Utilidad y comparación de diferentes escalas clinico-patologicas en el pronóstico del cáncer diferenciado de tiroides
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2024
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Antecedentes: El cáncer de tiroides es la neoplasia endocrinológica más frecuente y cerca del 95% de los casos corresponde a cáncer diferenciado de
tiroides (subtipos histológicos: papilar 70-80% y folicular 10-15%). Por tal motivo el uso de escalas pronosticas, constituye una herramienta de
utilidad para toma de decisiones, tanto en establecer la mejor opción terapéutica, como para estimar el riesgo de mortalidad y recurrencia de la enfermedad. Objetivo general: Determinar la utilidad y comparar las escalas clínico patológicas TNM (tamaño del tumor, ganglio, metástasis), MACIS (metástasis, edad, integridad de la resección, invasión, tamaño del tumor) y AMES (edad, metástasis a distancia, invasión extra tiroidea y tamaño del tumor), en el pronóstico del cáncer diferenciado de tiroides. Materiales y Métodos: Posterior al cálculo del tamaño muestral y tras aplicar los criterios de inclusión y exclusión se analizaron 275 casos, 249 mujeres (91%) y 26 hombres (9%) con una edad media de 48.5 años (IC 95%: 46.5 – 50.4), se
realizó un análisis de supervivencia con seguimiento de 130 meses, el análisis estadístico se llevó a cabo con las curvas de Kaplan Meier, el test de Log Rank y la proporción de varianza explicada. Resultados: las tres escala clínico-patológica TNM, MACIS y AMES presentaron un test de Log Rank con p< 0.05 y la proporción de varianza explicada fue mayor con la escala TNM 8 ° edición, seguida de la escala MACIS, de esta manera se puede concluir que estas escalas predicen adecuadamente la mortalidad en pacientes con cáncer diferenciado de tiroides
Background: Thyroid cancer is the most common endocrinological neoplasm and about 95% of cases correspond to differentiated thyroid cancer (histological subtypes: papillary 70-80% and follicular 10-15%). For this reason, the use of prognostic scales constitutes a useful tool for decision- making, both in establishing the best therapeutic option and in estimating the risk of mortality and recurrence of the disease. General objective: Determine the usefulness and compare the clinicopathological scales TNM (tumor size, node, metastasis), MACIS (metastasis, age, completeness of resection, invasion, tumor size) and AMES (age, distant metastasis, invasion extra thyroid and tumor size), in the prognosis of differentiated thyroid cancer. Materials and Methods: After calculating the sample size and after applying the inclusion and exclusion criteria, 275 cases were analyzed, 249 women (91%) and 26 men (9%) with a mean age of 48.5 years (95% CI: 46.5). – 50.4), a survival analysis was carried out with a follow-up of 130 months, the statistical analysis was carried out with the Kaplan Meier curves, the Log Rank test and the proportion of explained variance. Results: the three clinicopathological scales TNM, MACIS and AMES presented a Log Rank test with p < 0.05 and the proportion of explained variance was greater with the TNM scale 8th edition, followed by the MACIS scale, in this way it can be It is concluded that these scales adequately predict mortality in patients with differentiated thyroid cancer.
Background: Thyroid cancer is the most common endocrinological neoplasm and about 95% of cases correspond to differentiated thyroid cancer (histological subtypes: papillary 70-80% and follicular 10-15%). For this reason, the use of prognostic scales constitutes a useful tool for decision- making, both in establishing the best therapeutic option and in estimating the risk of mortality and recurrence of the disease. General objective: Determine the usefulness and compare the clinicopathological scales TNM (tumor size, node, metastasis), MACIS (metastasis, age, completeness of resection, invasion, tumor size) and AMES (age, distant metastasis, invasion extra thyroid and tumor size), in the prognosis of differentiated thyroid cancer. Materials and Methods: After calculating the sample size and after applying the inclusion and exclusion criteria, 275 cases were analyzed, 249 women (91%) and 26 men (9%) with a mean age of 48.5 years (95% CI: 46.5). – 50.4), a survival analysis was carried out with a follow-up of 130 months, the statistical analysis was carried out with the Kaplan Meier curves, the Log Rank test and the proportion of explained variance. Results: the three clinicopathological scales TNM, MACIS and AMES presented a Log Rank test with p < 0.05 and the proportion of explained variance was greater with the TNM scale 8th edition, followed by the MACIS scale, in this way it can be It is concluded that these scales adequately predict mortality in patients with differentiated thyroid cancer.
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NEOPLASIAS DE TIROIDE, MORTALIDAD, METASTASIS, FACTOR DE RIESGOS, HOSPITAL SOLCA DE GUAYAQUIL, CANTON GUAYAQUIL, ECUADOR