Toraih Eman, Hussein Mohammad, Elshazli Rami, Abdelmaksoud Ahmed, AbdAlnaeem Mahmoud A, Bashumeel Yaser Y, Bobba Tanvi, Bishop Julia, Paladugu Siva, Leei Grace S, Kandil Emad
Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA; Department of Cardiovascular Perfusion, Interprofessional Research, College of Health Professions, Upstate Medical University, 13210 NY, USA; Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt.
Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
Radiother Oncol. 2025 Apr;205:110706. doi: 10.1016/j.radonc.2025.110706. Epub 2025 Jan 23.
Radiofrequency ablation (RFA) is an emerging treatment option for small, low-risk papillary thyroid carcinoma (PTC). This systematic review and meta-analysis aimed to evaluate and compare the efficacy and safety profiles of RFA for primary T1a vs. T1b PTC.
PubMed, Web of Science, Embase, Google Scholar, and ScienceDirect databases were searched from inception to February 14, 2024 for studies reporting outcomes of RFA for T1a vs. T1b PTC with no known nodal or distant metastasis. The primary outcomes assessed were pooled proportions of tumor disappearance, volume reduction, complications, and recurrence.
Twenty studies with 6,613 RFA-treated PTC nodules were included. The median age was 44 years, and the average follow-up was 36.4 months. The mean tumor volume and diameter were 168.9 mm and 0.69 cm, respectively. The pooled tumor disappearance rate was 94.3 % for all tumors, with rates of 96.1 % for T1a and 76.7 % for T1b lesions (p = 0.05). The disappearance rate increased from 61.8 % at 12 months to 91.5 % at 48 months post-RFA. The overall volume reduction rate (VRR) was 99.4 % for both T1a and T1b tumors, increasing from 36.8 % at 1 month to 99.6 % at 48 months. Tumor progression occurred in only 1.33 % of the cases overall, with low recurrence rates in both T1a (1.11 %) and T1b (4.21 %) lesions. New cancer foci and lymph node metastases were rare, observed in 0.81 % and 0.20 % of cases, respectively. The overall complication rate was 1.71 %, with transient voice change (0.44 %) and neck pain (0.30 %) being the most common.
RFA is a safe and effective minimally invasive treatment option for both T1a and T1b PTC, with high tumor disappearance and volume reduction rates and low complication and recurrence rates. The low progression rates in both tumor sizes suggest that RFA is a promising alternative to surgery for selected low-risk PTC patients. Prospective studies with standardized protocols are warranted to validate these findings.
射频消融（RFA）是一种针对小型、低风险甲状腺乳头状癌（PTC）的新兴治疗选择。本系统评价和荟萃分析旨在评估和比较RFA治疗原发性T1a与T1b期PTC的疗效和安全性。
检索PubMed、Web of Science、Embase、谷歌学术和ScienceDirect数据库，检索时间从建库至2024年2月14日，查找报告RFA治疗T1a与T1b期PTC且无已知淋巴结或远处转移的研究。评估的主要结局为肿瘤消失、体积缩小、并发症和复发的合并比例。
纳入了20项研究，共6613个接受RFA治疗的PTC结节。中位年龄为44岁，平均随访时间为36.4个月。肿瘤平均体积和直径分别为168.9立方毫米和0.69厘米。所有肿瘤的合并肿瘤消失率为94.3%，T1a期病变为96.1%，T1b期病变为76.7%（p = 0.05）。RFA后12个月时消失率为61.8%，48个月时增至91.5%。T1a和T1b期肿瘤的总体积缩小率（VRR）均为99.4%，从1个月时的36.8%增至48个月时的99.6%。总体病例中仅1.33%发生肿瘤进展，T1a期（1.11%）和T1b期（4.21%）病变的复发率均较低。新发病灶和淋巴结转移罕见，分别在0.81%和0.20%的病例中观察到。总体并发症发生率为1.71%，最常见的是短暂性声音改变（0.44%）和颈部疼痛（0.30%）。
RFA是治疗T1a和T1b期PTC的一种安全有效的微创治疗选择，肿瘤消失率和体积缩小率高，并发症和复发率低。两种肿瘤大小的进展率均较低，表明对于选定的低风险PTC患者，RFA是一种有前景的手术替代方案。需要采用标准化方案的前瞻性研究来验证这些发现。
