Department of Surgery, Kuma Hospital, Kobe, Japan.
Department of Head and Neck Surgery, Kuma Hospital, Kobe, Japan.
Thyroid. 2023 Jul;33(7):817-825. doi: 10.1089/thy.2023.0076. Epub 2023 May 29.
It has been 30 years since the initiation of active surveillance (AS) for adult patients with low-risk papillary thyroid microcarcinoma (PTMC). This study compared the long-term oncological outcomes of patients who underwent AS or immediate surgery (IS). This is a retrospective review of extended follow-up data from patients enrolled in a single-center, prospective observational study in Japan. In total, 5646 patients diagnosed with low-risk PTMC at Kuma Hospital between 1993 and 2019 were enrolled in this study. Of these, 3222 patients underwent AS (AS group), whereas 2424 underwent IS (IS group). The patients were followed up regularly, at least once per year. Descriptive outcome data were presented according to the treatment group. In the AS group, 124 patients (3.8%) had tumor enlargement of ≥3 mm, and the 10- and 20-year enlargement rates were 4.7% and 6.6%, respectively. Novel lymph node metastases occurred in 27 patients (0.8%), and the 10- and 20-year nodal metastasis occurrence rates were 1.0% and 1.6%, respectively. In the IS group, 13 patients (0.5%) experienced lymph node recurrence postoperatively, and the 10- and 20-year nodal recurrence rates were 0.4% and 0.7%, respectively. Eighteen (1.4%) of the 1327 patients who underwent hemithyroidectomy experienced recurrence in the residual thyroid. The rate of lymph node metastasis was significantly higher in the AS group than in the IS group (1.1% vs. 0.4% and 1.7% vs. 0.7% at 10 and 20 years, respectively; = 0.009), but the differences were small. However, the proportion of patients who underwent one or more and two or more surgeries was significantly higher in the IS group than in the AS group (100% vs. 12.3% and 1.07% vs. 0.09%, < 0.01). Distant metastatic recurrence was observed in one patient after AS and conversion surgery and another after IS; however, they were alive (18.4 and 18.8 years after diagnosis, respectively). None of the patients in this study died of thyroid carcinoma. Long-term oncological outcomes of patients with PTMC generally did not differ clinically significantly between those undergoing AS and IS. AS is a viable initial management option for patients with low-risk PTMC.
自对低危型甲状腺微小乳头状癌（PTMC）成年患者实施主动监测（AS）以来，已经过去了 30 年。本研究比较了接受 AS 或即刻手术（IS）治疗的患者的长期肿瘤学结局。这是对日本单中心前瞻性观察研究中入组患者的扩展随访数据进行的回顾性分析。共有 5646 例 1993 年至 2019 年在久留米医院诊断为低危型 PTMC 的患者入组本研究。其中 3222 例患者接受 AS（AS 组），2424 例患者接受 IS（IS 组）。患者接受了定期随访，至少每年一次。根据治疗组描述了结局数据。在 AS 组中，124 例（3.8%）患者肿瘤增大≥3mm，10 年和 20 年的增大率分别为 4.7%和 6.6%。27 例（0.8%）出现新的淋巴结转移，10 年和 20 年的淋巴结转移发生率分别为 1.0%和 1.6%。在 IS 组中，13 例（0.5%）患者术后出现淋巴结复发，10 年和 20 年的淋巴结复发率分别为 0.4%和 0.7%。1327 例行甲状腺半切术的患者中有 18 例（1.4%）出现残甲状腺复发。AS 组的淋巴结转移率明显高于 IS 组（10 年和 20 年时分别为 1.1%比 0.4%和 1.7%比 0.7%；=0.009），但差异较小。然而，IS 组中接受一次或多次手术和两次或更多次手术的患者比例明显高于 AS 组（100%比 12.3%和 1.07%比 0.09%；<0.01）。1 例患者在 AS 后转换手术后和另 1 例患者在 IS 后出现远处转移复发，但他们均存活（诊断后分别为 18.4 年和 18.8 年）。本研究中无患者死于甲状腺癌。PTMC 患者的长期肿瘤学结局在接受 AS 和 IS 治疗的患者之间无临床显著差异。AS 是低危型 PTMC 患者初始治疗的可行选择。
