Liao Li-Jen, Ono Yukiko, Hung Shun-Fa, Chen Yong-Chen, Hsu Wan-Lun
Department of Otolaryngology, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan.
Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan.
Diagnostics (Basel). 2024 Nov 22;14(23):2628. doi: 10.3390/diagnostics14232628.
: There remain several challenges to the acceptance and standardization of active surveillance (AS) in patients with early thyroid cancer. The purpose of this study was to update the evidence of tumor progression outcomes in AS to support resolution of clinical concerns and to examine the effect of follow-up duration, period context such as diagnostic techniques, and tumor size at baseline on outcomes. : PubMed, Web of Science, and Embase were used to search for original articles in English until January 2024. The main outcomes were the pooled proportion of patients who showed tumor growth ≥ 3 mm, metastasis to cervical lymph nodes, and conversion to delayed thyroid surgery. A single-arm meta-analysis was performed using a random-effects model. : Fourteen studies with 7291 patients were included in the analysis. Pooled results showed that 5.6% (95% CI: 4.2-7.4) of patients increased tumor diameter by more than 3 mm, 1.1% (95% CI: 0.9-1.4) developed cervical lymph node metastases by clinical diagnosis and 3.6% (95% CI: 3.1-4.2) by pathology, 12.7% (95% CI: 9.9-16.1) of patients converted to delayed surgery, with 31.6% (95% CI: 25.3-38.7) of those conversions being due to tumor progression. Subgroup analysis showed a small difference in the proportion of outcomes by baseline tumor size but no increase in the proportion of tumor progression or conversion to surgery due to other factors. : This meta-analysis suggests long-term stability in the proportion of tumor progression in AS and less susceptibility to external influences.
早期甲状腺癌患者主动监测（AS）的接受度和标准化仍存在若干挑战。本研究的目的是更新主动监测中肿瘤进展结果的证据，以支持解决临床问题，并研究随访时间、诊断技术等时期背景以及基线时肿瘤大小对结果的影响。使用PubMed、Web of Science和Embase检索截至2024年1月发表的英文原创文章。主要结局包括肿瘤生长≥3 mm、发生颈部淋巴结转移以及转为延期甲状腺手术的患者合并比例。采用随机效应模型进行单臂荟萃分析。分析纳入了14项研究，共7291例患者。汇总结果显示，5.6%（95%CI：4.2 - 7.4）的患者肿瘤直径增加超过3 mm，临床诊断发现1.1%（95%CI：0.9 - 1.4）的患者发生颈部淋巴结转移，病理诊断发现3.6%（95%CI：3.1 - 4.2）的患者发生颈部淋巴结转移，12.7%（95%CI：9.9 - 16.1）的患者转为延期手术，其中31.6%（95%CI：25.3 - 38.7）的转为延期手术是由于肿瘤进展。亚组分析显示，根据基线肿瘤大小，结局比例存在微小差异，但肿瘤进展比例或因其他因素转为手术的比例并未增加。这项荟萃分析表明，主动监测中肿瘤进展比例具有长期稳定性，且对外界影响的敏感性较低。
