Department of Thyroid Surgery, The Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China.
Department of Endocrine, The Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China.
Eur J Surg Oncol. 2024 Sep;50(9):108470. doi: 10.1016/j.ejso.2024.108470. Epub 2024 Jun 5.
Confidence in long-term treatment results of radiofrequency ablation (RFA) for papillary thyroid microcarcinoma (PTMC) is required in comparison with surgery and active surveillance (AS). The objective of this meta-analysis is to report more than three years of follow-up results of radiofrequency ablation for PTMCs.
Ovid PUBMED, COCHRANE, and EMBASE databases were searched through Nov 19, 2023, for studies reporting outcomes in patients with PTMC treated with radiofrequency ablation and followed up for more than 3 years. The standard mean difference of the tumor volume before and after therapy, tumor recurrence, lymph node (LN) metastasis, distant metastasis, complications, and the pooled volume reduction rates (VRRs) at 1, 3, 6, 12, 24, 36, and 48 months after radiofrequency ablation were assessed. Data were extracted and methodological quality was assessed independently by two radiologists according to the PRISMA guidelines.
Eight studies, involving 2131 patients, met the inclusion criteria through database searches. The overall VRR was 99.81 % (95 % CI: 99.68, 99.95) in the last follow-up. During a mean pooled follow-up of 46.59 months, 69 patients experienced local PTMC recurrence, with 8 cases within the ablation area. Additionally, 44 patients were diagnosed with newly discovered PTMC, and 17 patients exhibited lymph node metastases. Among the patients with PTMC recurrence, 3 were under active surveillance while 59 underwent additional RFA. The pooled mean complication rate was 2.80 %, with no instances of life-threatening or delayed complications.
Radiofrequency ablation proves to be an effective local tumor control method for low-risk PTMC patients, resulting in clinically significant and enduring volume reduction. The rate of regrowth and retreatment requirement post-RFA was notably lower, positioning RFA as a compelling alternative to existing treatment options.
与手术和主动监测（AS）相比，需要对甲状腺乳头状微小癌（PTMC）的射频消融（RFA）长期治疗结果有信心。本荟萃分析的目的是报告 RFA 治疗 PTMC 超过 3 年的随访结果。
通过 Ovid PUBMED、COCHRANE 和 EMBASE 数据库检索，截至 2023 年 11 月 19 日，以检索报告接受射频消融治疗并随访超过 3 年的 PTMC 患者结局的研究。评估治疗前后肿瘤体积的标准均数差、肿瘤复发、淋巴结（LN）转移、远处转移、并发症以及射频消融后 1、3、6、12、24、36 和 48 个月的总体体积减少率（VRR）。数据由两名放射科医生根据 PRISMA 指南独立提取和评估方法学质量。
通过数据库检索，有 8 项研究共 2131 例患者符合纳入标准。最后一次随访时的总体 VRR 为 99.81%（95%可信区间：99.68，99.95）。在平均 46.59 个月的汇总随访中，69 例患者出现局部 PTMC 复发，其中 8 例位于消融区域内。此外，44 例患者被诊断为新发现的 PTMC，17 例患者出现淋巴结转移。在有 PTMC 复发的患者中，3 例患者处于主动监测中，而 59 例患者接受了额外的 RFA。汇总的平均并发症发生率为 2.80%，无危及生命或延迟并发症的发生。
射频消融术是低危 PTMC 患者有效的局部肿瘤控制方法，可显著降低肿瘤体积并具有持久效果。RFA 后的再生长和再治疗需求率明显较低，使 RFA 成为现有治疗选择的一种极具吸引力的替代方案。
