Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan.
Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan.
Eur J Surg Oncol. 2018 Mar;44(3):307-315. doi: 10.1016/j.ejso.2017.03.004. Epub 2017 Mar 16.
Papillary microcarcinoma (PMC) of the thyroid is defined as papillary thyroid carcinoma (PTC) measuring ≤1 cm. Many autopsy studies on subjects who died of non-thyroidal diseases reported latent small thyroid carcinoma in up to 5.2% of the subjects. A mass screening study for thyroid cancer in Japanese adult women detected small thyroid cancer in 3.5% of the examinees. This incidence was close to the incidence of latent thyroid cancer and more than 1000 times the prevalence of clinical thyroid cancer in Japanese women reported at that time. The question of whether it was correct to treat such PMCs surgically then arose. In 1993, according to Dr. Miyauchi's proposal, Kuma Hospital initiated an active surveillance trial for low-risk PMC as defined in the text. In 1995, Cancer Institute Hospital in Tokyo, Japan, started a similar observation trial. The accumulated data from the trials at these two institutions strongly suggest that active surveillance (i.e., observation without immediate surgery) can be the first-line management for low-risk PMC. Although our data showed that young age and pregnancy might be risk factors of disease progression, we think that these patients can also be candidates for active surveillance, because all of the patients who showed progression signs were treated successfully with a rescue surgery, and none of them died of PTC. In this review, we summarize the data regarding the active surveillance of low-risk PMC as support for physicians and institutions that are considering adopting this strategy.
甲状腺微小乳头状癌（PMC）被定义为直径≤1cm 的甲状腺乳头状癌（PTC）。许多关于死于非甲状腺疾病的患者的尸检研究报告称，高达 5.2%的患者存在潜在的小甲状腺癌。一项针对日本成年女性甲状腺癌的大规模筛查研究发现，3.5%的受检者患有小甲状腺癌。这一发病率与潜伏性甲状腺癌的发病率相近，是当时报告的日本女性临床甲状腺癌发病率的 1000 多倍。那么，是否应该对这些 PMC 进行手术治疗的问题就出现了。1993 年，根据宫内医生的建议，熊本医院启动了一项针对文中定义的低危 PMC 的主动监测试验。1995 年，日本东京癌症研究所也开始了类似的观察性试验。这两个机构的试验累积数据强烈表明，主动监测（即不立即手术的观察）可以作为低危 PMC 的一线治疗方法。虽然我们的数据显示，年轻和妊娠可能是疾病进展的危险因素，但我们认为这些患者也可以成为主动监测的候选者，因为所有出现进展迹象的患者都成功地接受了挽救性手术治疗，没有一例死于 PTC。在这篇综述中，我们总结了关于低危 PMC 主动监测的数据，为考虑采用这种策略的医生和机构提供支持。
