Is surgery necessary for locally advanced cancer in authoritative journals? Fudan Cancer Experts Establish a Specialized Scoring System Professor | System | Scoring
Thyroid cancer is one of the most common malignant tumors in China, and many people believe it is a type of lazy cancer with a good prognosis. At present, the overall five-year survival rate of thyroid cancer in China is 84.3%. The poor prognosis of advanced patients is the main factor affecting the overall survival rate, and improving the efficacy of advanced patients is crucial. Should surgery be performed on locally advanced patients? Not long ago, Professor Wang Yu, Director of Head and Neck Surgery at Fudan University Affiliated Cancer Hospital, and Professor Gu Yajia, Director of Radiology Diagnosis Department of the hospital, jointly released a study titled "Application of CT based scoring system to evaluate the resectability of locally advanced thyroid cancer". A specialized scoring system was established to provide scientific basis for the assessment of resectability in locally advanced patients, replacing the previous situation where resectability assessment relied on subjective judgment by doctors. The results are published online in the international authoritative academic journal "European Radiology", filling the research gap in related fields.
Expert explanation: Locally advanced thyroid cancer is a type of advanced thyroid cancer that can exist in various pathological types of thyroid cancer. Local advanced stage mainly refers to the invasive state of the tumor, which invades important organs or tissues in the neck. These patients can be life-threatening due to airway obstruction or massive bleeding, which is currently a clinical treatment challenge.
For a long time, surgery has been the main treatment for thyroid cancer, and for locally advanced thyroid cancer patients, surgery is also the primary choice. However, some locally advanced patients are difficult to completely remove through surgery and require neoadjuvant treatment before considering the possibility of surgery. How to accurately evaluate the resectability of patients? In the past, it was almost entirely based on the clinical experience of doctors.
The joint team aims to establish a specialized surgical resectability scoring system for locally advanced patients and conduct large-scale research. The study is based on a multicenter queue and evaluates the extent of tumor invasion in other parts of CT images. A 12 point and 14 point evaluation system is established, and the 12 point evaluation system is optimized into the final scoring system. Comparative analysis of clinical data from different centers shows that the scoring system is effective: the overall AUC for predicting tumor resectability is 0.882. Among them, the AUC of newly treated patients and postoperative relapsed patients were 0.826 and 0.976, respectively, both of which had good predictive power. Further data suggests that the overall accuracy of the score ranges from 78.9% to 89.4%, with an AUC of 0.875.
According to the scoring results, locally advanced patients can be divided into three groups. The overall R0/1 resection rate of patients with 1-4 points is 83.33%, with a high probability of resection, mainly through direct surgical resection; The overall R0/1 resection rate of patients with a score of 9-12 is 6.45%, with a high probability of tumor residue, and systematic treatment is the main approach; The overall R0/1 resection rate of patients with a score of 5-8 is 62.5%, which is in a critical resectable state. Wang Yu said, "The evaluation system provides objective reference standards for the resectability of locally advanced patients, helping clinical doctors optimize treatment decisions and achieve better survival benefits."