Universidad Central del Ecuador, Facultad de Ciencias Médicas, Quito, Ecuador.
CaTaLiNA- Cancer de Tiroides en Latino America, Quito, Ecuador.
Endocrine. 2024 Feb;83(2):330-341. doi: 10.1007/s12020-023-03502-8. Epub 2023 Sep 2.
The global prevalence of thyroid cancer is on the rise. About one-third of newly diagnosed thyroid cancer cases comprise low-risk papillary thyroid cancer (1.5 cm or more minor). While surgical removal remains the prevailing approach for managing low-risk papillary thyroid cancer (LPTC) in patients, other options such as active surveillance (AS), radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) are also being considered as viable alternatives. This study evaluated and compared surgical thyroid resection (TSR) versus non-surgical (NS) methods for treating patients with LPTC.
The study encompassed an analysis of comparisons between surgical thyroid resection (TSR) and alternative approaches, including active surveillance (AS), radiofrequency ablation (RFA), microwave ablation (MWA), or laser ablation (LA). The focus was on patients with biopsy-confirmed low-risk papillary thyroid cancer (LPTC) of less than 1.5 cm without preoperative indications of local or distant metastasis. The primary outcomes assessed were recurrence rates, disease-specific mortality, and quality of life (QoL). Data were collected from prominent databases, including Cochrane Database, Embase, MEDLINE, and Scopus, from inception to June 3rd, 2020. The CLARITY tool was utilized to evaluate bias risk. The analysis involved odds ratios (OR) with 95% confidence intervals (CI) for dichotomous outcomes, as well as mean differences (MD) and standardized mean differences (SMD) for continuous outcomes. The study is registered on PROSPERO under the identifier CRD42021235657.
The study incorporated 13 retrospective cohort studies involving 4034 patients. Surgical thyroid resection (TSR), active surveillance (AS), and minimally invasive techniques like radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) were performed in varying proportions of cases. The analysis indicated that specific disease mortality rates were comparable among AS, MWA, and TSR groups. The risk of recurrence, evaluated over different follow-up periods, showed no significant differences when comparing AS, RFA, MWA, or LA against TSR. Patients undergoing AS demonstrated better physical health-related quality of life (QoL) than those undergoing TSR. However, no substantial differences were observed in the overall mental health domain of QoL when comparing AS or RFA with TSR. The risk of bias was moderate in nine studies and high in four.
Low-quality evidence indicates comparable recurrence and disease-specific mortality risks among patients with LPTC who underwent ablation techniques or active surveillance (AS) compared to surgery. Nevertheless, individuals who opted for AS exhibited enhanced physical quality of life (QoL). Subsequent investigations are warranted to validate these findings.
全球甲状腺癌的患病率呈上升趋势。大约三分之一的新诊断甲状腺癌病例为低危型甲状腺乳头状癌（1.5 厘米或以上的微小癌）。虽然手术切除仍然是治疗低危型甲状腺乳头状癌（LPTC）患者的主要方法，但其他方法，如主动监测（AS）、射频消融（RFA）、微波消融（MWA）和激光消融（LA），也被认为是可行的替代方法。本研究评估并比较了手术甲状腺切除术（TSR）与非手术（NS）方法治疗 LPTC 患者的效果。
该研究分析了手术甲状腺切除术（TSR）与替代方法（包括主动监测（AS）、射频消融（RFA）、微波消融（MWA）或激光消融（LA））之间的比较。研究对象为经活检证实的低危型甲状腺乳头状癌（LPTC）患者，肿瘤直径小于 1.5 厘米，且无术前局部或远处转移的证据。主要结局评估包括复发率、疾病特异性死亡率和生活质量（QoL）。数据来自 Cochrane Database、Embase、MEDLINE 和 Scopus 等知名数据库，时间从建库至 2020 年 6 月 3 日。采用 CLARITY 工具评估偏倚风险。分析采用比值比（OR）和 95%置信区间（CI）表示二分类结局，以及均数差（MD）和标准化均数差（SMD）表示连续性结局。本研究已在 PROSPERO 上注册，注册号为 CRD42021235657。
该研究纳入了 13 项回顾性队列研究，共涉及 4034 例患者。手术甲状腺切除术（TSR）、主动监测（AS）和微创技术如射频消融（RFA）、微波消融（MWA）和激光消融（LA）在不同病例中被采用。分析表明，AS、MWA 和 TSR 组的特定疾病死亡率相当。在不同的随访期评估复发风险时，AS、RFA、MWA 或 LA 与 TSR 相比，复发风险无显著差异。与 TSR 相比，接受 AS 的患者的生理健康相关生活质量（QoL）更好。然而，与 TSR 相比，AS 或 RFA 与 TSR 相比，总体心理健康领域的 QoL 无显著差异。9 项研究的偏倚风险为中度，4 项研究的偏倚风险为高度。
低质量证据表明，接受消融技术或主动监测（AS）与手术治疗的 LPTC 患者的复发和疾病特异性死亡率风险相当。然而，选择 AS 的患者表现出更好的生理生活质量（QoL）。需要进一步的研究来验证这些发现。
