初始消融率可预测良性甲状腺结节射频消融治疗 5 年后的体积缩小和再治疗。

Initial Ablation Ratio Predicts Volume Reduction and Retreatment After 5 Years From Radiofrequency Ablation of Benign Thyroid Nodules.

机构信息

Department of Medical Sciences, University of Trieste, Trieste, Italy.

Institute of Medicina Clinica, Ospedale di Cattinara, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy.

出版信息

Front Endocrinol (Lausanne). 2021 Feb 1;11:582550. doi: 10.3389/fendo.2020.582550. eCollection 2020.

DOI:10.3389/fendo.2020.582550

PMID:33597921

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7883676/

Abstract

BACKGROUND

Radiofrequency ablation (RFA) has gained ground as an effective and well-tolerated technique to treat benign thyroid nodules. Most of the available studies have described the short-term outcomes of RFA, whereas there is a limited number of studies evaluating long-term issues, such as regrowth and the likelihood of retreatments. In addition, risk markers of regrowth and retreatment remain to be defined. The initial ablation ratio (IAR) is an index that measures the amount of ablation after RFA, which has been associated with technique efficacy (i.e. volume reduction >50% after 1 year from the procedure). This study aimed at evaluating i) IAR reproducibility and ii) IAR predictive value for RFA 5-year outcomes.

MATERIALS AND METHODS

This is a retrospective single center study on patients with benign thyroid nodules treated with RFA and followed for 5 years after initial treatment. IAR interobserver reproducibility was evaluated with Bland-Altman method and Lin's concordance correlation coefficient (ρc). IAR predictive value for RFA 5-year outcomes was evaluated with linear and logistic regression models, as well as with Cox models, while receiver operating characteristic (ROC) analyses were used for cut-offs.

RESULTS

We selected 78 patients with 82 benign thyroid nodules. The procedure significantly reduced nodule volume and this reduction was generally maintained over time. Technique efficacy was achieved in 92% of patients, while 23% of nodules regrew and 12% of nodules were retreated. Median IAR was 83%. Lin's concordance and Pearson's correlation coefficients suggested a good interobserver reproducibility of this index, consistent with the limits of agreement of the Bland-Altman plot. IAR was significantly associated with technique efficacy, 1- and 5-year volume reduction ratio, and with the likelihood of a retreatment, but not with nodule regrowth. ROC analyses showed that IAR cut-off was 49% for technique efficacy and 73% for retreatment.

CONCLUSIONS

Our results show for the first time that IAR is reproducible and that it predicts the volume reduction and the likelihood of a retreatment after 5 years from RFA.

摘要

背景

射频消融（RFA）作为一种有效且耐受性良好的技术，已被广泛用于治疗良性甲状腺结节。大多数现有研究都描述了 RFA 的短期疗效，而对于长期问题（如复发和再次治疗的可能性），研究数量有限。此外，复发和再次治疗的风险标志物仍有待确定。初始消融率（IAR）是衡量 RFA 后消融量的指标，它与技术疗效相关（即术后 1 年体积减少>50%）。本研究旨在评估 i）IAR 的可重复性和 ii）IAR 对 RFA 5 年疗效的预测价值。

材料和方法

这是一项回顾性的单中心研究，纳入了接受 RFA 治疗的良性甲状腺结节患者，并在初始治疗后随访 5 年。采用 Bland-Altman 法和 Lin 一致性相关系数（ρc）评估 IAR 的观察者间可重复性。采用线性和逻辑回归模型以及 Cox 模型评估 IAR 对 RFA 5 年疗效的预测价值，同时采用 ROC 分析确定截断值。

结果

我们选择了 78 例 82 个良性甲状腺结节患者。该操作显著降低了结节体积，且这种减少通常随时间保持。92%的患者达到了技术疗效，23%的结节复发，12%的结节需要再次治疗。中位 IAR 为 83%。Lin 的一致性和 Pearson 相关系数表明，该指标的观察者间可重复性良好，与 Bland-Altman 图的一致性范围一致。IAR 与技术疗效、1 年和 5 年体积减少率以及再次治疗的可能性显著相关，但与结节复发无关。ROC 分析显示，IAR 截断值为 49%时可预测技术疗效，为 73%时可预测再次治疗。