGES score.
It is an early scoring system from Mayo Medical Center, USA.
AGES prognostic score= Age (A) × 0.05 + tumor tissue grading (G) + tumor invasion extent (E) + tumor diameter (S) × 0.2. Age: 0 for those under 40 years old; 0 for those ≥ 40 years old × 0.05 Tumor tissue grading: “1” for highly or moderately differentiated carcinoma, “2” for poorly differentiated carcinoma. Tumor invasion range: tumor confined to the thyroid gland was scored as “0”, tumor beyond the thyroid gland was scored as “1”, and distant metastasis was scored as “3”. “Tumor size: tumor diameter (cm).
20-year survival rate:
For a score of ≤3.99, the 20-year survival rate is 99%; for a score of 4-4.99, the 20-year survival rate is 80%; for a score of 5-5.99, the 20-year survival rate is 67%; for a score of ≥6, the 20-year survival rate is 13%.
Example: A 50-year-old patient with moderately differentiated papillary adenocarcinoma, 4 cm in diameter, with distant metastases at the time of presentation.
The prognostic score is 50 × 0.05 + 1 + 3 + 0.8 = 7.3. The patient has a poor prognosis.