Liu C H, Zhao H, Xia Y, Cao Y, Zhang L Y, Zhao Y, Gao L Y, Liu R F, Liu Y W, Liu H F, Meng Z L, Liu S Z, Lu Y, Palashate Yeerkenbieke, Li X Y
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2023 Oct 31;103(40):3186-3192. doi: 10.3760/cma.j.cn112137-20230206-00168.
To investigate the oncological outcomes of active surveillance (AS) in patients showing thyroid nodules measuring≤1 cm with highly suspicious ultrasound features. A prospective single-center cohort study. A total of 534 patients with highly suspicious thyroid nodules (2015 American Thyroid Association Nodule Sonographic Patterns and Risk of Malignancy: High Suspicion) were enrolled in this study, the patients received AS at Peking Union Medical College Hospital between January 2017 and November 2022 to assess oncological outcomes (disease progression, recurrence/metastasis rate, etc). The patients were followed up every 6 months for physical examination and neck ultrasound examination. And the value of tumor volume changes in evaluating tumor enlargement was explored too. There were 413 females and 121 males in this cohort, with a mean age of (42.6±11.8) years. During a median follow-up period of 45.6 months (ranged from 3.5 to 176.0 months), disease progression occurred in 26 patients (4.9%) with highly suspicious thyroid nodules, characterized by a minimum 3-mm increase in tumor diameter in 19 patients (3.6%) and lymph node metastases in 7 patients (1.3%). Forty-seven (8.8%) patients opted for delayed surgery, with 29 patients due to a change in preference. There was no significant differences in pathologic and follow-up outcomes between patients with disease progression and preference change. Patients aged≤40 years had a higher cumulative incidence of 5-year disease progression than those aged>40 years (4.9% vs 1.9%, =0.060). No patients experienced distant metastases or deaths. Among the 595 high-risk thyroid nodules with continuous volume assessment results and an increase in nodule diameter of less than 3 mm (including all high-risk nodules in patients with single or multiple nodules), 184 (30.9%) and 79 (13.3%) nodules exhibited volume increases of more than 50% and 100%, respectively, in multiple measurements. Among the nodules with volume changes exceeding 50% and 100%, the proportion of nodules with a baseline tumor diameter of≤0.5 cm was significantly higher than those with a diameter of>0.5 cm, at 69.0% vs 31.0% (<0.001) and 77.2% vs 22.8% (<0.001), respectively Active surveillance in patients with highly suspicious subcentimeter thyroid nodules has good short-term oncological outcomes and can be considered a safe alternative to surgery. Due to the large variability in the measurement results of tumor volume, it is not suitable as an indicator for evaluating tumor enlargement
为研究超声特征高度可疑的≤1 cm甲状腺结节患者进行主动监测（AS）的肿瘤学结局。一项前瞻性单中心队列研究。本研究共纳入534例甲状腺结节高度可疑的患者（2015年美国甲状腺协会结节超声特征及恶性风险：高度可疑），这些患者于2017年1月至2022年11月在北京协和医院接受AS以评估肿瘤学结局（疾病进展、复发/转移率等）。患者每6个月接受一次体格检查和颈部超声检查。同时也探讨了肿瘤体积变化在评估肿瘤增大方面的价值。该队列中有413例女性和121例男性，平均年龄为（42.6±11.8）岁。在中位随访期45.6个月（范围为3.5至176.0个月）内，26例（4.9%）甲状腺结节高度可疑的患者出现疾病进展，其特征为19例（3.6%）患者肿瘤直径至少增加3 mm，7例（1.3%）患者出现淋巴结转移。47例（8.8%）患者选择延迟手术，其中29例是由于偏好改变。疾病进展患者和偏好改变患者的病理及随访结局无显著差异。年龄≤40岁的患者5年疾病进展累积发生率高于年龄>40岁的患者（4.9%对1.9%，P = 0.060）。无患者发生远处转移或死亡。在595个有连续体积评估结果且结节直径增加小于3 mm的高危甲状腺结节中（包括单结节或多结节患者的所有高危结节），184个（30.9%）和79个（13.3%）结节在多次测量中体积分别增加超过50%和100%。在体积变化超过50%和100%的结节中，基线肿瘤直径≤0.5 cm的结节比例显著高于直径>0.5 cm的结节，分别为69.0%对31.0%（P<0.001）和77.2%对22.8%（P<0.001）。对超声特征高度可疑的亚厘米级甲状腺结节患者进行主动监测具有良好的短期肿瘤学结局，可被视为手术的一种安全替代方案。由于肿瘤体积测量结果差异较大，其不适宜作为评估肿瘤增大的指标
