Liu Chunhao, Zhao Hao, Xia Yu, Cao Yue, Zhang Liyang, Zhao Ya, Gao Luying, Liu Ruifeng, Liu Yuewu, Liu Hongfeng, Meng Zhilan, Liu Shuzhou, Li Xiaoyi
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Front Oncol. 2022 Aug 26;12:981495. doi: 10.3389/fonc.2022.981495. eCollection 2022.
Active surveillance has been considered a safe alternative to surgery for low-risk papillary thyroid microcarcinoma. This study aimed to assess the oncological outcomes and psychological status of active surveillance of highly suspicious thyroid nodules ≤10 mm in China.
This prospective single-center cohort study enrolled 336 patients with highly suspicious thyroid nodules for active surveillance to assess oncological outcomes and psychological status. The psychological status of patients was assessed by two different questionnaires and compared among different patient groups.
During a median follow-up period of 28.5 months, eight patients underwent delayed surgery for tumor enlargement and one for lymph node metastases. The cumulative incidence of disease progression at 5 and 10 years was 6.0% and 12.8%, respectively. Patients who underwent delayed surgery had no permanent complications, and no patient had distant metastasis or death. Patients ≤30 years old had a higher baseline anxiety score (4.9 vs. 3.8, p=0.024), a higher proportion of baseline anxiety score, i.e., ≥8 points (24.0% vs. 12.6%, p=0.033), and a worse baseline emotional function (62.7 vs. 70.7, p=0.013) than patients >30. During AS, patients ≤30 years of age had higher overall anxiety levels (p=0.005) and a worse overall emotional function (p=0.001).
Active surveillance in Chinese patients with highly suspicious subcentimetre thyroid nodules has good oncological outcomes and can be used as a safe alternative to surgery. Younger patients (≤30) show a worse psychological status; therefore, more attention should be paid to younger patients.
对于低风险甲状腺微小乳头状癌，主动监测已被视为一种安全的手术替代方案。本研究旨在评估中国直径≤10mm的高度可疑甲状腺结节主动监测的肿瘤学结局和心理状态。
这项前瞻性单中心队列研究纳入了336例高度可疑甲状腺结节患者进行主动监测，以评估肿瘤学结局和心理状态。通过两种不同问卷评估患者的心理状态，并在不同患者组之间进行比较。
在中位随访期28.5个月期间，8例患者因肿瘤增大接受了延迟手术，1例因淋巴结转移接受了延迟手术。5年和10年疾病进展的累积发生率分别为6.0%和12.8%。接受延迟手术的患者无永久性并发症，无患者发生远处转移或死亡。≤30岁的患者基线焦虑评分较高（4.9对3.8，p=0.024），基线焦虑评分≥8分的比例较高（24.0%对12.6%，p=0.033），且基线情绪功能较差（62.7对70.7，p=0.013）。在主动监测期间，≤30岁的患者总体焦虑水平较高（p=0.005），总体情绪功能较差（p=0.001）。
中国直径≤1cm高度可疑甲状腺结节患者的主动监测具有良好的肿瘤学结局，可作为一种安全的手术替代方案。年轻患者（≤30岁）心理状态较差；因此，应更多关注年轻患者。
