Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland.
Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland.
PLoS One. 2020 Dec 31;15(12):e0244930. doi: 10.1371/journal.pone.0244930. eCollection 2020.
Currently, less aggressive treatment or even active surveillance of papillary thyroid microcarcinoma (PTMC) is widely accepted and recommended as a therapeutic management option. However, there are some concerns about these approaches. We investigated whether there are any demographic, clinical and ultrasound characteristics of PTMC patients that are easy to obtain and clinically available before surgery to help clinicians make proper therapeutic decisions.
We performed a retrospective chart review of 5,021 patients with thyroid tumors surgically treated in one center in 2008-2018. Finally, 182 (3.62%) PTMC patients were selected (158 (86.8%) females and 24 (13.2%) males, mean age 48.8±15.4 years). We analyzed the disease-free survival (DFS) time of the PTMC patients according to demographic and histopathological parameters. Univariate and multivariate logistic regression analyses were used to assess the relationships of demographic, clinical and ultrasound characteristics with aggressive histopathological features.
Age ≥55 years, hypoechogenicity, microcalcifications, irregular tumor shape, smooth margins and high vascularity significantly increased the risk for minimal extrathyroidal extension (minETE), lymph node metastasis (LNM), and capsular and vascular invasion (p<0.0001). Multivariate logistic regression analysis demonstrated a statistically significant risk of LNM (OR = 5.98, 95% CI: 2.32-15.38, p = 0.0002) and trends toward significantly higher rates of minETE and capsular and vascular invasion (OR = 2.24, 95% CI: 0.97-5.19, p = 0.056) in patients ≥55 years than in their younger counterparts. The DFS time was significantly shorter in patients ≥55 years (p = 0.015), patients with minETE and capsular and vascular invasion (p = 0.001 for all), patients with tumor size >5 mm (p = 0.021), and patients with LNM (p = 0.002).
The absence of microcalcifications, irregular tumor shape, blunt margins, hypoechogenicity and high vascularity in PTMC patients below 55 years and with tumor diameters below 5 mm may allow clinicians to select individuals with a low risk of local recurrence so that they can receive less aggressive management.
目前，广泛接受并推荐对甲状腺微小乳头状癌（PTMC）采取不那么积极的治疗方法，甚至是主动监测作为治疗管理选择。然而，这些方法存在一些担忧。我们研究了在手术前是否存在任何易于获得和临床可用的人口统计学、临床和超声特征，以帮助临床医生做出适当的治疗决策。
我们对 2008 年至 2018 年在一个中心接受手术治疗的 5021 例甲状腺肿瘤患者进行了回顾性图表审查。最后，选择了 182 例（3.62%）PTMC 患者（158 例女性和 24 例男性，平均年龄 48.8±15.4 岁）。我们根据人口统计学和组织病理学参数分析了 PTMC 患者的无病生存率（DFS）。使用单变量和多变量逻辑回归分析评估人口统计学、临床和超声特征与侵袭性组织病理学特征的关系。
年龄≥55 岁、低回声、微钙化、不规则肿瘤形状、边界不平整和高血管性显著增加微小甲状腺外侵犯（minETE）、淋巴结转移（LNM）、包膜和血管侵犯的风险（p<0.0001）。多变量逻辑回归分析表明，LNM（OR=5.98，95%CI：2.32-15.38，p=0.0002）和 minETE 以及包膜和血管侵犯的发生率有统计学意义的趋势（OR=2.24，95%CI：0.97-5.19，p=0.056）显著更高，在≥55 岁的患者中。在≥55 岁的患者中，DFS 时间显著缩短（p=0.015），有 minETE 和包膜和血管侵犯的患者（所有 p=0.001）、肿瘤直径>5mm 的患者（p=0.021）和有 LNM 的患者（p=0.002）。
在<55 岁且肿瘤直径<5mm 的 PTMC 患者中，缺乏微钙化、不规则肿瘤形状、边界不平整、低回声和高血管性可能使临床医生能够选择局部复发风险较低的个体，从而使他们能够接受不那么积极的治疗。
