Cheong Wei Shuen Clarissa, Au Xin Yi Joy, Lim Ming Yann, Fu Ernest Weizhong, Li Hao, Pua Uei, Soon Yong Quan Alvin, Gan Yijin Jereme
Department of Otorhinolaryngology, Khoo Teck Puat Hospital, Singapore.
Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore.
Ann Acad Med Singap. 2025 Mar 14;54(3):170-177. doi: 10.47102/annals-acadmedsg.2024241.
Radiofrequency ablation (RFA) avoids the complications of general anaesthesia, reduces length of hospitalisation and reduces morbidity from surgery. As such, it is a strong alternative treatment for patients with comorbidities who are not surgical candidates. However, to our knowledge, there have only been 1 systematic review and 3 combined systematic review and meta-analyses on this topic to date. This systematic review and meta-analysis seeks to evaluate the efficacy and safety of RFA in the treatment of papillary thyroid carcinoma (PTC) with longer follow-up durations.
PubMed, Embase and Cochrane databases were searched for relevant studies published from 1990 to 2021; 13 studies with a total of 1366 patients were included. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and Sandelowski et al.'s approach1 to "negotiated consensual validation" were used to achieve consensus on the final list of articles to be included. All authors then assessed each study using a rating scheme modified from the Oxford Centre for Evidence-Based Medicine.
Pooled volume reduction rates (VRRs) from 1 to 48 months after RFA, complete disappearance rates (CDR) and complications were assessed. Pooled mean VRRs were 96.59 (95% confidence interval [CI] 91.05-102.13, I2=0%) at 12 months2-6 and 99.31 (95% CI 93.74-104.88, I2=not applicable) at 48 months.2,5 Five studies showed an eventual CDR of 100%.2,4,7-9 No life-threatening complications were recorded. The most common complications included pain, transient voice hoarseness, fever and less commonly, first-degree burn.
RFA may be an effective and safe alternative to treating PTC. Larger clinical trials with longer follow-up are needed to further evaluate the effectiveness of RFA in treating PTC.
射频消融术（RFA）可避免全身麻醉的并发症，缩短住院时间并降低手术发病率。因此，对于患有合并症且不适合手术的患者而言，它是一种有力的替代治疗方法。然而，据我们所知，迄今为止关于该主题仅有1篇系统评价以及3篇系统评价与荟萃分析相结合的文章。本系统评价与荟萃分析旨在评估随访时间更长的情况下，RFA治疗甲状腺乳头状癌（PTC）的疗效和安全性。
检索了PubMed、Embase和Cochrane数据库中1990年至2021年发表的相关研究；纳入了13项研究，共计1366例患者。采用系统评价和荟萃分析的首选报告项目指南以及桑德洛维斯基等人的“协商一致验证”方法，就最终纳入文章清单达成共识。然后，所有作者使用从牛津循证医学中心修改而来的评分方案对每项研究进行评估。
评估了RFA术后1至48个月的合并体积缩小率（VRR）、完全消失率（CDR）和并发症。12个月时的合并平均VRR为96.59（95%置信区间[CI]91.05 - 102.13，I2 = 0%），2 - 6 48个月时为99.31（95% CI 93.74 - 104.88，I2 = 不适用）。2,5五项研究显示最终CDR为100%。2,4,7 - 9未记录有危及生命的并发症。最常见的并发症包括疼痛、短暂性声音嘶哑、发热，较少见的有一度烧伤。
RFA可能是治疗PTC的一种有效且安全的替代方法。需要开展随访时间更长的更大规模临床试验，以进一步评估RFA治疗PTC的有效性。
