Tuttle R Michael, Fagin James A, Minkowitz Gerald, Wong Richard J, Roman Benjamin, Patel Snehal, Untch Brian, Ganly Ian, Shaha Ashok R, Shah Jatin P, Pace Mark, Li Duan, Bach Ariadne, Lin Oscar, Whiting Adrian, Ghossein Ronald, Landa Inigo, Sabra Mona, Boucai Laura, Fish Stephanie, Morris Luc G T
Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York.
JAMA Otolaryngol Head Neck Surg. 2017 Oct 1;143(10):1015-1020. doi: 10.1001/jamaoto.2017.1442.
Active surveillance of low-risk papillary thyroid cancer (PTC) is now an accepted alternative to immediate surgery, but experience with this approach outside of Japan is limited. The kinetics (probability, rate, and magnitude) of PTC tumor growth under active surveillance have not been well defined.
To describe the kinetics of PTC tumor growth during active surveillance.
DESIGN, SETTING, AND PARTICIPANTS: Cohort study of 291 patients undergoing active surveillance for low-risk PTC (intrathyroidal tumors ≤1.5 cm) with serial tumor measurements via ultrasonography at a tertiary referral center in the United States.
Active surveillance.
The cumulative incidence, rate, and magnitude of the change in tumor diameter or volume, as well as associations with patient and tumor characteristics.
Of the 291 patients, 219 (75.3%) were women; mean (SD) age was 52 (15) years. During a median (range) active surveillance of 25 (6-166) months, growth in tumor diameter of 3 mm or more was observed in 11 of 291 (3.8%) patients, with a cumulative incidence of 2.5% (2 years) and 12.1% (5 years). No regional or distant metastases developed during active surveillance. In all cases, 3-dimensional measurements of tumor volume allowed for earlier identification of growth (median, 8.2 months; range, 3-46 months before increase in tumor diameter). In multivariable analysis, both younger age at diagnosis (hazard ratio per year, 0.92; 95% CI, 0.87-0.98; P = .006) and risk category at presentation (hazard ratio for inappropriate, 55.17; 95% CI, 9.4-323.19; P < .001) were independently associated with the likelihood of tumor growth. Of the tumors experiencing volume growth, kinetics demonstrated a classic exponential growth pattern, with a median doubling time of 2.2 years (range, 0.5-4.8 years; median r2 = 0.75; range, 0.42-0.99).
The rates of tumor growth during active surveillance in a US cohort with PTCs measuring 1.5 cm or less were low. Serial measurement of tumor volumes may facilitate early identification of tumors that will continue to grow and thereby inform the timing of surveillance imaging and therapeutic interventions.
对低风险甲状腺乳头状癌（PTC）进行主动监测目前已成为立即手术之外的一种可接受的替代方法，但日本以外地区采用这种方法的经验有限。在主动监测下PTC肿瘤生长的动力学（概率、速率和大小）尚未明确界定。
描述主动监测期间PTC肿瘤生长的动力学。
设计、设置和参与者：对291例接受低风险PTC（甲状腺内肿瘤≤1.5 cm）主动监测的患者进行队列研究，在美国一家三级转诊中心通过超声对肿瘤进行系列测量。
主动监测。
肿瘤直径或体积变化的累积发病率、速率和大小，以及与患者和肿瘤特征的关联。
291例患者中，219例（75.3%）为女性；平均（标准差）年龄为52（15）岁。在中位（范围）25（6 - 166）个月的主动监测期间，291例患者中有11例（3.8%）观察到肿瘤直径增长3 mm或更多，2年累积发病率为2.5%，5年累积发病率为12.1%。在主动监测期间未发生区域或远处转移。在所有病例中，肿瘤体积的三维测量能够更早地识别生长情况（中位时间为8.2个月；范围为肿瘤直径增加前3 - 46个月）。在多变量分析中，诊断时年龄较小（每年风险比，0.92；95%置信区间，0.87 - 0.98；P = 0.006）和初诊时风险类别（不恰当风险比，55.17；95%置信区间，9.4 - 323.19；P < 0.001）均与肿瘤生长可能性独立相关。在经历体积增长的肿瘤中，动力学表现出典型的指数增长模式，中位倍增时间为2.2年（范围，0.5 - 4.8年；中位r2 = 0.75；范围，0.42 - 0.99）。
在美国一组肿瘤大小为1.5 cm或更小的PTC患者中，主动监测期间肿瘤生长速率较低。对肿瘤体积进行系列测量可能有助于早期识别将继续生长的肿瘤，从而为监测成像和治疗干预的时机提供依据。
