The First Clinical Medical College of Nanjing Medical University, Nanjing, China.
School of Public Health, Nanjing Medical University, Nanjing, China.
Int J Hyperthermia. 2020;37(1):913-924. doi: 10.1080/02656736.2020.1777331.
Thermal ablation (TA), as an alternative to surgery, has shown some benefits in the treatment of papillary thyroid microcarcinoma (PTMC) patients, especially for those who are at high risk for surgery or refuse surgery. We performed a systematic review and meta-analysis to evaluate the efficiency, safety, and economy of TA, compared with those of routine surgery (RS), for the treatment of PTMC.
PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases were retrieved from inception to 10 January 2020 to identify relevant original studies on comparison of TA and RS for treatment of PTMC. The recurrence rate, recurrence-free survival (RFS), complication rate, operation time, postoperative length of stay, and cost during the perioperative period were extracted as main indices. The pooled standardized mean difference (SMD) or odds ratio (OR) with 95% confidence intervals (CI) were calculated and analyzed. Chi-square test and statistic were applied to determine the heterogeneity among studies. The sensitivity analysis was applied to explore the origin of heterogeneity, and the publication bias was evaluated by Egger's test.
Seven retrospective studies with a total of 867 patients met the eligibility criteria and were included in the final meta-analysis. Our study demonstrated that TA showed significant reduction in complication with a pooled OR 0.24 (95% CI 0.13 to 0.43), postoperative length of stay with a pooled SMD -3.14 (95% CI -4.77 to -1.51) and cost during the perioperative period with a pooled SMD of -1.69 (95% CI -3.18 to -0.20). It also demonstrated that both TA and RS had similar pooled proportion of recurrence of OR 0.93 (95% CI 0.38 to 2.30) and recurrence-free survive (RFS). The sensitivity analysis showed that each included study had no significant effect on the results and the results were stable and reliable. The Egger's test demonstrated publication bias was acceptable.
TA may not be oncologically inferior to RS, and it is a relatively safe and economical alternative for the treatment of PTMC.
热消融 (TA) 作为手术的替代方法，在治疗甲状腺微小乳头状癌 (PTMC) 患者方面显示出一些益处，特别是对于那些手术风险高或拒绝手术的患者。我们进行了一项系统评价和荟萃分析，以评估 TA 与常规手术 (RS) 治疗 PTMC 的疗效、安全性和经济性。
从建库至 2020 年 1 月 10 日，我们检索了 PubMed、Embase、Cochrane 图书馆、中国知网 (CNKI)、万方和维普数据库，以确定比较 TA 和 RS 治疗 PTMC 的相关原始研究。提取复发率、无复发生存率 (RFS)、并发症发生率、手术时间、术后住院时间和围手术期成本作为主要指标。计算并分析汇总标准化均数差 (SMD) 或比值比 (OR) 及其 95%置信区间 (CI)。采用卡方检验和 I 2 统计量确定研究间的异质性。采用敏感性分析探索异质性的来源，并采用 Egger 检验评估发表偏倚。
共有 7 项回顾性研究符合纳入标准，共纳入 867 例患者。我们的研究表明，TA 显著降低了并发症的发生率，汇总 OR 为 0.24(95%CI 0.13 至 0.43)，术后住院时间缩短，汇总 SMD 为-3.14(95%CI -4.77 至 -1.51)，围手术期成本降低，汇总 SMD 为-1.69(95%CI -3.18 至 -0.20)。此外，TA 和 RS 的复发率汇总 OR 均为 0.93(95%CI 0.38 至 2.30)，无复发生存率 (RFS)相似。敏感性分析表明，每个纳入的研究对结果均无显著影响，结果稳定可靠。Egger 检验表明发表偏倚可接受。
TA 在肿瘤学上并不劣于 RS，是治疗 PTMC 的一种相对安全、经济的替代方法。
