Qian Kai, Guo Kai, Zheng Xiaoke, Sun Tuanqi, Li Duanshu, Wu Yi, Ji Qinghai, Wang Zhuoying
Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
Department of Oncology, Fudan University Shanghai Medical College, Shanghai 200032, China.
Oncotarget. 2017 Jul 22;8(39):65836-65846. doi: 10.18632/oncotarget.19503. eCollection 2017 Sep 12.
Screening out patients who do not require immediate surgery is a growing trend in the field of thyroid research. In this study, we retrospectively compared the application of two surveillance selection criteria in 1001 patients who had undergone surgical treatment of papillary thyroid microcarcinoma (PTMC): low-risk PTMC characteristics defined by Kuma Hospital and CATO consensus on PTMC management of active surveillance. Treatment outcomes were compared between groups. We then analyzed the prognostic indicators of patients who could be managed by surveillance. A total of 724 patients met Kuma screening criteria and 135 met CATO screening criteria. The Kuma low-risk group had a lower incidence of multifocal lesions and CLNM than Kuma high-risk group. We also found more obvious differences in multifocal lesions, CLNM and extrathyroidal extension when evaluating the CATO low-risk criteria in the same manner. On the other hand, patients in the CATO low-risk group had a lower disease progression rate and longer disease-free survival than those in CATO high-risk group. There was no significant difference in prognosis between the Kuma low-risk group and Kuma high-risk group. Our logistic regression analysis showed that a preoperative ultrasound size of >5 mm, male sex, younger age, and malignant lesions without concurrent benign nodules could be predictors of CLNM. In conclusion, patients classified in CATO low-risk criteria had lower proportion of clinicopathological risk factors than the ones in Kuma low-risk criteria. We also found more risk factors may not be suitable for surveillance, such as tumors without concurrent benign nodules.
筛选出不需要立即手术的患者是甲状腺研究领域日益增长的趋势。在本研究中，我们回顾性比较了两种监测选择标准在1001例接受甲状腺微小乳头状癌（PTMC）手术治疗患者中的应用：由熊本医院定义的低风险PTMC特征以及关于PTMC主动监测管理的CATO共识。比较了两组之间的治疗结果。然后我们分析了可通过监测管理的患者的预后指标。共有724例患者符合熊本筛查标准，135例符合CATO筛查标准。熊本低风险组的多灶性病变和中央区淋巴结转移（CLNM）发生率低于熊本高风险组。以同样方式评估CATO低风险标准时，我们还发现多灶性病变、CLNM和甲状腺外侵犯方面存在更明显差异。另一方面，CATO低风险组患者的疾病进展率低于CATO高风险组，无病生存期更长。熊本低风险组和熊本高风险组之间的预后无显著差异。我们的逻辑回归分析表明，术前超声检查大小>5 mm、男性、年龄较小以及无并发良性结节的恶性病变可能是CLNM的预测因素。总之，符合CATO低风险标准的患者的临床病理风险因素比例低于符合熊本低风险标准的患者。我们还发现更多风险因素可能不适合监测，例如无并发良性结节的肿瘤。
