Shi Liuhong, Le Kehao, Qi Haiou, Feng Yibing, Zhou Liang, Wang Jianbiao, Xie Lei
Department of Head and Neck Surgery, Affiliated to Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Department of Nursing, Affiliated to Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Front Oncol. 2023 Oct 10;13:1046014. doi: 10.3389/fonc.2023.1046014. eCollection 2023.
When active surveillance (AS) is developed in the patients with low-risk papillary thyroid microcarcinoma (PTMC), a medical center needs to ensure the delayed operation that is caused by PTMC clinical progression to have the same prognosis as that of immediate operation. The objective of this study was to investigate the efficacy of delayed surgery by simulating clinical progression (tumor size enlargement and appearance of lymph node metastasis) of PTMCs with AS in a single medical center.
We retrospectively analyzed the response to therapy in 317 papillary thyroid carcinoma patients treated with total thyroidectomy and post-operative radioactive iodine ablation. They were classified into three groups according to tumor size (group A ≤0.5 cm; group B >0.5 cm and ≤1 cm; group C >1 cm and ≤1.5 cm) or two groups according to the presence (cN1) or absence (cN0) of the clinical lymph node (LN) metastasis. Groups C and cN1 were regarded as simulated clinical progression of observational PTMC and the operation for them was assumed to be "delayed surgery". However, Groups A, B and cN0 were regarded as no clinical progression and the operation for them was considered as immediate surgery.
There were no significantly differences in excellent response to therapy and recurrence-free survival not only among the group A, B and C, but also between the group cN0 and cN1. In other words, these insignificant differences were found between immediate and simulated "delayed" surgeries.
For the PTMC patients suitable for AS, the oncological outcomes were also excellent even if surgery was delayed until after the presence of clinical progression, according to our clinical simulation. Furthermore, we consider that it was feasible for medical centers to assess the ability to implement AS for PTMC patients by retrospectively analyzing their own previous clinical data using the described simulation.
在为低风险甲状腺微小乳头状癌（PTMC）患者开展主动监测（AS）时，医疗中心需要确保由PTMC临床进展导致的延迟手术与即刻手术具有相同的预后。本研究的目的是通过在单一医疗中心模拟PTMCs的临床进展（肿瘤大小增大和出现淋巴结转移）来研究延迟手术的疗效。
我们回顾性分析了317例行全甲状腺切除术及术后放射性碘消融治疗的甲状腺乳头状癌患者的治疗反应。根据肿瘤大小将他们分为三组（A组≤0.5 cm；B组>0.5 cm且≤1 cm；C组>1 cm且≤1.5 cm），或根据临床淋巴结（LN）转移情况分为两组（cN1组有转移；cN0组无转移）。C组和cN1组被视为观察性PTMC的模拟临床进展，对其进行的手术被假定为“延迟手术”。然而，A组、B组和cN0组被视为无临床进展，对其进行的手术被视为即刻手术。
不仅A组、B组和C组之间，而且cN0组和cN1组之间在治疗的良好反应和无复发生存方面均无显著差异。换句话说，即刻手术和模拟“延迟”手术之间存在这些不显著的差异。
根据我们的临床模拟，对于适合AS的PTMC患者，即使手术延迟至出现临床进展后，肿瘤学结局也同样良好。此外，我们认为医疗中心通过使用所描述的模拟方法回顾性分析其自身先前的临床数据来评估对PTMC患者实施AS的能力是可行的。
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