From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.L., J.H.K.); Department of Radiology (J.Y.L., J.H.K.), Department of Internal Medicine (S.W.C., D.J.P., Y.J.P.), Department of Surgery (S.J.K., K.E.L.), and Integrated Major in Innovative Medical Science (K.E.L.), Seoul National University College of Medicine, Seoul, Republic of Korea; Departments of Radiology (Y.K.K.) and Internal Medicine (J.H.M.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; Departments of Radiology (C.Y.L.) and Internal Medicine (E.K.L., H.Y.), National Cancer Center, Goyang, Republic of Korea; Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea (H.S.C.); and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea (Y.J.P.).
Radiology. 2023 Oct;309(1):e230006. doi: 10.1148/radiol.230006.
Background Active surveillance (AS) is an accepted strategy for patients with low-risk papillary thyroid microcarcinoma (PTMC). While previous studies have evaluated the prognostic value of US features, results have been inconsistent. Purpose To determine if US features can help predict tumor progression in patients with low-risk PTMC undergoing AS. Materials and Methods This prospective study enrolled 1177 participants with PTMC from three hospitals between June 2016 and January 2021. Participants were self-assigned to either immediate surgery or AS, and those with two or more US examinations in the absence of surgery were included in the analysis. A χ test was used to compare estimated tumor progression rate at 4 years between participants stratified according to US features. Multivariable Cox regression analysis was used to assess the association of clinical and US features with overall tumor progression and specific progression criteria. Results Among 699 participants included in the analysis, 68 (mean age, 49 years ± 12 [SD]; 40 female participants) showed tumor progression (median follow-up, 41.4 months ± 16 [SD]). Tumor progression was associated with the US features of diffuse thyroid disease (DTD) (hazard ratio [HR], 2.3 [95% CI: 1.4, 3.7]; = .001) and intratumoral vascularity (HR, 1.7 [95% CI: 1.0, 3.0]; = .04) and the participant characteristics of male sex (HR, 2.8 [95% CI: 1.7, 4.6]; < .001), age less than 30 years (HR, 2.9 [95% CI: 1.2, 6.8]; = .01), and thyroid-stimulating hormone level of 7 µU/mL or higher (HR, 6.9 [95% CI: 2.7, 17.4]; < .001). The risk of tumor progression was higher for participants with DTD (14%, = .001) or intratumoral vascularity (14%, = .02) than for participants without these features (6%). DTD and intratumoral vascularity were associated with tumor enlargement (HR, 2.7 [95% CI: 1.4, 5.1]; = .002) and new lymph node metastasis (HR, 5.0 [95% CI: 1.3, 19.4]; = .02), respectively. Conclusion DTD and intratumoral vascularity were associated with an increased risk of tumor progression in participants with PTMC undergoing AS. Clinical trial registration no. NCT02938702 © RSNA, 2023 See also the editorial by Reuter and the review "International Expert Consensus on US Lexicon for Thyroid Nodules" by Durante et al in this issue.
背景 主动监测（AS）是一种被接受的低危甲状腺微小乳头状癌（PTMC）患者的治疗策略。虽然先前的研究已经评估了 US 特征的预后价值，但结果并不一致。目的 确定 US 特征是否有助于预测接受 AS 的低危 PTMC 患者的肿瘤进展。材料与方法 本前瞻性研究纳入了 2016 年 6 月至 2021 年 1 月期间三所医院的 1177 名 PTMC 患者。患者自行分配至立即手术或 AS 组，在未行手术且有两次或两次以上 US 检查的患者被纳入分析。采用 χ2 检验比较按 US 特征分层的 4 年肿瘤进展估计率。采用多变量 Cox 回归分析评估临床和 US 特征与总体肿瘤进展和特定进展标准的相关性。结果 在纳入分析的 699 名参与者中，68 名（平均年龄，49 岁±12[标准差]；40 名女性参与者）出现肿瘤进展（中位随访时间，41.4 个月±16[标准差]）。肿瘤进展与 US 特征弥漫性甲状腺疾病（DTD）（风险比[HR]，2.3[95%CI：1.4,3.7]； =.001）和肿瘤内血管生成（HR，1.7[95%CI：1.0,3.0]； =.04）以及患者特征中的男性（HR，2.8[95%CI：1.7,4.6]； <.001）、年龄小于 30 岁（HR，2.9[95%CI：1.2,6.8]； =.01）和促甲状腺激素水平为 7 μU/mL 或更高（HR，6.9[95%CI：2.7,17.4]； <.001）相关。具有 DTD（14%， =.001）或肿瘤内血管生成（14%， =.02）的患者比没有这些特征的患者（6%）肿瘤进展风险更高。DTD 和肿瘤内血管生成与肿瘤增大（HR，2.7[95%CI：1.4,5.1]； =.002）和新的淋巴结转移（HR，5.0[95%CI：1.3,19.4]； =.02）相关。结论 DTD 和肿瘤内血管生成与接受 AS 的 PTMC 患者的肿瘤进展风险增加相关。临床试验注册号 NCT02938702 ©RSNA，2023 还请参阅本期Durante 等人的“甲状腺结节的国际专家共识超声词汇”社论和 Reuter 的社论。
