Wang Tracy S, Goffredo Paolo, Sosa Julie Ann, Roman Sanziana A
Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA,
World J Surg. 2014 Sep;38(9):2297-303. doi: 10.1007/s00268-014-2602-3.
The clinical importance of papillary thyroid microcarcinoma (PTMC) remains controversial, with current guidelines suggesting that thyroid lobectomy alone is sufficient. The purpose of this study was to identify population-level treatment patterns in the USA for PTMC.
Patients with PTMC in SEER (1998-2010) were included; demographic, clinical (extent of surgery, administration of post-operative radioactive iodine [RAI]), and pathologic characteristics were examined. Outcomes of interest were 5- and 10-year overall survival (OS) and disease-specific survival (DSS).
The cohort consisted of 29,512 patients. Mean age at diagnosis was 48.5 years; mean tumor size was 0.53 cm. Overall, 73.4 % of patients underwent total thyroidectomy, and RAI was administered to 31.3 %. In multivariate analysis, total thyroidectomy was more frequently performed in patients with multifocal (odds ratio [OR] 2.55), 'regional', or 'distant' PTMC (OR 2.90 and 2.59). Non-operative management was associated with male patients (OR 4.24) and those aged ≥65 years (OR 6.31). Post-operative RAI was associated with multifocal PTMC (OR 2.57). Overall, 5- and 10-year DSS was 99.6 and 99.3 %, respectively, with no difference in DSS between patients who underwent partial versus total thyroidectomy. OS of patients with PTMC who underwent any thyroid operation was similar to that of the general population of the USA.
An increasing number of patients are undergoing total thyroidectomy and RAI for PTMC. While there may be a subset of patients for whom more aggressive therapy is indicated, many patients with PTMC may be over-treated, with no demonstrable benefit to survival.
甲状腺微小乳头状癌（PTMC）的临床重要性仍存在争议，目前的指南表明单纯甲状腺叶切除术就足够了。本研究的目的是确定美国PTMC的人群水平治疗模式。
纳入SEER（1998 - 2010年）中患有PTMC的患者；检查人口统计学、临床（手术范围、术后放射性碘[RAI]的使用）和病理特征。感兴趣的结局是5年和10年总生存率（OS）和疾病特异性生存率（DSS）。
该队列由29,512名患者组成。诊断时的平均年龄为48.5岁；平均肿瘤大小为0.53厘米。总体而言，73.4%的患者接受了全甲状腺切除术，31.3%的患者接受了RAI治疗。在多变量分析中，多灶性（比值比[OR] 2.55）、“区域”或“远处”PTMC患者更常进行全甲状腺切除术（OR分别为2.90和2.59）。非手术治疗与男性患者（OR 4.24）和年龄≥65岁的患者（OR 6.31）相关。术后RAI与多灶性PTMC相关（OR 2.57）。总体而言，5年和10年DSS分别为99.6%和99.3%，部分甲状腺切除术与全甲状腺切除术患者的DSS无差异。接受任何甲状腺手术的PTMC患者的OS与美国普通人群相似。
越来越多的PTMC患者正在接受全甲状腺切除术和RAI治疗。虽然可能有一部分患者需要更积极的治疗，但许多PTMC患者可能接受了过度治疗，对生存没有明显益处。
