title: Risk-stratified management of well-differentiated thyroid cancers: a review of experience from a single institution, 1990-2003.
abstract: BACKGROUND
  Controversy persists regarding ideal management strategies in well-differentiated thyroid cancers (WDTC). This retrospective study reviews the utilization of a modified AMES risk stratification in the management of our institution's patients.
  
  
  METHODS
  A total of 352 patients (median follow-up of 5.5 years) were reviewed and were risk stratified. Surgical resection was performed, and patients with clinically palpable lymph nodes were subjected to radical neck dissection. Patients were referred for adjuvant therapy if necessary.
  
  
  RESULTS
  Of the 352 patients, 264 (75%) were females and 276 (78%) had papillary thyroid cancer (PTC). For those with lymph nodes (50%), 95% had PTC. In this series, 72% of the patients underwent total thyroidectomy; 5-year disease-free survival probability was 100% in low-risk patients, 92% in intermediate-risk patients, and 64% in high-risk patients. The 5-year overall survival probability was 100% in low-risk patients, 96% in intermediate-risk patients, and 69% in high-risk patients, respectively (both logrank trend p<0.001).
  
  
  CONCLUSIONS
  Management of WDTC requires multimodal treatment and should be based on patient risk classifications. We recommend aggressive surgical resection for all gross disease in high-risk and intermediate-risk patients. Adjuvant therapy is recommended in high-risk patients, but should be individualized for intermediate-risk patients. Total thyroidectomy may not be necessary in low-risk patients.
authors.affiliation: Department of General Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Republic of Singapore.
authors.forename: M H
authors.initials: MH
authors.lastname: Chew
authors.forename: G
authors.initials: G
authors.lastname: Chan
authors.forename: M M A
authors.initials: MM
authors.lastname: Siddiqui
authors.forename: B C
authors.initials: BC
authors.lastname: Tai
authors.forename: R
authors.initials: R
authors.lastname: Sivanandan
authors.forename: K C
authors.initials: KC
authors.lastname: Soo
authors.forename: D T H
authors.initials: DT
authors.lastname: Lim
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000401:mortality / Q000601:surgery*; D000328:Adult; D002291:Carcinoma, Papillary / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012306:Risk; D012846:Singapore / Q000453:epidemiology; D013964:Thyroid Neoplasms / Q000401:mortality / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods / Q000706:statistics & numerical data*