Yan Lin, Li Yingying, Li XinYang, Xiao Jing, Jing Haoyu, Yang Zhen, Li Miao, Song Qing, Wang Shurong, Che Ying, Luo Yukun
Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China.
Department of Ultrasound, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China.
JAMA Otolaryngol Head Neck Surg. 2024 Nov 7;151(1):9-17. doi: 10.1001/jamaoto.2024.3229.
Image-guided thermal ablation has been administered for patients with T1N0M0 papillary thyroid carcinoma (PTC) who elect to not undergo surgery or receive active surveillance. Considering the indolent nature of PTC, long-term outcomes of ablation are needed.
To investigate l0-year outcomes of thermal ablation in treating T1N0M0 PTC.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter study was conducted at 4 university-affiliated hospitals in China and included 179 consecutive patients with T1N0M0 PTC (median [IQR] volume, 88.0 [163.2] mm3) who underwent thermal ablation between June 2010 and March 2014. Patients who were ineligible to undergo surgery or elected not to were included, and patients had PTC tumors that were smaller than 20 mm as confirmed by biopsy; no clinical or imaging evidence of extrathyroidal extension, lymph node metastasis (LNM), or distant metastasis; and no history of neck irradiation.
The primary outcomes were disease progression (LNM, newly developed tumors, persistent tumors, and distant metastasis) and disease-free survival (DFS). Secondary outcomes were technical success, volume reduction rate, tumor disappearance, complications, and delayed surgery. DFS was calculated using a Kaplan-Meier analysis.
Among the 179 patients, the mean (SD) age was 45.8 (12.7) years, and 118 (65.9%) were female. During a mean (SD) follow-up period of 120.8 (10.8) months, disease progression was found in 11 of 179 patients (6.1%), including LNM in 4 patients (2.2%), newly developed tumors in 6 patients (3.3%), and persistent tumor in 1 patient (0.6%). The 10-year DFS was 93.9%. The technical success, median volume reduction rate, and tumor disappearance rate was 100%, 100%, and 97.2%, respectively. The magnitude of the disease progression (6.1% vs 7.1%; difference, 1.0%; 95% CI, -6.5% to 25.6%) and DFS (93.9% vs 92.9%; difference, 1.0%, 95% CI, -6.5% to 25.6%) between patients with T1a and T1b tumors was small. The difference in the rate of tumor disappearance between T1a and T1b tumors was large (99.4% vs 71.4%; difference, 28.0%; 95% CI, 10.9%-54.0%). One patient experienced transient voice hoarseness (0.6%). Because of anxiety, 1 patient underwent delayed surgery (0.6%).
The results of this 10-year multicenter cohort study suggest that thermal ablation is an effective and safe alternative for patients with T1N0M0 PTC who do not undergo surgery or receive active surveillance. For safe and effective treatment, accurate radiologic evaluation, an understanding of ablation techniques, and experienced physicians are recommended.
对于选择不接受手术或接受主动监测的T1N0M0期乳头状甲状腺癌（PTC）患者，已采用图像引导下热消融治疗。鉴于PTC的惰性本质，需要了解消融的长期结果。
研究热消融治疗T1N0M0期PTC的10年结果。
设计、地点和参与者：这项多中心研究在中国4家大学附属医院进行，纳入了2010年6月至2014年3月期间连续接受热消融治疗的179例T1N0M0期PTC患者（中位[四分位间距]体积，88.0[163.2]mm³）。纳入了不符合手术条件或选择不接受手术的患者，这些患者经活检证实PTC肿瘤小于20mm；无甲状腺外侵犯、淋巴结转移（LNM）或远处转移的临床或影像学证据；且无颈部放疗史。
主要结局为疾病进展（LNM、新出现的肿瘤、持续性肿瘤和远处转移）和无病生存期（DFS）。次要结局为技术成功率、体积缩小率、肿瘤消失情况、并发症和延迟手术。采用Kaplan-Meier分析计算DFS。
179例患者中，平均（标准差）年龄为45.8（12.7）岁，118例（65.9%）为女性。在平均（标准差）120.8（10.8）个月的随访期内，179例患者中有11例（6.1%）出现疾病进展，包括4例（2.2%）发生LNM、6例（3.3%）出现新出现的肿瘤和1例（0.6%）出现持续性肿瘤。10年DFS为93.9%。技术成功率、中位体积缩小率和肿瘤消失率分别为100%、100%和97.2%。T1a期和T1b期肿瘤患者之间的疾病进展幅度（6.1%对7.1%；差异，1.0%；95%CI，-6.5%至25.6%）和DFS（93.9%对92.9%；差异，1.0%，95%CI，-6.5%至25.6%）较小。T1a期和T1b期肿瘤的肿瘤消失率差异较大（99.4%对71.4%；差异，28.0%；95%CI，10.9%-54.）。1例患者出现短暂性声音嘶哑（0.6%）。由于焦虑，1例患者接受了延迟手术（0.6%）。
这项10年多中心队列研究的结果表明，对于不接受手术或接受主动监测的T1N0M0期PTC患者，热消融是一种有效且安全的替代治疗方法。为实现安全有效的治疗，建议进行准确的放射学评估、了解消融技术并由经验丰富的医生操作。
