Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China.
Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China.
Ann Surg. 2023 May 1;277(5):846-853. doi: 10.1097/SLA.0000000000005800. Epub 2023 Jan 19.
To report more than 5-year outcomes of ultrasound-guided thermal ablation (TA) for patients with solitary low-risk papillary thyroid microcarcinoma (PTMC) in a large multicenter cohort.
TA, including radiofrequency ablation (RFA) and microwave ablation (MWA) have been used in patients with low-risk PTMC who refuse surgery or active surveillance. However, its clinical value remains controversial.
This retrospective multicenter study included 474 patients with solitary low-risk PTMC treated with TA (357 for RFA; 117 for MWA) from 4 centers and followed up for at least 5 years. Disease progression including lymph node metastasis and recurrent tumors, volume reduction rate (VRR), tumor disappearance rate, complications, and delayed surgery were assessed. RFA and MWA outcomes were compared using propensity score matching.
During the median follow-up period of 77.2 months, disease progression incidence, lymph node metastasis, and recurrent tumors rates were 3.6%, 1.1%, and 2.5%, respectively. Age below 40 years old, male sex, Hashimoto thyroiditis, and tumor size were not independent factors associated with disease progression by Cox analysis. The median VRR was 100% and 471 tumors disappeared radiographically. Eight patients experienced transient voice change (1.7%) which recovered within 3 months. None of the patients underwent delayed surgery because of anxiety. After 1:1 matching, no significant differences were found in the disease progression, VRR, tumor disappearance rate, or complications between RFA and MWA subgroups.
This multicenter study revealed that TA was an effective and safe treatment for patients with solitary low-risk PTMC, which could be offered as a treatment option for the management for low-risk PTMC.
报告在一个大型多中心队列中，对患有单发低危甲状腺微小乳头状癌（PTMC）的患者进行超声引导热消融（TA）治疗 5 年以上的结果。
TA，包括射频消融（RFA）和微波消融（MWA），已被用于拒绝手术或主动监测的低危 PTMC 患者。然而，其临床价值仍存在争议。
本回顾性多中心研究纳入了 4 家中心的 474 例接受 TA（357 例 RFA；117 例 MWA）治疗的单发低危 PTMC 患者，随访时间至少 5 年。评估疾病进展（包括淋巴结转移和复发性肿瘤）、体积缩小率（VRR）、肿瘤消失率、并发症和延迟手术。使用倾向评分匹配比较 RFA 和 MWA 的结果。
在中位随访 77.2 个月期间，疾病进展发生率、淋巴结转移和复发性肿瘤发生率分别为 3.6%、1.1%和 2.5%。Cox 分析显示，年龄<40 岁、男性、桥本甲状腺炎和肿瘤大小不是与疾病进展相关的独立因素。中位 VRR 为 100%，471 个肿瘤在影像学上消失。8 例患者出现短暂性声音改变（1.7%），在 3 个月内恢复。由于焦虑，无患者行延迟手术。1:1 匹配后，RFA 和 MWA 亚组之间在疾病进展、VRR、肿瘤消失率或并发症方面无显著差异。
本多中心研究表明，TA 是治疗单发低危 PTMC 的有效且安全的方法，可作为低危 PTMC 管理的治疗选择。
