Yan Lin, Zhang Mingbo, Song Qing, Xie Fang, Luo Yukun
Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China.
Eur Radiol. 2022 Feb;32(2):1216-1226. doi: 10.1007/s00330-021-08133-z. Epub 2021 Aug 6.
To investigate and compare the clinical outcomes of radiofrequency ablation (RFA) for multifocal papillary thyroid microcarcinoma (PTMC) versus unifocal PTMC in a large cohort.
Patients with low-risk PTMC (n = 487) who underwent RFA were included in this retrospective study and divided into the unifocal group (U group) (n = 432) and the multifocal group (M group) (n = 55) according to the number of lesions. After 1:1 propensity score matching (PSM), volume, volume reduction ratio (VRR), the development of local tumor progression including lymph node metastasis (LNM), recurrent PTMC and persistent lesions, and recurrence-free survival (RFS) rate were evaluated and compared between the two groups. The different impacts of multifocality on recurrence after RFA for PTMC were investigated by Cox analysis.
During a mean follow-up time of 49.25 ± 12.98 months, the overall VRR was 99.40 ± 4.43% and the overall incidence of local tumor progression was 3.70% (18/487). No complications occurred after RFA. After PSM, no significant differences were found in volume (0.11 ± 0.69 mm vs 0 mm, p = 0.441), VRR (99.87 ± 0.78% vs 100%, p = 0.441), complete disappearance rate (95.61% vs 89.09%, p = 0.201), incidence of local tumor progression (5.45% vs 5.45%, p = 1.000), LNM (1.82% vs 0%, p = 0.317), recurrent PTMC (1.82% vs 5.45%, p = 0.611), persistent lesions (1.82% vs 0%, p = 0.317), and RFS rate (96.36% vs 94.55%, p = 0.632) between the M group and U group. The association between multifocality and local tumor recurrence also remained nonsignificant (p = 0.619). No distant metastasis or delayed surgery occurred.
The impact of multifocality on the prognosis after RFA for low-risk PTMC was little. RFA might be a promising treatment for both unifocal and multifocal PTMC in properly selected patients after sufficient preoperative evaluation.
• No significant differences are found in the local tumor progression between the unifocal PTMC and multifocal PTMC. • Multifocality is not associated with higher recurrence after RFA for low-risk PTMC. • RFA is a promising alternative for both unifocal and multifocal PTMC.
在一个大型队列中研究并比较多灶性甲状腺微小乳头状癌（PTMC）与单灶性PTMC的射频消融（RFA）临床结局。
本回顾性研究纳入了接受RFA治疗的低风险PTMC患者（n = 487），并根据病灶数量分为单灶组（U组）（n = 432）和多灶组（M组）（n = 55）。在1:1倾向评分匹配（PSM）后，评估并比较两组的体积、体积缩小率（VRR）、包括淋巴结转移（LNM）、复发性PTMC和持续性病灶在内的局部肿瘤进展情况以及无复发生存（RFS）率。通过Cox分析研究多灶性对PTMC RFA术后复发的不同影响。
在平均49.25±12.98个月的随访期内，总体VRR为99.40±4.43%，局部肿瘤进展的总体发生率为3.70%（18/487）。RFA术后未发生并发症。PSM后，M组和U组在体积（0.11±0.69 mm对0 mm，p = 0.441）、VRR（99.87±0.78%对100%，p = 0.441）、完全消失率（95.61%对89.09%，p = 0.201）、局部肿瘤进展发生率（5.45%对5.45%，p = 1.000）、LNM（1.82%对0%，p = 0.317）、复发性PTMC（1.82%对5.45%，p = 0.611）、持续性病灶（1.82%对0%，p = 0.317）以及RFS率（96.36%对94.55%，p = 0.632）方面均未发现显著差异。多灶性与局部肿瘤复发之间的关联也无统计学意义（p = 0.619）。未发生远处转移或延迟手术。
多灶性对低风险PTMC RFA术后预后的影响较小。在经过充分的术前评估后，对于合适选择的患者，RFA可能是单灶性和多灶性PTMC的一种有前景的治疗方法。
• 单灶性PTMC和多灶性PTMC在局部肿瘤进展方面无显著差异。• 多灶性与低风险PTMC RFA术后较高复发率无关。• RFA是单灶性和多灶性PTMC的一种有前景的替代治疗方法。
