Skip to main content
SpringerLink
Log in

Optimizing the Treatment of AMES High-risk Papillary Thyroid Carcinoma

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

A minority of patients with papillary thyroid carcinoma (PTC) is at high-risk of developing recurrent disease and death. Risk group stratification as defined by age, metastases to distant site, extrathyroidal invasion, and tumor size (AMES) criteria is frequently employed to identify high-risk patients for aggressive surgical and adjuvant treatments. The present study aimed at evaluating risk factors and the impact of treatment on cause-specific mortality (CSM) in this group of high-risk patients. From 1961 to 2000, 150 of 499 patients surgically treated for PTC were considered as high-risk by AMES criteria. At 10-years CSM was significantly higher in high-risk patients (28%) than in low-risk patients (2%) (p < 0.0001). The clinicopathologic features, treatment, and outcome of AMES high-risk patients were retrospectively studied and risk factors for CSM were analyzed. There were 58 men and 92 women with a median age of 62 years (range: 18–87 years). Bilateral thyroidectomy was performed for 143 (95%) patients and concomitant neck dissection was performed for 82 patients (55%). Thirty-six patients (24%) underwent incomplete tumor excision with residual disease. Radioactive iodine (I131) ablation and external-beam irradiation were administered to 102 (68%) and 46 patients (31%), respectively. Over a median follow-up of 7.6 years, the overall mortality was 23% and 44%, whereas the CSM was 14% and 28% at 5 and 10 years, respectively. Using the Cox proportional hazard model, distant metastasis at presentation, incomplete tumor excision, and no postoperative I131 treatment were independent prognostic factors of poor survival. Patients who underwent an incomplete excision showed improved survival after I131 ablation (p = 0.0008), external-beam irradiation (p = 0.02), or both forms of treatment (p = 0.04). Within this high-risk AMES group, International Union Against Cancer (UICC) pTNM staging and MACIS (Metastasis, Age, Completeness, Invasion, Size) scoring correlated significantly with CSM. AMES high-risk PTC patients should undergo total thyroidectomy aiming at complete tumor resection followed by I131 ablation. External-beam irradiation should be added for patients with residual disease after an incomplete excision.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.

Similar content being viewed by others

References

  1. EL Mazzaferri RT Kloos (2001) ArticleTitleCurrent approaches to primary therapy for papillary and follicular thyroid cancer J. Clin. Endocrinol. Metab. 86 1447–1463 Occurrence Handle10.1210/jc.86.4.1447 Occurrence Handle1:CAS:528:DC%2BD3MXivVCltLw%3D Occurrence Handle11297567

    Article  CAS  PubMed  Google Scholar 

  2. ID Hay CS Grant WF Taylor et al. (1987) ArticleTitleIpsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma—a retrospective analysis of surgical outcome using a novel prognostic scoring system Surgery 102 88–95 Occurrence Handle3589980

    PubMed  Google Scholar 

  3. B Cady R Rossi (1988) ArticleTitleAn expanded view of risk-group definition in differentiated thyroid carcinoma Surgery 104 947–953 Occurrence Handle1:STN:280:BiaD2Mfot1Q%3D Occurrence Handle3194846

    CAS  PubMed  Google Scholar 

  4. DP Byar SB Green P Dor et al. (1979) ArticleTitleA prognostic index for thyroid carcinoma. A study of the E.O.R.T.C. Thyroid Cancer Cooperative Group Eur. J. Cancer 15 1033–1041 Occurrence Handle10.1016/0014-2964(79)90291-3 Occurrence Handle1:STN:280:Bi%2BD28fpvFA%3D Occurrence Handle510341

    Article  CAS  PubMed  Google Scholar 

  5. LJ DeGroot EL Kaplan M McCormick et al. (1990) ArticleTitleNatural history, treatment, and course of papillary thyroid carcinoma J. Clin. Endocrinol. Metab. 71 414–424 Occurrence Handle1:STN:280:By%2BA3sfjtFc%3D Occurrence Handle2380337

