Smulever Anabella, Pitoia Fabián
Division of Endocrinology, Instituto de Investigaciones Médicas A. Lanari, University of Buenos Aires, Buenos Aires, Argentina.
Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, Argentina.
Endocrine. 2025 May 27. doi: 10.1007/s12020-025-04296-7.
Active surveillance (AS) for low-risk papillary thyroid carcinoma (PTC) has been practiced for over 30 years with encouraging results globally. However, its adoption remains limited in certain contexts. This study aimed to evaluate the long-term oncological outcomes of patients undergoing AS and compare changes in the acceptance and discontinuation rates in Argentina over the past decade.
This prospective, observational cohort study (2014-2024) included 358 patients diagnosed with low-risk PTC measuring ≤1.5 cm across two university hospitals. Of these, 104 patients (29%) opted for AS and were followed up with thyroid ultrasounds and function tests annually for at least 24 months. Surgery was recommended for tumors showing a ≥3 mm increase in size, newly detected foci, or metastatic involvement. Outcomes were analyzed in two distinct phases: 2014-2019 (A) and 2020-2024 (B).
Of the 104 patients under AS, 10.6% developed tumor growth of ≥3 mm, and 7.6% developed new PTC foci. The 5- and 10-year cumulative incidence of tumor growth was 7 and 8%, respectively. Lymph node metastases occurred in 0.9%. AS acceptance rates remained stable between Phase A (25%) and Phase B (30%) (p = 0.82). AS discontinuation rates were also similar: 19.5% in A and 12.6% in B (p = 0.63). Among patients discontinuing AS due to tumor progression, 31% underwent surgery. Anxiety was the main reason for surgery in 66% of cases in Phase A and 40% in Phase B. Lobectomies increased from 1.5% (A) to 9% (B, p = 0.8). No evidence of disease was achieved in 84% of cases at the end of follow-up.
Despite persistently low acceptance and adherence to AS, the long-term outcomes observed in this prospective study reinforce this approach as a feasible initial management option for low-risk PTC. These findings underscore the need for further efforts to improve the acceptance of AS among eligible patients.
对低风险乳头状甲状腺癌（PTC）进行主动监测（AS）已在全球范围内开展了30多年，取得了令人鼓舞的成果。然而，在某些情况下，其应用仍然有限。本研究旨在评估接受主动监测的患者的长期肿瘤学结局，并比较阿根廷过去十年中主动监测的接受率和终止率的变化。
这项前瞻性观察性队列研究（2014 - 2024年）纳入了两家大学医院中358例诊断为低风险PTC且肿瘤最大径≤1.5 cm的患者。其中，104例患者（29%）选择了主动监测，并每年进行甲状腺超声和功能检查，随访至少24个月。对于肿瘤大小增加≥3 mm、新发现病灶或有转移累及的患者，建议进行手术。结果在两个不同阶段进行分析：2014 - 2019年（A阶段）和2020 - 2024年（B阶段）。
在104例接受主动监测的患者中，10.6%出现了≥3 mm的肿瘤生长，7.6%出现了新的PTC病灶。肿瘤生长的5年和10年累积发生率分别为7%和8%。淋巴结转移发生率为0.9%。主动监测的接受率在A阶段（25%）和B阶段（30%）之间保持稳定（p = 0.82）。主动监测的终止率也相似：A阶段为19.5%，B阶段为12.6%（p = 0.63）。在因肿瘤进展而终止主动监测的患者中，31%接受了手术。在A阶段，66%的病例和B阶段40%的病例中，焦虑是手术的主要原因。叶切除术从A阶段的1.5%增加到B阶段的9%（p = 0.8）。随访结束时，84%的病例达到无病状态。
尽管主动监测的接受率和依从性一直较低，但这项前瞻性研究中观察到的长期结局强化了主动监测作为低风险PTC可行的初始管理选择的地位。这些发现强调需要进一步努力提高符合条件的患者对主动监测的接受度。
