Nguyen Van Cuong, Song Chang Myeon, Ji Yong Bae, Moon Shinje, Park Jung Hwan, Kim Dong Sun, Tae Kyung
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, 04763, Republic of Korea.
Eur Arch Otorhinolaryngol. 2025 May;282(5):2239-2252. doi: 10.1007/s00405-024-09141-7. Epub 2024 Dec 12.
This study aimed to evaluate the outcomes and effectiveness of active surveillance (AS) in patients with low-risk papillary thyroid carcinoma (PTC) and compare them to those of immediate surgery (IS).
A systematic review and meta-analysis, including 14 comparative studies and 7 noncomparative studies, was conducted, encompassing a total of 9,397 patients.
AS was associated with lower rates of familial history of thyroid cancer, multiplicity, and overall mortality compared to IS. The disease progression rate during AS was 14.53% (95% CI, 9.59-21.43%), and the delayed surgery rate was 14.91% (95% CI, 8.35-25.21%). No thyroid cancer-related mortality was observed in either the AS and IS groups. Clinicopathological characteristics showed no significant differences between delayed surgery and IS, except for higher rates of extrathyroidal extension and multiplicity in the delayed surgery group. Overall complication and recurrence rates were higher in the delayed surgery group than in the IS group. Quality of life and anxiety levels were similar between AS and IS, except for interest in sex, where AS was more beneficial.
AS is a feasible and reliable option for managing low-risk PTC, with a relatively low rate of disease progression and no thyroid cancer-related mortality. However, AS should be undertaken with caution, given the higher rates of overall complications and recurrence in the delayed surgery group compared to the IS group. Further studies with larger sample sizes and long-term follow-up are needed to clarify the role and effectiveness of AS.
本研究旨在评估主动监测（AS）在低危乳头状甲状腺癌（PTC）患者中的结局和有效性，并将其与即刻手术（IS）的结局和有效性进行比较。
进行了一项系统评价和荟萃分析，纳入14项比较研究和7项非比较研究，共计9397例患者。
与即刻手术相比，主动监测与甲状腺癌家族史、多灶性和总死亡率较低相关。主动监测期间的疾病进展率为14.53%（95%CI，9.59 - 21.43%），延迟手术率为14.91%（95%CI，8.35 - 25.21%）。主动监测组和即刻手术组均未观察到甲状腺癌相关死亡。临床病理特征显示，延迟手术与即刻手术之间无显著差异，但延迟手术组的甲状腺外侵犯和多灶性发生率较高。延迟手术组的总体并发症和复发率高于即刻手术组。主动监测和即刻手术的生活质量和焦虑水平相似，但在性兴趣方面，主动监测更有益。
主动监测是管理低危PTC的一种可行且可靠的选择，疾病进展率相对较低，且无甲状腺癌相关死亡。然而，鉴于延迟手术组的总体并发症和复发率高于即刻手术组，应谨慎进行主动监测。需要进行更大样本量和长期随访的进一步研究，以阐明主动监测的作用和有效性。
