Nakamura Tomohiko, Miyauchi Akira, Ito Yasuhiro, Ito Mitsuru, Kudo Takumi, Tanaka Mika, Kohsaka Kazuyoshi, Kasahara Toshihiko, Nishihara Eijun, Fukata Shuji, Nishikawa Mitsushige
From the Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan..
From the Center for Excellence in Thyroid Care, Kuma Hospital, Kobe, Japan.
Endocr Pract. 2020 Dec;26(12):1451-1457. doi: 10.4158/EP-2020-0201.
This study aimed to compare the quality of life (QoL) and psychological issues of patients with papillary thyroid microcarcinoma (PMC) who were under active surveillance (AS) and those who underwent immediate surgery (OP).
This was a cross-sectional study conducted on 347 patients with low-risk PMC who were under AS (n = 298) or who underwent OP (n = 49). They were asked to complete two questionnaires (thyroid cancer-specific health-related QoL [THYCA-QoL] and the Hospital Anxiety and Depression Scale [HADS]). The results between the AS and OP groups were compared.
The mean ages of patients in the AS and OP groups were 58.6±12.5 and 58.4±13.1 years (P =.94), respectively, and the male ratios were 34/298 (11%) and 2/49 (4.1%) (P =.14), respectively. The median follow-up periods from diagnosis in the AS and OP groups were 56.5 months (interquartile range [IQR], 32 to 88 months) and 84 months (IQR, 64 to 130 months) (P<.001), respectively. In the THYCA-QoL questionnaire, the OP group had more complaints about "voice" (P<.001), "psychological" (P =.025), "problems with scar" (P<.001), and "gained weight" (P =.047) than the AS group. Other scales of the THYCA-QoL were comparable in the two groups. In the HADS questionnaire, the AS group had significantly better anxiety (P =.020), depression (P =.027), and total scores (P =.014) than the OP group.
PMC patients in the OP group had more complaints and were more anxious and depressed than the AS group. These findings suggest that AS is a reasonable alternative to surgery for patients with low-risk PMC from the point of view of QoL and psychology.
AS = active surveillance; CI = confidence interval; HADS = Hospital Anxiety and Depression Scale; LT4 = levothyroxine; OP = immediate surgery; PMC = papillary microcarcinoma; PTC = papillary thyroid carcinoma; QoL = quality of life; STAI = State-Trait Anxiety Inventory; THYCA-QoL = thyroid cancer-specific health-related quality of life; TSH = thyrotropin.
本研究旨在比较接受主动监测（AS）的甲状腺微小乳头状癌（PMC）患者与接受即刻手术（OP）的患者的生活质量（QoL）和心理问题。
这是一项横断面研究，对347例低风险PMC患者进行了研究，其中298例接受AS，49例接受OP。他们被要求完成两份问卷（甲状腺癌特异性健康相关生活质量问卷[THYCA-QoL]和医院焦虑抑郁量表[HADS]）。比较了AS组和OP组的结果。
AS组和OP组患者的平均年龄分别为58.6±12.5岁和58.4±13.1岁（P = 0.94），男性比例分别为34/298（11%）和2/49（4.1%）（P = 0.14）。AS组和OP组从诊断开始的中位随访期分别为56.5个月（四分位间距[IQR]，32至88个月）和84个月（IQR，64至130个月）（P<0.001）。在THYCA-QoL问卷中，OP组在“声音”（P<0.001）、“心理”（P = 0.025）、“疤痕问题”（P<0.001）和“体重增加”（P = 0.047）方面的抱怨比AS组更多。THYCA-QoL的其他量表在两组中具有可比性。在HADS问卷中，AS组的焦虑（P = 0.020）、抑郁（P = 0.027）和总分（P = 0.014）明显优于OP组。
OP组的PMC患者比AS组有更多的抱怨，并且更焦虑和抑郁。这些发现表明，从生活质量和心理角度来看，对于低风险PMC患者，AS是手术的合理替代方案。
AS = 主动监测；CI = 置信区间；HADS = 医院焦虑抑郁量表；LT4 = 左甲状腺素；OP = 即刻手术；PMC = 微小乳头状癌；PTC = 甲状腺乳头状癌；QoL = 生活质量；STAI = 状态-特质焦虑量表；THYCA-QoL = 甲状腺癌特异性健康相关生活质量；TSH = 促甲状腺激素
