Department of Thyroid Surgery, Clinical Research Center for Thyroid Diseases of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
Department of Ultrasound Imaging of The First Affiliated Hospital of Kunming Medical University, Kunming, China.
Endocr Pract. 2022 Apr;28(4):391-397. doi: 10.1016/j.eprac.2022.01.013. Epub 2022 Feb 4.
Active surveillance (AS) has been shown to be a safe approach that can effectively block transition from overdiagnosis to overtreatment in patients with low-risk papillary thyroid microcarcinoma (PTMC). This study aimed to determine whether the AS approach can be implemented in China and investigate the population characteristics of Chinese patients who underwent AS.
The epidemiologic and clinical characteristics as well as patient adherence were evaluated in 115 patients who underwent AS management as an alternative to immediate surgery for low-risk (or highly suspected) PTMC.
The mean patient age was 41.8 ± 10.3 years, with 41.7% and 4.4% of the patients aged <40 and ≥60 years, respectively. The median baseline diameter of index tumors was 4 (range, 3-6) mm, with 73.0% of the tumors being ≤5 mm. A total of 84.4% of the patients had a junior college, college, or graduate degree, and 83.5% were employed by the government, public institutions, companies, or technical posts. After a median 25-month follow-up, a tumor growth of ≥3 mm occurred in 3 patients (2.6%), and no new lymph node metastasis occurred. Surgery was performed in 4 patients because of patient preferences rather than because of disease progression. There was satisfactory adherence in 109 patients (94.8%) in a simulated ideal medical environment.
The AS approach can be used as an alternative to low-risk PTMC management in China. Given the difference in epidemiologic and clinical characteristics, Chinese institutions should fully consider the features of the Chinese population while developing candidate criteria, surveillance intervals, and follow-up strategies for AS.
主动监测（AS）已被证明是一种安全的方法，可有效阻止低危甲状腺微小乳头状癌（PTMC）患者从过度诊断转变为过度治疗。本研究旨在确定 AS 方法是否可以在中国实施，并研究接受 AS 的中国患者的人群特征。
对 115 例低危（或高度疑似）PTMC 患者行 AS 管理替代立即手术的患者，评估其流行病学和临床特征以及患者依从性。
患者平均年龄为 41.8 ± 10.3 岁，<40 岁和≥60 岁的患者分别占 41.7%和 4.4%。指数肿瘤的基线直径中位数为 4（范围 3-6）mm，73.0%的肿瘤直径≤5mm。84.4%的患者具有大专、本科或研究生学历，83.5%的患者受雇于政府、公共机构、公司或技术岗位。中位随访 25 个月后，3 例（2.6%）患者肿瘤生长≥3mm，无新发淋巴结转移。由于患者偏好而非疾病进展，4 例患者接受了手术。在模拟理想医疗环境中，109 例（94.8%）患者的依从性令人满意。
AS 方法可作为中国低危 PTMC 管理的替代方法。鉴于流行病学和临床特征的差异，中国医疗机构在制定 AS 的候选标准、监测间隔和随访策略时，应充分考虑中国人群的特点。
