Zhang Chi, Li Yanshuang, Li Jiyu, Chen Xiao
Department of Breast and Thyroid Surgery, Shandong Provincial Hospital Affiliated to Shandong University.
Department of Neurology, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.
Medicine (Baltimore). 2020 Feb;99(6):e19073. doi: 10.1097/MD.0000000000019073.
This systematic review and meta-analysis collected data for evaluating the effect of surgical extent on overall survival (OS) and recurrence-free survival (RFS) in patients with papillary thyroid cancer (PTC).
We searched the PubMed, Embase, and Cochrane Library databases. The included studies compared two groups of patients with PTC: the total thyroidectomy (TT) group and the lobectomy (LT) group. The combined hazard ratio (HR) was calculated.
Thirteen studies were included in the present study. The TT and LT groups had similar OS results (HR = 1.04; 95% CI: 0.90-1.21; P = .60). In the subgroup analysis, the combined HR of the ≤1 cm group and the 1.0 to 2.0 cm group showed that TT had no advantage with regard to OS compared to LT. In the 2.0 to 4.0 cm group, TT provided better OS than LT (HR = 0.88; 95% CI: 0.79-0.99; P = .03). Patients who underwent TT had a better RFS outcome than those who underwent LT (HR = 0.56; 95% CI: 0.41-0.77; P < .0001). In the subgroup analysis, both the ≤1 cm group and >1 cm group that underwent TT were associated with better RFS.
Our meta-analysis suggested that LT increased the risk of recurrence in PTC patients with tumors ≤1.0 cm and in PTC patients with tumors >1.0 cm. More importantly, LT was associated with higher mortality in PTC patients with 2.0 to 4.0 cm tumors. Caution is warranted when LT is performed in this group of patients.
本系统评价和荟萃分析收集数据，以评估手术范围对甲状腺乳头状癌（PTC）患者总生存期（OS）和无复发生存期（RFS）的影响。
我们检索了PubMed、Embase和Cochrane图书馆数据库。纳入的研究比较了两组PTC患者：全甲状腺切除术（TT）组和甲状腺叶切除术（LT）组。计算合并风险比（HR）。
本研究纳入了13项研究。TT组和LT组的OS结果相似（HR = 1.04；95%CI：0.90 - 1.21；P = 0.60）。在亚组分析中，≤1 cm组和1.0至2.0 cm组的合并HR显示，与LT相比，TT在OS方面无优势。在2.0至4.0 cm组中，TT的OS优于LT（HR = 0.88；95%CI：0.79 - 0.99；P = 0.03）。接受TT的患者的RFS结果优于接受LT的患者（HR = 0.56；95%CI：0.41 - 0.77；P < 0.0001）。在亚组分析中，接受TT的≤1 cm组和>1 cm组均与更好的RFS相关。
我们的荟萃分析表明，LT增加了肿瘤≤1.0 cm的PTC患者和肿瘤>1.0 cm的PTC患者的复发风险。更重要的是，LT与肿瘤大小为2.0至4.0 cm的PTC患者的更高死亡率相关。对这组患者进行LT时需谨慎。
