Ito Yasuhiro, Miyauchi Akira, Kudo Takumi, Ota Hisashi, Yoshioka Kana, Oda Hitomi, Sasai Hisanori, Nakayama Ayako, Yabuta Tomonori, Masuoka Hiroo, Fukushima Mitsuhiro, Higashiyama Takuya, Kihara Minoru, Kobayashi Kaoru, Miya Akihiro
Thyroid. 2016 Jan;26(1):156-60. doi: 10.1089/thy.2015.0393. Epub 2015 Dec 15.
An active-surveillance clinical trial of low-risk papillary microcarcinoma (PMC) patients has been performed at the authors' institution, Kuma Hospital, since 1993. Favorable oncological results have been reported. During the trial, a few patients were encountered with PMC that showed enlargement during pregnancy, and these cases have been reported. During pregnancy, a large amount of human chorionic gonadotropin (hCG) having weak thyrotropin (TSH) activity is produced, possibly affecting the progression of PMC. This study investigated how pregnancy and delivery influenced the progression of PMC in the entire active surveillance PMC patient series.
From 1993 to 2013, 1841 patients with low-risk PMC chose the active surveillance program. Fifty of the 1549 female PMC patients experienced 51 pregnancies/deliveries. To minimize observer variation, a single specialist sonographer re-evaluated the changes in the size of these 50 patients' PMCs before and after the pregnancies/deliveries.
Four patients (8%) showed enlargement of PMC by ≥3 mm; one patient (2%) showed a decrease by ≥3 mm, and the remaining 44 patients (45 events, 90%) showed stable disease. None of the patients had a novel appearance of lymph node metastases during pregnancy. Of the four patients with enlargement, two underwent surgery after delivery, and the other two continued the active surveillance, since their tumors did not grow after the delivery. After delivery, the PMC of one of these four patients remained stable, and another showed a decrease in PMC size. To date, six more PMC patients underwent surgery after delivery for reasons other than disease progression due to pregnancy and delivery: two opted out of active surveillance, two were identified with a nodal metastasis during active surveillance after delivery, one had Graves' disease, and one showed enlargement of nodules of the contralateral lobe.
Pregnancy and delivery was associated with an increase in size of PMCs in only 8% of the 51 pregnancies/delivery cases. None of the patients developed nodal metastasis during pregnancy. Thus, a possible future pregnancy does not prevent such patients from undergoing active surveillance, although watchful observation during pregnancy is recommended.
自1993年以来，作者所在机构熊本医院对低风险乳头状微癌（PMC）患者开展了一项主动监测临床试验。已报告了良好的肿瘤学结果。在试验期间，遇到了一些PMC患者，其肿瘤在妊娠期间出现增大，这些病例已被报道。在妊娠期间，会产生大量具有微弱促甲状腺素（TSH）活性的人绒毛膜促性腺激素（hCG），这可能会影响PMC的进展。本研究调查了妊娠和分娩对整个主动监测PMC患者系列中PMC进展的影响。
1993年至2013年，1841例低风险PMC患者选择了主动监测方案。1549例女性PMC患者中有50例经历了51次妊娠/分娩。为尽量减少观察者差异，由一名专业超声检查医师重新评估这50例患者妊娠/分娩前后PMC大小的变化。
4例患者（8%）的PMC增大≥3 mm；1例患者（2%）的PMC缩小≥3 mm，其余44例患者（45次事件，90%）病情稳定。没有患者在妊娠期间出现新的淋巴结转移。在4例增大的患者中，2例在分娩后接受了手术，另外2例继续进行主动监测，因为她们的肿瘤在分娩后没有生长。在这4例患者中，有1例患者分娩后的PMC保持稳定，另一例患者的PMC大小减小。迄今为止，另有6例PMC患者在分娩后因妊娠和分娩以外的疾病进展以外的原因接受了手术：2例选择退出主动监测，2例在分娩后的主动监测期间被发现有淋巴结转移，1例患有格雷夫斯病，1例对侧叶结节增大。
在51次妊娠/分娩病例中，仅8%的病例中妊娠和分娩与PMC大小增加有关。没有患者在妊娠期间发生淋巴结转移。因此，未来可能的妊娠并不妨碍此类患者进行主动监测，尽管建议在妊娠期间进行密切观察。
