a Department of Radiology , The Catholic University of Korea College of Medicine, Seoul St. Mary's Hospital , Seoul , Korea.
b Department of Thyroid Surgery , The Catholic University of Korea College of Medicine, Seoul St. Mary's Hospital , Seoul , Korea.
Int J Hyperthermia. 2019;36(1):359-367. doi: 10.1080/02656736.2019.1571248. Epub 2019 Mar 5.
To compare the efficacy and complication rates of radiofrequency ablation (RFA) and repeat surgery in the treatment of locally recurrent thyroid cancers.
A total of 221 patients with locally recurrent thyroid cancers who underwent either RFA (n = 96) or repeat surgery (n = 125) between March 2008 and March 2017 were retrospectively enrolled (range of follow-up, 1-10 years). Each cohort consisted of 70 patients after propensity score adjustment. Patients with more than three recurrent lesions were excluded. The primary and secondary end points were recurrence-free survival and complication rates, respectively. Recurrence-free survival curves were compared via the log-rank test. The complications-voice changes, hypocalcemia, and immediate procedural complications-were compared between the groups. In addition, pretreatment serum thyroglobulin (T) levels and those at the last follow-up were also compared between the two groups to examine therapeutic efficacy.
After propensity score matching, both groups showed no significant differences in baseline characteristics. The recurrence-free survival rates were comparable between the RFA and surgery groups (p = .2). There were no significant differences in mean serum T levels and their mean decrease after treatment between the groups (p = .891 and p = .963, respectively). Immediate procedural complications and voice changes also showed no significant between-group differences (p = .316, p = .084, respectively). Hypocalcemia occurred only in the repeat surgery group (n = 18). Overall complications were significantly more frequent in the repeat surgery group (RFA, n = 7; surgery, n = 27; p < .001).
RFA may be an effective and safe alternative to repeat surgery in the treatment of a small number of locally recurrent thyroid cancers.
比较射频消融（RFA）和重复手术治疗局部复发性甲状腺癌的疗效和并发症发生率。
回顾性纳入 2008 年 3 月至 2017 年 3 月期间接受 RFA（n=96）或重复手术（n=125）治疗的 221 例局部复发性甲状腺癌患者（随访时间 1-10 年）。每个队列均经倾向评分调整后包含 70 例患者。排除有 3 个以上复发病灶的患者。主要终点为无复发生存率，次要终点为并发症发生率。通过对数秩检验比较无复发生存曲线。比较两组间的并发症（声音改变、低钙血症和即刻手术并发症）。此外，还比较了两组间治疗前后的血清甲状腺球蛋白（T）水平，以评估治疗效果。
经倾向评分匹配后，两组的基线特征无显著差异。RFA 组和手术组的无复发生存率无显著差异（p=0.2）。两组间的平均血清 T 水平及其治疗后平均下降值无显著差异（p=0.891 和 p=0.963）。即刻手术并发症和声音改变也无显著组间差异（p=0.316，p=0.084）。仅在重复手术组中出现低钙血症（n=18）。重复手术组的总并发症发生率明显高于 RFA 组（RFA 组：n=7；手术组：n=27；p<0.001）。
RFA 可能是治疗少数局部复发性甲状腺癌的一种有效且安全的替代方法。
