Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China.
Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Eur Radiol. 2023 Dec;33(12):8727-8735. doi: 10.1007/s00330-023-09932-2. Epub 2023 Jul 19.
OBJECTIVES: Microwave ablation (MWA) has been widely used for unifocal papillary thyroid carcinoma (U-PTC) and has recently been preliminarily used in multifocal papillary thyroid carcinoma (M-PTC). However, the efficacy and safety of MWA for M-PTC have not been investigated in large samples. The aim of the present study was to evaluate the efficacy and safety of MWA for M-PTC and compare them with MWA for U-PTC. MATERIALS AND METHODS: This retrospective multicentre study enrolled 504 patients (376 females) who underwent MWA for U-PTC (340 cases) or M-PTC (164 cases) from Jan 2015 to Dec 2020. The median age of the patients was 43 years (age range, 20-80 years). Propensity score matching (PSM) was used to balance the baseline characteristics between M-PTC group and U-PTC group. The tumour progression, tumour disappearance, and complication rates were compared between the two groups. RESULTS: The complete ablation was achieved in all enrolled cases in one session. According to the statistical results, no significant differences were shown in tumour progression-free survival (p = 0.29) or cumulative tumour progression rate (6.7% vs. 4.3%, p = 0.33) between the M-PTC and U-PTC groups during the follow-up time. However, the tumour disappearance rate in the M-PTC group was lower in the U-PTC group (40.9% vs. 62.8%, p < 0.001), and tumour disappearance was slower in the M-PTC group (p < 0.001). The complication rate showed no significant difference (3.0% vs. 4.9%, p = 0.571). CONCLUSIONS: MWA is an effective and safe treatment for selected patients with M-PTC, and the prognosis is similar to that of U-PTC. CLINICAL RELEVANCE STATEMENT: The present study provided evidence that compared with unifocal papillary thyroid cancer, microwave ablation could also treat multifocal T1N0M0 papillary thyroid cancer safely with similar clinical outcome, which could promote the application of minimally invasive treatment for papillary thyroid cancer. KEY RESULTS: • Microwave ablation for multifocal and unifocal T1N0M0 papillary thyroid carcinoma had similar tumour progression rates after propensity score matching (6.7% vs. 4.3%, p = 0.33). • The tumour disappearance rate in the multifocal group was lower than that in the unifocal group (40.9% vs. 62.8%, p < 0.001), and tumour disappearance was slower in the multifocal group (p < 0.001). • Tumour size, number, and location were not risk factors for tumour progression in the multifocal papillary thyroid cancer group.
目的：微波消融（MWA）已广泛应用于单发甲状腺乳头状癌（U-PTC），最近已初步应用于多发甲状腺乳头状癌（M-PTC）。然而，MWA 治疗 M-PTC 的疗效和安全性尚未在大样本中进行研究。本研究旨在评估 MWA 治疗 M-PTC 的疗效和安全性，并将其与 MWA 治疗 U-PTC 进行比较。
材料和方法：本回顾性多中心研究纳入了 2015 年 1 月至 2020 年 12 月期间因 U-PTC（340 例）或 M-PTC（164 例）接受 MWA 治疗的 504 例患者（376 例女性）。患者的中位年龄为 43 岁（年龄范围为 20-80 岁）。采用倾向评分匹配（PSM）平衡 M-PTC 组和 U-PTC 组的基线特征。比较两组之间的肿瘤进展、肿瘤消失和并发症发生率。
结果：所有纳入病例均在一次治疗中达到完全消融。根据统计结果，在随访期间，M-PTC 组和 U-PTC 组的无肿瘤进展生存率（p=0.29）或累积肿瘤进展率（6.7%比 4.3%，p=0.33）无显著差异。然而，M-PTC 组的肿瘤消失率低于 U-PTC 组（40.9%比 62.8%，p<0.001），且 M-PTC 组的肿瘤消失速度较慢（p<0.001）。并发症发生率无显著差异（3.0%比 4.9%，p=0.571）。
结论：MWA 是治疗选择患者 M-PTC 的有效且安全的治疗方法，其预后与 U-PTC 相似。
临床相关性声明：本研究提供的证据表明，与单发甲状腺乳头状癌相比，微波消融术也可以安全地治疗多发 T1N0M0 甲状腺乳头状癌，具有相似的临床效果，这可以促进甲状腺乳头状癌微创治疗的应用。
主要结果：①在倾向评分匹配后，多发和单发 T1N0M0 甲状腺乳头状癌的 MWA 治疗肿瘤进展率相似（6.7%比 4.3%，p=0.33）。②多发组的肿瘤消失率低于单发组（40.9%比 62.8%，p<0.001），且多发组的肿瘤消失速度较慢（p<0.001）。③肿瘤大小、数量和位置不是多发甲状腺乳头状癌组肿瘤进展的危险因素。
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