Department of Internal Medicine Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.
Endocrinol Metab (Seoul). 2024 Feb;39(1):152-163. doi: 10.3803/EnM.2023.1794. Epub 2024 Jan 22.
Active surveillance (AS) has been introduced as a management strategy for low-risk papillary thyroid carcinoma (PTC) due to its typically indolent nature. Despite this, the widespread adoption of AS has encountered several challenges. The aim of this systematic review was to evaluate the safety of AS related to disease progression and its benefits compared with immediate surgery (IS).
Studies related to AS in patients with low-risk PTC were searched through the Ovid MEDLINE, Embase, Cochrane Library, and KoreaMed databases. Studies on disease progression, surgical complication, quality of life (QoL), and cost-effectiveness were separately analyzed and narratively synthesized.
In the evaluation of disease progression, the proportions of cases with tumor growth ≥3 mm and a volume increase >50% were 2.2%-10.8% and 16.0%-25.5%, respectively. Newly detected lymph node metastasis was identified in 0.0%-1.4% of patients. No significant difference was found between IS and delayed surgery in surgical complications, including vocal cord paralysis and postoperative hypoparathyroidism. AS was associated with better QoL than IS. Studies on the cost-effectiveness of AS reported inconsistent data, but AS was more cost-effective when quality-adjusted life years were considered.
AS is an acceptable management option for patients with low-risk PTC based on the low rate of disease progression and the absence of an increased mortality risk. AS has additional benefits, including improved QoL and greater QoL-based cost-effectiveness.
由于低危型甲状腺乳头状癌（PTC）的惰性特征，主动监测（AS）已被引入作为一种管理策略。尽管如此，AS 的广泛采用还是遇到了一些挑战。本系统评价的目的是评估与疾病进展相关的 AS 的安全性，并与立即手术（IS）相比评估其获益。
通过 Ovid MEDLINE、Embase、Cochrane 图书馆和 KoreaMed 数据库检索与低危型 PTC 患者 AS 相关的研究。分别对疾病进展、手术并发症、生活质量（QoL）和成本效益进行分析和叙述性综合。
在评估疾病进展方面，肿瘤生长≥3mm 和体积增加>50%的病例比例分别为 2.2%-10.8%和 16.0%-25.5%。新发现的淋巴结转移在 0.0%-1.4%的患者中被检出。在手术并发症方面，包括声带麻痹和术后甲状旁腺功能减退，AS 与延迟手术之间没有发现显著差异。AS 与 IS 相比与更好的 QoL 相关。AS 的成本效益研究报告的数据不一致，但在考虑了质量调整生命年的情况下，AS 更具成本效益。
基于低疾病进展率和无增加死亡率的风险，AS 是低危型 PTC 患者可接受的管理选择。AS 还有额外的获益，包括改善 QoL 和基于 QoL 的更高成本效益。
