From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.).
Radiology. 2024 Apr;311(1):e230459. doi: 10.1148/radiol.230459.
Background Microwave ablation (MWA) is currently under preliminary investigation for the treatment of multifocal papillary thyroid carcinoma (PTC) and has shown promising treatment efficacy. Compared with surgical resection (SR), MWA is minimally invasive and could preserve thyroid function. However, a comparative analysis between MWA and SR is warranted to draw definitive conclusions. Purpose To compare MWA and SR for preoperative US-detected T1N0M0 multifocal PTC in terms of overall and 1-, 3-, and 5-year progression-free survival rates and complication rates. Materials and Methods In this retrospective study, 775 patients with preoperative US-detected T1N0M0 multifocal PTC treated with MWA or SR across 10 centers between May 2015 and December 2021 were included. Propensity score matching (PSM) was performed for patients in the MWA and SR groups, followed by comparisons between the two groups. The primary outcomes were overall and 1-, 3-, and 5-year progression-free survival (PFS) rates and complication rates. Results After PSM, 229 patients (median age, 44 years [IQR 36.5-50.5 years]; 179 female) in the MWA group and 453 patients (median age, 45 years [IQR 37-53 years]; 367 female) in the SR group were observed for a median of 20 months (range, 12-74 months) and 26 months (range, 12-64 months), respectively. MWA resulted in less blood loss, shorter incision length, and shorter procedure and hospitalization durations (all < .001). There was no evidence of differences in overall and 1-, 3-, or 5-year PFS rates (all > .05) between MWA and SR (5-year rate, 77.2% vs 83.1%; = .36) groups. Permanent hoarseness (2.2%, = .05) and hypoparathyroidism (4.0%, = .005) were encountered only in the SR group. Conclusion There was no evidence of a significant difference in PFS rates between MWA and SR for US-detected multifocal T1N0M0 PTC, and MWA resulted in fewer complications. Therefore, MWA is a feasible option for selected patients with multifocal T1N0M0 PTC. © RSNA, 2024 See also the editorial by Georgiades in this issue.
背景 微波消融 (MWA) 目前正处于治疗多灶性甲状腺乳头状癌 (PTC) 的初步研究阶段，已显示出有希望的治疗效果。与手术切除 (SR) 相比，MWA 具有微创性，并能保留甲状腺功能。然而，仍需要对 MWA 和 SR 进行比较分析，以得出明确的结论。目的 比较 MWA 和 SR 治疗术前超声检测的 T1N0M0 多灶性 PTC 的总生存率、1 年、3 年和 5 年无进展生存率以及并发症发生率。材料与方法 本回顾性研究纳入了 2015 年 5 月至 2021 年 12 月期间在 10 个中心接受 MWA 或 SR 治疗的术前超声检测 T1N0M0 多灶性 PTC 的 775 例患者。对 MWA 组和 SR 组的患者进行倾向评分匹配 (PSM)，然后对两组进行比较。主要结局为总生存率、1 年、3 年和 5 年无进展生存率 (PFS) 以及并发症发生率。结果 经 PSM 后，MWA 组的 229 例患者 (中位年龄 44 岁 [IQR 36.5-50.5 岁]；179 例女性) 和 SR 组的 453 例患者 (中位年龄 45 岁 [IQR 37-53 岁]；367 例女性) 分别观察了中位时间为 20 个月 (范围 12-74 个月) 和 26 个月 (范围 12-64 个月)。MWA 导致更少的出血量、更短的切口长度以及更短的手术和住院时间 (均 <.001)。两组的总生存率以及 1 年、3 年或 5 年的无进展生存率均无差异 (均 >.05) (5 年生存率：77.2%比 83.1%； =.36)。永久性声音嘶哑 (2.2%， =.05) 和甲状旁腺功能减退症 (4.0%， =.005) 仅见于 SR 组。结论 在术前超声检测的 T1N0M0 多灶性 PTC 中，MWA 与 SR 相比，PFS 率无显著差异，且 MWA 导致的并发症更少。因此，MWA 是 T1N0M0 多灶性 PTC 患者的一种可行选择。 由 Georgiades 在本期杂志上撰写的社论也对此进行了讨论。
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