    CAS  PubMed  Google Scholar 

  6. ID Hay EJ Bergstralh JR Goellner et al. (1993) ArticleTitlePredicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989 Surgery 114 1050–1058 Occurrence Handle1:STN:280:ByuD2sfisVI%3D Occurrence Handle8256208

    CAS  PubMed  Google Scholar 

  7. MP Cunningham RB Duda W Recant et al. (1990) ArticleTitleSurvival discriminants for differentiated thyroid cancer Am. J. Surg. 160 344–347 Occurrence Handle1:STN:280:By6D38zislw%3D Occurrence Handle2221232

    CAS  PubMed  Google Scholar 

  8. AM Schindler G Melle Particlevan B Evequoz et al. (1991) ArticleTitlePrognostic factors in papillary carcinoma of the thyroid Cancer 68 324–330 Occurrence Handle1:STN:280:By6A3c%2Fkt1M%3D Occurrence Handle2070332

    CAS  PubMed  Google Scholar 

  9. JP Shah TR Loree D Dharker et al. (1992) ArticleTitlePrognostic factors in differentiated carcinoma of the thyroid gland Am. J. Surg. 164 658–661 Occurrence Handle1:STN:280:ByyD1MfjslE%3D Occurrence Handle1463119

    CAS  PubMed  Google Scholar 

  10. TG Lorentz PWK Lau CY Lo et al. (1994) ArticleTitleMultivariate analysis of risk factors influencing survival in 110 ethnic Chinese with papillary thyroid cancer World J. Surg. 18 547–551 Occurrence Handle1:STN:280:ByqB2c3nslw%3D Occurrence Handle7725743

    CAS  PubMed  Google Scholar 

  11. LA Akslen AO Myking H Salvesen et al. (1992) ArticleTitlePrognostic importance of various clinicopathological features in papillary thyroid carcinoma Eur. J. Cancer 29A 44–51 Occurrence Handle1:STN:280:ByyD2srlslE%3D Occurrence Handle1445745

    CAS  PubMed  Google Scholar 

  12. SO Sebastian JM Rodriguez Gonzalez PP Paricio et al. (2000) ArticleTitlePapillary thyroid carcinoma; prognostic index for survival including the histological variety Arch. Surg. 135 272–277 Occurrence Handle10.1001/archsurg.135.3.272 Occurrence Handle1:STN:280:DC%2BD3c7osFWjsA%3D%3D Occurrence Handle10722027

    Article  CAS  PubMed  Google Scholar 

  13. LA Akslen VA Li Volsi (2000) ArticleTitlePrognostic significance of histologic grading compared with subclassification of papillary thyroid carcinoma Cancer 88 1902–1908 Occurrence Handle10.1002/(SICI)1097-0142(20000415)88:8<1902::AID-CNCR20>3.3.CO;2-P Occurrence Handle1:STN:280:DC%2BD3c3isFKjtg%3D%3D Occurrence Handle10760768

    Article  CAS  PubMed  Google Scholar 

  14. B Cady (1997) ArticleTitleOur AMES is true: how an old concept still hits the mark: or, risk group assignment points the arrow to rational therapy selection in differentiated thyroid cancer Am. J. Surg. 174 462–468 Occurrence Handle10.1016/S0002-9610(97)00162-1 Occurrence Handle1:STN:280:DyaK1c%2FktVeksw%3D%3D Occurrence Handle9374215

    Article  CAS  PubMed  Google Scholar 

  15. LE Sanders B Cady (1998) ArticleTitleDifferentiated thyroid cancer; reexamination of risk groups and outcome of treatment Arch. Surg. 133 419–425 Occurrence Handle10.1001/archsurg.133.4.419 Occurrence Handle1:STN:280:DyaK1c3isVOqtw%3D%3D Occurrence Handle9565123

