Yu Yunfang, Shen Yuxin, Tan Yujie, Yalikun Yisikandaer, Tian Tian, Tang Qingqing, Ou Qiyun, Zhu Yue, Long Miaoyun
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Department of Medical Oncology, Department of Thyroid Surgery, Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
Guangdong Provincial Key Laboratory of Cancer Pathogenesis and Precision Diagnosis and Treatment, Joint Big Data Laboratory, Department of Medical Oncology, Shenshan Medical Center, Memorial Hospital of Sun Yat-sen University, Shanwei 516621, China.
Precis Clin Med. 2025 Apr 29;8(2):pbaf009. doi: 10.1093/pcmedi/pbaf009. eCollection 2025 Jun.
This prospective observational cohort real-world study evaluates and compares the efficacy and prognosis of ultrasound (US) and gene-based microwave ablation (MWA) and surgical treatment in patients with low-risk papillary thyroid carcinoma (PTC), emphasizing the influence of genetic mutations on low-risk patient selection.
MWA, a minimally invasive technique, is increasingly recognized in the management of PTC. While traditional criteria for ablation focus on tumor size, number, and location, the impact of genetic mutations on treatment efficacy remains underexplored.
A total of 201 patients with low-risk PTC without metastasis were prospectively enrolled. All patients underwent US and next-generation sequencing to confirm low-risk status. Patients chose either ablation or surgery and were monitored until November 2024. Efficacy and complications were assessed using thyroid US and contrast-enhanced US.
The median follow-up of this study is 12 months. There is no significant difference between the ablation group (3.0%) and the surgery group (1.0%) in disease free survival ( = 0.360). However, the surgery group exhibited a significantly higher complication rate, particularly for temporary hypoparathyroidism ( < 0.001). Ablation offers notable advantages, including shorter treatment duration, faster recovery, less intraoperative blood loss, and reduced costs ( < 0.001), while maintaining favorable safety and comparable efficiency.
For patients with low-risk genetic mutations, ablation provides comparable efficacy and disease free survival to surgery, with significant benefits in safety, recovery, and overall cost. Guided by US and next-generation sequencing, precise patient selection enhances the potential of ablation as a promising, minimally invasive alternative to surgery in the management of low-risk PTC .
这项前瞻性观察性队列真实世界研究评估并比较超声（US）、基于基因的微波消融（MWA）和手术治疗低风险乳头状甲状腺癌（PTC）患者的疗效和预后，强调基因突变对低风险患者选择的影响。
MWA作为一种微创技术，在PTC的治疗中越来越受到认可。虽然传统的消融标准侧重于肿瘤大小、数量和位置，但基因突变对治疗效果的影响仍未得到充分探索。
前瞻性纳入201例无转移的低风险PTC患者。所有患者均接受超声检查和二代测序以确认低风险状态。患者选择消融或手术治疗，并进行监测直至2024年11月。使用甲状腺超声和超声造影评估疗效和并发症。
本研究的中位随访时间为12个月。消融组（3.0%）和手术组（1.0%）的无病生存率无显著差异（P = 0.360）。然而，手术组的并发症发生率明显更高，尤其是暂时性甲状旁腺功能减退（P < 0.001）。消融具有显著优势，包括治疗时间短、恢复快、术中出血量少和成本降低（P < 0.001），同时保持良好的安全性和相当的效率。
对于低风险基因突变的患者，消融与手术具有相当的疗效和无病生存率，在安全性、恢复和总体成本方面具有显著优势。在超声和二代测序的指导下，精确的患者选择提高了消融作为一种有前景的微创替代手术治疗低风险PTC的潜力。
