Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan.
Department of Head and Neck Surgery, Kuma Hospital, Kobe 650-0011, Japan.
Endocr J. 2024 Jan 29;71(1):7-21. doi: 10.1507/endocrj.EJ23-0395. Epub 2023 Oct 4.
Active surveillance (AS) for low-risk papillary thyroid microcarcinoma (PTMC), which was initiated at Kuma Hospital (Kobe, Japan) in 1993 and Cancer Institute Hospital (Tokyo) in 1995, is now gradually being adopted worldwide, and several prospective studies have described the favorable outcomes of PTMC patients who underwent AS. The most important factor predicting PTMC growth is young age, and PTMC enlargement in young patients may be affected by high serum levels of thyroid-stimulating hormone. This review notes that one patient showed lung metastasis after conversion surgery (CS) following AS, but there are no reports of patients dying of thyroid carcinoma during or after AS. Some PTMCs enlarge or show newly appeared metastatic nodes requiring CS, and findings on the postoperative prognosis and incidence of significant surgical complications (e.g., permanent vocal cord paralysis, hypoparathyroidism) do not differ significantly between patients who underwent CS after AS and those who underwent immediate surgery (IS). IS has been associated with significantly higher incidences of these complications compared to AS as the initial management. Several studies have examined the quality of life (QoL) of patients who underwent AS versus IS, and reported discrepant findings regarding various psychological conditions (including anxiety). Medical costs for AS and IS vary regionally, and in Japan, the 10-year total cost of IS was 4.1 times greater than that of AS in 2017. Taken together, the existing findings demonstrate that AS can be appropriate for the initial management of patients with PTMC.
主动监测（AS）用于低危型甲状腺微小乳头状癌（PTMC），该方法于 1993 年在日本神户的久马医院（Kuma Hospital）和 1995 年在东京癌症研究所医院（Cancer Institute Hospital）开始实施，目前正在全球范围内逐渐采用，并且有几项前瞻性研究描述了接受 AS 治疗的 PTMC 患者的良好结局。预测 PTMC 生长最重要的因素是年龄较小，而年轻患者的 PTMC 增大可能与甲状腺刺激激素的血清水平较高有关。本综述指出，有 1 例患者在 AS 后行转换手术（CS）后出现肺转移，但尚无患者在 AS 期间或之后死于甲状腺癌的报道。一些 PTMC 增大或出现新的转移性淋巴结，需要 CS，术后预后和显著手术并发症（如永久性声带麻痹、甲状旁腺功能减退）的发生率在 AS 后行 CS 的患者和立即手术（IS）的患者之间无显著差异。与 AS 作为初始治疗相比，IS 与这些并发症的发生率显著更高相关。几项研究比较了接受 AS 和 IS 的患者的生活质量（QoL），并报告了各种心理状况（包括焦虑）的不一致发现。AS 和 IS 的医疗费用因地区而异，在日本，2017 年 IS 的 10 年总成本是 AS 的 4.1 倍。综上所述，现有研究结果表明，AS 可适用于 PTMC 患者的初始治疗。
