Yi Dandan, Song Peng, Huang Tao, Tang Xiaoqiao, Sang Jianfeng
Department of general surgery, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu Province, China.
Department of General Surgery, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province, China.
Oncotarget. 2017 Jan 24;8(4):7148-7156. doi: 10.18632/oncotarget.12698.
Whether total thyroidectomy reduces the recurrence rate in patients with papillary thyroid microcarcinoma (PTMC) is currently controversy. Conclusions of sporadic, inconsistent, and mono-institutional studies need a meta-analysis to evaluate. 525 relevant studies were obtained from initial search on PubMed, 511 studies were excluded by inclusion and exclusion criteria. Eligible data were extracted from each included study. The Odds ratios (ORs) and 95% confidence interval (CI) were used to assess the difference in the recurrence rates between PTMC patients treated with total thyroidectomy and non-total thyroidectomy. OR and 95% CI were calculated using a fixed-effects or a random-effects model. The Q statistic was used to evaluate homogeneity and Begg's test was used to assess publication bias. 14 studies meeting the inclusion criteria were included in this meta-analysis. The over all recurrence rates of pooled patients with total thyroidectomy and non-total thyroidectomy were 2.83% and 2.84% respectively. Primary random-effects model analysis showed, no significant difference of recurrence rates existed between two operation modes (OR = 0.732, 95% CI: 0.444 - 1.208), while, high heterogeneity among studies was found, I-squared index (I2) = 40.2%. After remove one study with high heterogeneity, the OR of the pooled recurrence rates of the total thyroidectomy and the non-total thyroidectomy groups was 0.786 (95% CI: 0.363 - 1.701), further suggesting no significant difference of the recurrence rate exists between two operation modes. Our meta-analysis demonstrated postoperative recurrence of PTMC is not reduced by total thyroidectomy, non-total thyroidectomy is also a good choice to treat PTMC patients.
甲状腺全切除术是否能降低甲状腺微小乳头状癌（PTMC）患者的复发率目前存在争议。零星、不一致且单中心研究的结论需要进行荟萃分析来评估。通过在PubMed上的初步检索获得了525项相关研究，根据纳入和排除标准排除了511项研究。从每项纳入研究中提取符合条件的数据。采用比值比（OR）和95%置信区间（CI）来评估接受甲状腺全切除术和非甲状腺全切除术的PTMC患者复发率的差异。使用固定效应模型或随机效应模型计算OR和95%CI。Q统计量用于评估同质性，Begg检验用于评估发表偏倚。本荟萃分析纳入了14项符合纳入标准的研究。接受甲状腺全切除术和非甲状腺全切除术的汇总患者的总体复发率分别为2.83%和2.84%。初步随机效应模型分析显示，两种手术方式之间的复发率无显著差异（OR = 0.732，95%CI：0.444 - 1.208），然而，研究之间存在高度异质性，I²指数（I²） = 40.2%。在剔除一项具有高度异质性的研究后，甲状腺全切除术组和非甲状腺全切除术组汇总复发率的OR为0.786（95%CI：0.363 - 1.701），进一步表明两种手术方式之间的复发率无显著差异。我们的荟萃分析表明，甲状腺全切除术并不能降低PTMC的术后复发率，非甲状腺全切除术也是治疗PTMC患者的一个好选择。
