Li Xinyang, Yan Lin, Xiao Jing, Li Yingying, Yang Zhen, Zhang Mingbo, Luo Yukun
School of Medicine, Nankai University, No.94 Weijin Road, Nankai District, 300071, Tianjin, China.
Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.
Eur Radiol. 2024 Feb;34(2):761-769. doi: 10.1007/s00330-023-10022-6. Epub 2023 Aug 19.
To define a response-to-ablation system based on dynamic risk stratification proposed by the 2015 American Thyroid Association guidelines for predicting clinical outcomes and guiding follow-up strategies for patients with low-risk papillary thyroid microcarcinoma (PTMC) who underwent radiofrequency ablation (RFA).
This retrospective study reviewed patients with low-risk PTMC who underwent RFA between 2014 and 2018. We classified patients into three groups based on their response to therapy at the 1-year follow-up: complete, indeterminate, and incomplete. The primary endpoints were local tumor progression (LTP) and disease-free survival (DFS).
Among the 748 patients (mean age, 43.7 years ± 9.8; 586 women), 4.0% (30/748) had LTP during a median follow-up of 5 years. The response was complete in 80.2% (600/748) of the patients, indeterminate in 18.1% (135/748), and incomplete in 1.7% (13/748). The LTP rate in the final follow-up was 1% (6/600), 8.1% (11/135), and 100% (13/13), respectively. The risk of LTP was significantly different in the incomplete response group (HR, 1825.82; 95% CI: 458.27, 7274.36; p < 0.001) and indeterminate response group (HR, 8.12; 95% CI: 2.99, 22.09; p < 0.001) than in the complete response group. There were significant differences in DFS among groups (p < 0.001). The proportion of variation explained and C-index of the system was high (27.66% and 0.79, respectively).
We defined a response-to-ablation system that provides a new paradigm for the management of patients with PTMC who underwent RFA. Our data confirm that the system can effectively predict the risk of LTP and guide ongoing follow-up recommendations.
• The response-to-ablation system can classify patients with low-risk PTMC who underwent RFA into complete, indeterminate, or incomplete response categories. • Results suggest that, in this population, this system can identify three separate cohorts of patients who have significantly different clinical outcomes. • The response-to-ablation system will help better tailor the ongoing follow-up recommendations.
基于2015年美国甲状腺协会指南提出的动态风险分层，定义一种消融反应系统，用于预测接受射频消融（RFA）的低风险甲状腺微小乳头状癌（PTMC）患者的临床结局并指导随访策略。
这项回顾性研究纳入了2014年至2018年间接受RFA的低风险PTMC患者。我们根据患者在1年随访时的治疗反应将其分为三组：完全反应、不确定反应和不完全反应。主要终点为局部肿瘤进展（LTP）和无病生存期（DFS）。
在748例患者（平均年龄43.7岁±9.8；586例女性）中，中位随访5年期间，4.0%（30/748）发生了LTP。80.2%（600/748）的患者反应完全，18.1%（135/748）不确定，1.7%（13/748）不完全。最终随访时的LTP发生率分别为1%（6/600）、8.1%（11/135）和100%（13/13）。与完全反应组相比，不完全反应组（HR，1825.82；95%CI：458.27，7274.36；p<0.001）和不确定反应组（HR，8.12；95%CI：2.99，22.09；p<0.001）的LTP风险显著更高。各组间DFS存在显著差异（p<0.001）。该系统的变异解释比例和C指数较高（分别为27.66%和0.79）。
我们定义了一种消融反应系统，为接受RFA的PTMC患者的管理提供了一种新范式。我们的数据证实，该系统可以有效预测LTP风险并指导后续随访建议。
• 消融反应系统可将接受RFA的低风险PTMC患者分为完全反应、不确定反应或不完全反应类别。• 结果表明，在该人群中，该系统可识别出临床结局显著不同的三个独立患者队列。• 消融反应系统将有助于更好地制定后续随访建议。
