Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Centro de estudios traslacionales de Endocrinología (Cetren) UC, Santiago, Chile.
Arch Endocrinol Metab. 2024 May 6;68:e230146. doi: 10.20945/2359-4292-2023-0146.
After initial treatment, up to 30% of patients with papillary thyroid cancer (PTC) have incomplete response, mainly cervical lymph node (LN) disease. Previous studies have suggested that active surveillance (AS) is a possible option for these patients. Our aim was to report the results of AS in patients with PTC and cervical LN disease.
In this retrospective observational study, we included adult patients treated and followed for PTC, who presented with cervical LN disease and were managed with AS. Growth was defined as an increase ≥ 3mm in either diameter.
We included 32 patients: 27 (84.4%) women, age of 39 ± 14 years, all initially treated with total thyroidectomy, and 22 (69%) with therapeutic neck dissection. Cervical LN disease was diagnosed 1 year (0.3-12.6) after initial management, with a diameter of 9.0 mm (6.0-19.0). After a median AS of 4.3 years (0.6-14.1), 4 (12.5%) patients had LNgrowth: 2 (50%) of whom were surgically removed, 1 (25%) was effectively treated with radiotherapy, and 1 (25%) had a scheduled surgery. Tg increase was the only predictive factor of LN growth evaluated as both the delta Tg (p < 0.0366) and percentage of Tg change (p < 0.0140). None of the included patients died, had local complications due to LN growth or salvage therapy, or developed distant metastases during follow-up.
In selected patients with PTC and suspicious cervical LNs diagnosed after initial treatment, AS is a feasible and safe strategy as it allows effective identification and treatment of the minority of patients who progress.
在初始治疗后，多达 30%的甲状腺乳头状癌 (PTC) 患者存在不完全缓解，主要为颈部淋巴结 (LN) 疾病。既往研究表明，主动监测 (AS) 可能是这些患者的一种选择。我们的目的是报告 AS 在 PTC 伴颈部 LN 疾病患者中的结果。
在这项回顾性观察研究中，我们纳入了接受 PTC 治疗和随访的成年患者，这些患者存在颈部 LN 疾病，并接受 AS 治疗。生长定义为直径增加≥3mm。
我们纳入了 32 名患者：27 名（84.4%）女性，年龄 39±14 岁，均初始接受全甲状腺切除术治疗，22 名（69%）接受治疗性颈部淋巴结清扫术。初始治疗后 1 年（0.3-12.6 年）诊断出颈部 LN 疾病，直径为 9.0mm（6.0-19.0mm）。在中位 4.3 年（0.6-14.1 年）的 AS 后，4 名（12.5%）患者发生 LNgrowth：2 名（50%）患者接受手术切除，1 名（25%）患者接受有效放射治疗，1 名（25%）患者计划手术。Tg 增加是唯一评估的 LN 生长预测因素，包括 Tg 差值（p<0.0366）和 Tg 变化百分比（p<0.0140）。在随访期间，没有患者死亡，没有因 LN 生长或挽救性治疗而发生局部并发症，也没有发生远处转移。
在初始治疗后诊断出 PTC 伴可疑颈部 LN 的选定患者中，AS 是一种可行且安全的策略，因为它可以有效识别和治疗少数进展患者。
