甲状腺乳头状癌的主动监测：六种最常见肿瘤体积动力学模式的发生频率和时间进程。
Active Surveillance of Papillary Thyroid Cancer: Frequency and Time Course of the Six Most Common Tumor Volume Kinetic Patterns.
机构信息
Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
出版信息
Thyroid. 2022 Nov;32(11):1337-1345. doi: 10.1089/thy.2022.0325.
The change in size of the papillary thyroid cancer (PTC) nodule during active surveillance has traditionally been characterized as either stable, increasing, or decreasing based on changes in maximal tumor diameter or tumor volume. More recently, it has been observed that the changes in tumor size observed during observation are more complex with tumor volume kinetic patterns that can be characterized either as stable (Pattern I), early increase in volume (Pattern II), later increase in volume (Pattern III), early increase in volume followed by stability (Pattern IV), stability followed by an increase in volume (Pattern V), or a decrease in tumor volume (Pattern VI). The frequency, time course, and clinical correlates of these six tumor volume kinetic patterns were analyzed in a cohort of 483 patients with low-risk PTC up to 1.5 cm in maximal diameter followed with active surveillance at our center for a median of 3.7 years. The cumulative incidence of an increase in tumor volume for the entire cohort was 15.9% [confidence interval (CI) 11.8-20.0] at 5 years. At 5 years, most tumors demonstrated stability (78.8%, Pattern I) with 10.0% showing early growth (Pattern II), 4.1% late growth (Pattern III), 1.9% growth then stability (Pattern IV), 0.6% stability then growth (Pattern V), and 5.6% with a decrease in tumor volume (Pattern VI). Tumor volume doubling time during exponential growth significantly differed across the kinetic patterns, with median values of 2.4, 7.1, and 3.3 years for Patterns II, III, and IV, respectively ( < 0.01). Similarly, the time to a change in tumor volume was significantly different across the kinetic patterns, with median values of 1.5, 3, 1.6, 4.7, and 4.1 years for Patterns II, III, IV, V, and VI, respectively (analysis of variance, < 0.01). Clinical correlates at baseline were not associated with tumor volume kinetic pattern. These six kinetic tumor volume patterns provide a comprehensive description of the changes in PTC tumor volume observed during the first 5 years of active surveillance.
甲状腺乳头状癌 (PTC) 结节在主动监测期间的大小变化传统上根据最大肿瘤直径或肿瘤体积的变化特征为稳定、增大或减小。最近，人们观察到，在观察期间观察到的肿瘤大小变化更加复杂，肿瘤体积动力学模式可以表现为稳定 (模式 I)、体积早期增加 (模式 II)、体积后期增加 (模式 III)、体积早期增加后稳定 (模式 IV)、体积稳定后增加 (模式 V) 或肿瘤体积减少 (模式 VI)。在本研究中，我们分析了在本中心接受主动监测的最大直径达 1.5cm 的低危 PTC 患者 483 例中这六种肿瘤体积动力学模式的频率、时间过程和临床相关性，中位随访时间为 3.7 年。在整个队列中，肿瘤体积增加的累积发生率为 15.9%（95%置信区间 [CI] 11.8-20.0），在 5 年时。在 5 年时，大多数肿瘤表现出稳定（78.8%，模式 I），10.0%表现出早期生长（模式 II），4.1%表现出晚期生长（模式 III），1.9%生长后稳定（模式 IV），0.6%稳定后生长（模式 V），5.6%肿瘤体积缩小（模式 VI）。指数增长期间的肿瘤体积倍增时间在动力学模式之间有显著差异，模式 II、III 和 IV 的中位值分别为 2.4、7.1 和 3.3 年（ < 0.01）。同样，肿瘤体积变化的时间在动力学模式之间也有显著差异，模式 II、III、IV、V 和 VI 的中位数分别为 1.5、3、1.6、4.7 和 4.1 年（方差分析， < 0.01）。基线时的临床特征与肿瘤体积动力学模式无关。这六种肿瘤体积动力学模式全面描述了主动监测的前 5 年中 PTC 肿瘤体积的变化。
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