Department of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam, Korea.
Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Korean J Radiol. 2021 Oct;22(10):1730-1741. doi: 10.3348/kjr.2020.1308.
Although thermal ablation is effective in treating low-risk papillary thyroid microcarcinomas (PTMCs), comparison of treatment outcomes between thermal ablation and surgery has not yet been systematically evaluated. This study aimed to compare the efficacy and safety of thermal ablation and surgery for the treatment of low-risk PTMCs.
Ovid-MEDLINE and EMBASE databases were searched for studies reporting comparisons of treatment results between thermal ablation and surgery for patients with low-risk PTMC published up to April 6, 2020. The analysis evaluated the efficacy (local tumor recurrence, occurrence of new tumor, metastasis, and rescue surgery) and safety (complication rate) of thermal ablation and surgery.
This systematic review included four studies with a total of 339 PTMCs in 339 patients who underwent thermal ablation and 320 PTMCs in 314 patients who underwent surgery. There was no local tumor recurrence or distant metastasis in either group. There was no significant difference in the pooled proportion of lymph node metastasis (2.6% with thermal ablation vs. 3.3% with surgery, = 0.65), occurrence of new tumors (1.4% with thermal ablation vs. 1.3% with surgery, = 0.85), or rescue surgery (2.6% with thermal ablation vs. 1.6% with surgery, = 0.62). However, the pooled complication rate was significantly higher in the surgery group than in the ablation group (3.3% with thermal ablation vs. 7.8% with surgery, = 0.03).
Both thermal ablation and surgery are effective and safe options for the management of low-risk PTMCs, with thermal ablation achieving a lower complication rate. Therefore, thermal ablation may be considered as an alternative treatment option for low-risk PTMC in patients who refuse surgery and active surveillance or are ineligible for surgery.
尽管热消融治疗低危甲状腺微小乳头状癌（PTMC）效果显著，但热消融与手术治疗的疗效对比尚未得到系统评价。本研究旨在比较热消融与手术治疗低危 PTMC 的疗效和安全性。
检索 Ovid-MEDLINE 和 EMBASE 数据库，收集截至 2020 年 4 月 6 日发表的比较低危 PTMC 患者热消融与手术治疗结果的研究。分析评估了热消融与手术治疗的疗效（局部肿瘤复发、新发肿瘤、转移和挽救性手术）和安全性（并发症发生率）。
本系统评价纳入 4 项研究，共 339 例接受热消融治疗的患者（339 例 PTMC）和 314 例接受手术治疗的患者（320 例 PTMC）。两组均无局部肿瘤复发或远处转移。淋巴结转移的合并发生率（热消融组 2.6%，手术组 3.3%， = 0.65）、新发肿瘤的发生率（热消融组 1.4%，手术组 1.3%， = 0.85）或挽救性手术的发生率（热消融组 2.6%，手术组 1.6%， = 0.62）差异均无统计学意义。然而，手术组的合并并发症发生率明显高于热消融组（热消融组 3.3%，手术组 7.8%， = 0.03）。
热消融和手术均为治疗低危 PTMC 的有效且安全的方法，热消融的并发症发生率较低。因此，对于拒绝手术、主动监测或不适合手术的低危 PTMC 患者，热消融可能是一种替代治疗选择。