    Article  CAS  PubMed  Google Scholar 

  16. RW Tsang JD Brierley WJ Simpson et al. (1998) ArticleTitleThe effects of surgery, radioiodine, and external radiation therapy on the clinical outcome of patients with differentiated thyroid carcinoma Cancer 82 375–388 Occurrence Handle10.1002/(SICI)1097-0142(19980115)82:2<389::AID-CNCR19>3.3.CO;2-E Occurrence Handle1:STN:280:DyaK1c7gsF2ktg%3D%3D Occurrence Handle9445196

    Article  CAS  PubMed  Google Scholar 

  17. WJ Simpson T Panzarella JS Carruthers et al. (1988) ArticleTitlePapillary and follicular thyroid cancer: impact of treatment in 1578 patients Int. J. Radiat. Oncol. Biol. Phys. 14 1063–1075 Occurrence Handle1:STN:280:BieB2Mnns1M%3D Occurrence Handle2454902

    CAS  PubMed  Google Scholar 

  18. EL Mazzaferri SM Jhiang (1994) ArticleTitleLong-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer Am. J. Med. 97 418–428 Occurrence Handle10.1016/0002-9343(94)90321-2 Occurrence Handle1:STN:280:ByqD28fgtlI%3D Occurrence Handle7977430

    Article  CAS  PubMed  Google Scholar 

  19. DR Cox (1972) ArticleTitleRegression models and life tables J. R. Stat. Soc. Ser. B 34 187–220

    Google Scholar 

  20. Sobin, LH, Wittle-kind, C (1997) UICC: TNM Classification of malignant tumors. 5th ed., Wiley, New York

  21. ST Kukkonen RK Haapiainen KO Franssila et al. (1990) ArticleTitlePapillary thyroid carcinoma; the new, age-related TNM classification system in a retrospective analysis of 199 patients World J. Surg. 14 837–842 Occurrence Handle1:STN:280:By6D2srnvFQ%3D Occurrence Handle2256356

    CAS  PubMed  Google Scholar 

  22. B Cady R Rossi M Silverman et al. (1985) ArticleTitleFurther evidence of the validity of risk group definition in differentiated thyroid carcinoma Surgery 98 1171–1178 Occurrence Handle1:STN:280:BimD2s%2FovFA%3D Occurrence Handle4071392

    CAS  PubMed  Google Scholar 

  23. P Hannequin JC Liehn MJ Delisle (1986) ArticleTitleMultifactorial analysis of survival in thyroid cancer. Pitfalls of applying the results of published studies to another population Cancer 58 1749–1755 Occurrence Handle1:STN:280:BiiD3c7ptlA%3D Occurrence Handle3756796

    CAS  PubMed  Google Scholar 

  24. ID Hay CS Grant EJ Bergstralh et al. (1998) ArticleTitleUnilateral total lobectomy; is it sufficient surgical treatment for patients with AMES low-risk papillary thyroid carcinoma? Surgery 124 958–966 Occurrence Handle10.1067/msy.1998.91825 Occurrence Handle1:STN:280:DyaK1M%2FntFOgsQ%3D%3D Occurrence Handle9854569

    Article  CAS  PubMed  Google Scholar 

  25. NF Esnaola SB Cantor SI Sherman et al. (2001) ArticleTitleOptimal treatment strategy in patients with papillary thyroid cancer; a decision analysis Surgery 130 912–930 Occurrence Handle10.1067/msy.2001.118370

    Article  Google Scholar 

  26. BL Solomon L Wartofsky KD Burman (1996) ArticleTitleCurrent trends in the management of well differentiated papillary thyroid carcinoma J. Clin. Endocrinol. Metab. 81 333–339 Occurrence Handle10.1210/jc.81.1.333 Occurrence Handle1:CAS:528:DyaK28XkvV2jsQ%3D%3D Occurrence Handle8550774

    Article  CAS  PubMed  Google Scholar 

  27. SA Hundahl B Cady MP Cunningham et al. (2000) ArticleTitleInitial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the United States during 1996. US and German Thyroid Cancer Study Group. An American College of Surgeons Commission on Cancer Patient Care Evaluation Study Cancer 89 202–217 Occurrence Handle10.1002/1097-0142(20000701)89:1<202::AID-CNCR27>3.0.CO;2-A Occurrence Handle1:STN:280:DC%2BD3czlslSlsg%3D%3D Occurrence Handle10897019

