Cáncer diferenciado de tiroides. Tratamiento quirúrgicoasignación de grupos de riesgo y análisis de supervivencia. (Estudio uni y multivariantes)

Abstract

Background: Many risk factors have been identified in differentiated thyroid cancer; with these in mind, some prognostic scores have been designed to assign risk of recurrence and survival. Objective: To evaluate usefulness of different methods of risk assignment in differentiated thyroid cancer in surgical patients Material and Methods: This is a retrospective review of 232 patients with differentiated thyroid cancer treated in our hospital full of 1991-2014, ranked the pTNM system (7th edition, 2010). Was calculated according to risk group MACIS, AGES, AMES and ATA systems. Correlation of recurrences and survival was carried out according to score or risk assignment. 200 surgeries were performed in one surgery and 32 surgeries totalization, 201 (86, 6%) total thyroidectomy, 11 (4.7%) subtotal thyroidectomy and 20 (8.6%) with isthmectomy hemithyroidectomies, partnering lymphadenectomy of the central compartment and side of the neck in 113 (48, 7%) cases. Curves were calculated disease-free interval, mortality related and not related to the thyroid tumor, age, sex, histological type, grading and survival Kaplan-Meyer actuarial, statistical significance and Wilconson test for comparison of pathological data. Results: Statistical analysis of 232 operated patients followed for 1-23 years (mean = 7.83 years), reveals a total mortality related and unrelated thyroid cancer 15 cases (6,46 %), mortality related to thyroid cancer 6 cases (2,58%), overall survival at 5, 10 and 20 years of 96%, 93% and 84% and a median disease-free survival of 18, 5 years (range 1-20 years) with a mean survival of 16,019 years. In the multivariate analysis, the variables that affected the prognosis with respect to overall survival were: tumor size> 4 cm., Tall-cell histologic type, tumor grade, lymph node involvement, invasion of soft tissue and vascular histology. According to the system AGES 23,2% were high risk, to the MACIS 5,6%, 27,2% to the AMES and 5,2% to the ATA. This study shows that between 60 and 80% of our patients are low risk. (MACIS: 82,3%; AGES: 76,2%; AMES:72,8% and ATA 59.9%). Conclusion: MACIS, AGES and AMES systems are useful for allocating risk in our population, but it is necessary to become familiar with its use to select the aggressiveness of therapy in each case.