甲状腺癌患者行肺叶切除术后对可疑对侧结节进行主动监测的结果。
Outcomes of nonsuspicious contralateral nodules with active surveillance after lobectomy in patients with papillary thyroid carcinoma.
机构信息
Department of Head and Neck Surgical Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Front Endocrinol (Lausanne). 2022 Jul 15;13:941080. doi: 10.3389/fendo.2022.941080. eCollection 2022.
OBJECTIVE
To observe the outcomes of nonsuspicious contralateral nodules with active surveillance in patients with papillary thyroid carcinoma (PTC).
METHODS
4pt?>Consecutive patients who underwent lobectomy for PTC were retrospectively reviewed. Patients with one or more nodules with nonsuspicious ultrasonography (US) features in the contralateral lobe were included.
RESULTS
Two hundred and eighty-three patients were included. All patients underwent thyroid lobectomy with ipsilateral prophylactic central neck dissection. A total of 123 patients (43.5%) were classified as ATA low-risk, and 160 patients (56.5%) were classified as intermediate-risk. The median size of the contralateral nodules was 3 mm (range, 2 to 16 mm). After a period of follow-up, the median size change of contralateral nodules was 0 mm (range, -7 to 8 mm). Eight patients (2.8%) had nodule growth >3 mm, 223 patients (78.8%) had stable or decreased nodules, and 52 patients (18.4%) had no detectable nodules. Nodules in 24 patients had suspicious US features, 16 of which were diagnosed with PTMC by either cytology after FNA (in 7 patients) or histopathology after completion thyroidectomy (in 9 patients). Another four patients received completion thyroidectomy for ipsilateral cervical lymph node metastasis. The 5-year residual lobe recurrence (RLR) rate and recurrence-free survival (RFS) rate were 7.4% and 89.8%, respectively. Multivariate analysis showed that multifocality and ATA intermediate-risk were independent predictors for RLR (HR4.083, 95%CI 1.480-11.261, = 0.007; HR 6.045, 95%CI 1.370-26.662, = 0.017, respectively) and RFS (HR 5.240, 95%CI 2.114-12.991, < 0.001; HR 5.223, 95%CI 1.353-17.765, = 0.008, respectively).
CONCLUSIONS
Active surveillance for nonsuspicious contralateral nodules in patients with low-risk and selected intermediate-risk PTC is safe. Multifocality and ATA intermediate-risk are predicters for recurrence. Early detection and salvage surgery are effective.
目的
观察甲状腺乳头状癌（PTC）患者中对侧可疑阴性结节行主动监测的结果。
方法
回顾性分析了 4pt?>例因 PTC 行甲状腺叶切除术的连续患者。纳入对侧叶有一个或多个超声表现可疑的结节患者。
结果
共纳入 283 例患者。所有患者均行甲状腺叶切除术及同侧预防性中央颈部淋巴结清扫术。123 例（43.5%）患者被归类为 ATA 低危，160 例（56.5%）患者被归类为中危。对侧结节的中位大小为 3mm（范围，2-16mm）。经过一段时间的随访，对侧结节的中位大小变化为 0mm（范围，-7-8mm）。8 例（2.8%）患者结节生长>3mm，223 例（78.8%）患者结节稳定或缩小，52 例（18.4%）患者无可检测到的结节。24 例患者的结节有可疑的超声特征，其中 16 例经细针穿刺抽吸细胞学检查（7 例）或甲状腺全切除术后组织病理学检查（9 例）诊断为甲状腺微小乳头状癌。另外 4 例患者因同侧颈淋巴结转移而行甲状腺全切除术。5 年残留叶复发（RLR）率和无复发生存率（RFS）分别为 7.4%和 89.8%。多因素分析显示，多发病灶和 ATA 中危是 RLR（HR4.083，95%CI 1.480-11.261，=0.007；HR 6.045，95%CI 1.370-26.662，=0.017）和 RFS（HR 5.240，95%CI 2.114-12.991，<0.001；HR 5.223，95%CI 1.353-17.765，=0.008）的独立预测因子。
结论
低危和部分中危 PTC 患者对侧可疑阴性结节行主动监测是安全的。多发病灶和 ATA 中危是复发的预测因子。早期发现和挽救性手术是有效的。
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