MAeSTro研究中低风险甲状腺微小乳头状癌患者的手术结局：主动监测后立即手术与延迟手术的多中心前瞻性队列研究

Surgical Outcomes in Patients With Low-risk Papillary Thyroid Microcarcinoma From MAeSTro Study: Immediate Operation Versus Delayed Operation After Active SurveillanceA Multicenter Prospective Cohort Study.

作者信息

Hwang Hyeonuk, Choi June Young, Yu Hyeong Won, Moon Jae Hoon, Kim Ji-Hoon, Lee Eun Kyung, Kim Yeo Koon, Lee Chang Yoon, Cho Sun Wook, Chung Eun-Jae, Ryu Chang Hwan, Ryu Junsun, Yi Ka Hee, Park Do Joon, Lee Kyu Eun, Park Young Joo, Kim Su-Jin, Jung Yuh-Seog

机构信息

Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea.

Department of Surgery, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Republic of Korea.

出版信息

Ann Surg. 2023 Nov 1;278(5):e1087-e1095. doi: 10.1097/SLA.0000000000005841. Epub 2023 Mar 13.

DOI:10.1097/SLA.0000000000005841

PMID:36912439

Abstract

OBJECTIVE

To investigate surgical, and clinical outcomes in patients with low-risk papillary thyroid microcarcinoma (PTMC) according to treatment options [immediate operation (IOP) vs delayed operation after active surveillance (AS) (DOP)].

BACKGROUND

AS has been adopted as an alternative to immediate surgery in patients with low-risk PTMC. Although some patients undergo surgery during AS, there is little information on surgical, and clinical outcomes after delayed operation after AS.

METHODS

A multicenter prospective cohort study including 1177 patients was conducted at 3 tertiary hospitals in Korea from June 2016 to January 2020. Patients with low-risk PTMC were enrolled. The participants were self-assigned into AS or IOP, and during AS, the patients underwent surgery if there were signs of disease progression or if the patient's choice changed.

RESULTS

A total of 516 patients underwent operation; 384 (74.4%) in the IOP group and 132 (25.6%) in the DOP group. Compared with the IOP group, the DOP group was significantly associated with a larger tumor size ( P =0.002), higher rates of lymphatic invasion ( P =0.002), and multifocality ( P =0.008). However, the rates of total thyroidectomy, postoperative hypoparathyroidism and vocal cord palsy did not differ significantly between the groups ( P = 0.283, P =0.184, and P =0.284, respectively). Of the 132 patients in the DOP group, disease progression was present in 39 (29.5%) patients. The DOP group with disease progression had a significantly higher rate of lymph node metastasis ( P =0.021) and radioiodine therapy ( P =0.025) than the DOP group without disease progression.

CONCLUSIONS

These results suggest that AS might be considered an alternative treatment option for patients with low-risk PTMC regarding the extent of thyroidectomy and postoperative complications in the DOP group. To assess oncologic outcomes, long-term follow-up will be needed.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02938702.

摘要

目的

根据治疗方案[即刻手术（IOP）与主动监测（AS）后延迟手术（DOP）]，研究低危甲状腺乳头状微小癌（PTMC）患者的手术及临床结局。

背景

AS已被用作低危PTMC患者即刻手术的替代方案。尽管部分患者在AS期间接受了手术，但关于AS后延迟手术的手术及临床结局的信息较少。

方法

2016年6月至2020年1月在韩国3家三级医院进行了一项纳入1177例患者的多中心前瞻性队列研究。纳入低危PTMC患者。参与者自行选择进入AS组或IOP组，在AS期间，若出现疾病进展迹象或患者改变选择，则患者接受手术。

结果

共有516例患者接受了手术；IOP组384例（74.4%），DOP组132例（25.6%）。与IOP组相比，DOP组肿瘤更大（P =0.002）、淋巴侵犯率更高（P =0.002）、多灶性更高（P =0.008）。然而，两组间全甲状腺切除术率、术后甲状旁腺功能减退和声带麻痹发生率差异无统计学意义（分别为P = 0.283、P =0.184和P =0.284）。DOP组的132例患者中，39例（29.5%）出现疾病进展。有疾病进展的DOP组淋巴结转移率（P =0.021）和放射性碘治疗率（P =0.025）显著高于无疾病进展的DOP组。