Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy.
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Ann Surg Oncol. 2021 Aug;28(8):4334-4344. doi: 10.1245/s10434-020-09481-8. Epub 2021 Feb 10.
Controversies remain about the ideal risk-based surgical approach for differentiated thyroid cancer (DTC).
At a single tertiary care institution, 370 consecutive patients with low- or intermediate-risk DTC were submitted to either lobectomy (LT) or total thyroidectomy (TT) and were followed up.
Event-free survival by Kaplan-Meier curves was significantly higher after TT than after LT for the patients with either low-risk (P = 0.004) or intermediate-risk (P = 0.032) tumors. At the last follow-up visit, the prevalence of event-free patients was higher in the TT group than in the LT low-risk group (95% and 87.5%, respectively; P = 0.067) or intermediate-risk group (89% and 50%; P = 0.008). No differences in persistence prevalence were found among microcarcinomas treated by LT or TT (low risk, P = 0.938 vs. intermediate-risk, P = 0.553). Nevertheless, 15% of the low-risk and 50% of the intermediate-risk microcarcinomas treated by LT were submitted to additional treatments. On the other hand, macrocarcinomas were significantly more persistent if treated with LT than with TT (low-risk, P = 0.036 vs. intermediate-risk, P = 0.004). Permanent hypoparathyroidism was more frequent after TT (P = 0.01). After LT, thyroglobulin (Tg)/thyroid-stimulating hormone (TSH) had shown decreasing trend in 68% of the event-free patients and an increasing trend in the persistent cases.
Lobectomy can be proposed for low-risk microcarcinomas, although in a minority of cases, additional treatments are needed, and a longer follow-up period usually is required to confirm an event-free outcome compared with that for patients treated with TT. On the other hand, to achieve an excellent response, TT should be favored for intermediate-risk micro- and macro-DTCs despite the higher frequency of postsurgical complications.
对于分化型甲状腺癌（DTC），理想的基于风险的手术方法仍存在争议。
在一家三级医疗机构中，370 例低危或中危 DTC 患者接受了甲状腺叶切除术（LT）或全甲状腺切除术（TT），并进行了随访。
Kaplan-Meier 曲线显示，低危（P=0.004）和中危（P=0.032）肿瘤患者 TT 后的无事件生存率显著高于 LT。在最后一次随访时，TT 组无事件患者的比例高于 LT 低危组（95%和 87.5%，分别；P=0.067）或中危组（89%和 50%；P=0.008）。LT 或 TT 治疗的微癌患者的持续存在率无差异（低危，P=0.938 与中危，P=0.553）。然而，15%的低危微癌和 50%的中危微癌患者需要接受额外治疗。另一方面，LT 治疗的大癌比 TT 更易持续存在（低危，P=0.036 与中危，P=0.004）。TT 后甲状旁腺功能减退症更常见（P=0.01）。LT 后，68%的无事件患者的甲状腺球蛋白（Tg）/促甲状腺激素（TSH）呈下降趋势，而持续存在的患者则呈上升趋势。
对于低危微癌，可建议行甲状腺叶切除术，但在少数情况下，需要额外治疗，并且需要更长的随访时间才能确认无事件结果，这与 TT 治疗的患者相比。另一方面，为了获得良好的反应，尽管术后并发症的发生率较高，对于中危微癌和大癌，仍应首选 TT。
