Malik Azhar A, Aziz Faisal, Beshyah Salem A, Aldahmani Khaled M
Divison of Endocrinology, Tawam Hospital, Al Ain, Dubai.
Interdisciplinary Metabolic Medicine Trials Unit, Department of Endocrinology and Diabetology, Medical university of Graz, Graz, Austria.
Saudi J Med Med Sci. 2022 Jan-Apr;10(1):42-48. doi: 10.4103/sjmms.sjmms_393_21. Epub 2022 Jan 17.
Recent guidelines in the management of papillary thyroid microcarcinoma (PTMC) recommend limiting surgery. However, trends in the characteristics and management of PTMC from the Middle East and North Africa region is lacking.
To determine the clinical features, management strategy, and outcomes of PTMC in a large tertiary care center in the United Arab Emirates (UAE).
This retrospective study included all patients diagnosed with PTMC (i.e., size ≤10 mm) at Tawam Hospital, Al Ain, UAE, between 2008 and 2019. Tumor histopathology, management strategy, and outcomes were the primary analyzed variables.
A total of 213 patients with PTMC met the inclusion criteria, of which 83.6% were women and 58.7% were Emiratis. The majority had the classical tumor subtype (76.1%) and tumor of size 5-10 mm (71.4%). Multifocal disease was present in 41.1% and lymph node metastasis (LNM) in 16.6% of the patients. According to the 2015 American Thyroid Association categorization, the majority (93.9%) had a low-risk disease, and all except one patient had Stage 1 disease. Total thyroidectomy was performed in 91.1% of the patients, and 47.9% received radioiodine (RAI) therapy. None of the patients were under active surveillance strategy. RAI treatment was used more often in patients with non-incidental tumors, larger tumor size, multifocal disease, positive LNM, tumors in the intermediate/high ATA category, and those who underwent total thyroidectomy or neck dissection (for all, < 0.05). After a median follow-up of 32.4 months, about 73% had an excellent response to dynamic risk stratification assessment, and only one patient had disease recurrence.
The majority of the patients had low-risk PTMC, yet most patients underwent total thyroidectomy, and almost 50% were treated with RAI ablation. Further studies are needed to determine if these trends are also present regionally and to explore reasons for not adopting a less aggressive approach in this indolent tumor.
甲状腺微小乳头状癌（PTMC）管理的最新指南建议限制手术。然而，中东和北非地区PTMC的特征及管理趋势尚缺乏相关研究。
确定阿拉伯联合酋长国（阿联酋）一家大型三级医疗中心PTMC的临床特征、管理策略及治疗结果。
这项回顾性研究纳入了2008年至2019年间在阿联酋艾因市塔瓦姆医院诊断为PTMC（即肿瘤大小≤10mm）的所有患者。肿瘤组织病理学、管理策略及治疗结果为主要分析变量。
共有213例PTMC患者符合纳入标准，其中83.6%为女性，58.7%为阿联酋人。大多数患者为经典肿瘤亚型（76.1%），肿瘤大小为5 - 10mm（71.4%）。41.1%的患者存在多灶性病变，16.6%的患者有淋巴结转移（LNM）。根据2015年美国甲状腺协会的分类，大多数（93.9%）患者为低风险疾病，除1例患者外，所有患者均为Ⅰ期疾病。91.1%的患者接受了全甲状腺切除术，47.9%的患者接受了放射性碘（RAI）治疗。没有患者采用主动监测策略。RAI治疗在非偶然发现的肿瘤、肿瘤较大、多灶性病变、LNM阳性、ATA分类为中/高风险的肿瘤以及接受全甲状腺切除术或颈部清扫术的患者中使用更为频繁（所有情况，P < 0.05）。中位随访32.4个月后，约73%的患者对动态风险分层评估有良好反应，仅有1例患者疾病复发。
大多数患者为低风险PTMC，但大多数患者接受了全甲状腺切除术，近50%的患者接受了RAI消融治疗。需要进一步研究以确定这些趋势在该地区是否也存在，并探讨在这种惰性肿瘤中未采用侵袭性较小方法的原因。