    Article  CAS  PubMed  Google Scholar 

  28. PA Singer DS Cooper GH Daniels et al. (1996) ArticleTitleTreatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. American Thyroid Association Arch. Intern. Med. 156 2165–2172 Occurrence Handle10.1001/archinte.156.19.2165 Occurrence Handle1:STN:280:ByiD2c%2FltVU%3D Occurrence Handle8885814

    Article  CAS  PubMed  Google Scholar 

  29. JD Brierley RW Tsang (1999) ArticleTitleExternal-beam radiation therapy in the treatment of differentiated thyroid cancer Semin. Surg. Oncol. 16 42–49 Occurrence Handle10.1002/(SICI)1098-2388(199901/02)16:1<42::AID-SSU8>3.0.CO;2-4 Occurrence Handle1:STN:280:DyaK1M7gsFOntw%3D%3D Occurrence Handle9890739

    Article  CAS  PubMed  Google Scholar 

  30. M Tubiana E Haddad M Schlumberger et al. (1985) ArticleTitleExternal radiotherapy in thyroid cancers Cancer 55 2062–2071 Occurrence Handle1:STN:280:BiqC2M7msFw%3D Occurrence Handle3919920

    CAS  PubMed  Google Scholar 

  31. O Esik G Nemeth J Eller (1994) ArticleTitleProphylactic external irradiation in differentiated thyroid cancer; a retrospective study over a 30-year observation period Oncology 51 372–379 Occurrence Handle1:STN:280:ByuB28fotFA%3D Occurrence Handle8208524

    CAS  PubMed  Google Scholar 

  32. TH Kim DS Yang KY Jung et al. (2003) ArticleTitleValue of external irradiation for locally advanced papillary thyroid cancer Int. J. Radiat. Oncol. Biol. Phys. 55 1006–1012 Occurrence Handle10.1016/S0360-3016(02)04203-7 Occurrence Handle12605980

    Article  PubMed  Google Scholar 

  33. J Farahati C Reiners M Stuschke et al. (1996) ArticleTitleDifferentiated thyroid cancer. Impact of adjuvant external radiotherapy in patients with perithyroidal tumor infiltration (stage pT4) Cancer 77 172–180 Occurrence Handle10.1002/(SICI)1097-0142(19960101)77:1<172::AID-CNCR28>3.0.CO;2-1 Occurrence Handle1:STN:280:BymB38zjsV0%3D Occurrence Handle8630926

    Article  CAS  PubMed  Google Scholar 

  34. XL Wu YH Hu QH Li et al. (1987) ArticleTitleValue of postoperative radiotherapy for thyroid cancer Head Neck Surg. 10 107–112 Occurrence Handle1:STN:280:BiaC2szpt1I%3D Occurrence Handle3507418

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments.

The authors thank Ms. K.Y. Ng, Research Assistant, for her help in data collection.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong, China

    Chung-Yau Lo M.B.B.S., M.S. & Wai-Fan Chan M.B.B.S.

  2. Division of Pathology, School of Medicine, James Cook University, Townsville, Queensland, Australia

    King-Yin Lam M.B.B.S.

  3. Department of Clinical Oncology, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong, China

    Koon-Yat Wan M.B.B.S.

Authors
  1. Chung-Yau Lo M.B.B.S., M.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wai-Fan Chan M.B.B.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. King-Yin Lam M.B.B.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Koon-Yat Wan M.B.B.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chung-Yau Lo M.B.B.S., M.S..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lo, CY., Chan, WF., Lam, KY. et al. Optimizing the Treatment of AMES High-risk Papillary Thyroid Carcinoma. World J. Surg. 28, 1103–1109 (2004). https://doi.org/10.1007/s00268-004-7420-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-004-7420-6

Keywords

Search

Navigation