Comparison of efficacy and complications between radiofrequency ablation and repeat surgery in the treatment of locally recurrent thyroid cancers: a single-center propensity score matching study
Comparison of efficacy and complications between radiofrequency ablation and repeat surgery in the treatment of locally recurrent thyroid cancers: a single-center propensity score matching study
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DOI：
10.1080/02656736.2019.1571248
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发表时间：
2019-01-01
影响因子：
3.1
通讯作者：
Kim, Bum-Soo
中科院分区：
文献类型：
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作者：
Choi, Yangsean;Jung, So Lyung;Kim, Bum-Soo
目的：比较射频消融（RFA）和再次手术治疗局部复发性甲状腺癌的疗效和并发症发生率。材料与方法：回顾性入组了2008年3月至2017年3月期间接受RFA（n = 96）或重复手术（n = 125）的221例局部复发性甲状腺癌患者（随访范围，1-10年）。每个队列由倾向评分调整后的70例患者组成。排除3个以上复发病灶的患者。主要和次要终点分别为无复发生存率和并发症发生率。通过对数秩检验比较无复发生存曲线。对两组的并发症-声音变化、低钙血症和即刻手术并发症进行比较。此外，还比较了两组治疗前和末次随访时的血清甲状腺球蛋白（T-g）水平，以检查治疗效果。结果：倾向评分匹配后，两组基线特征无显著差异。RFA组和手术组的无复发生存率相当（p = .2）。两组治疗后的平均血清T-g水平及其平均降低值无显著差异（分别为p = 0.891和p = 0.963）。即刻手术并发症和声音变化也显示组间无显著差异（分别为p = 0.316，p = 0.084）。低钙血症仅发生在重复手术组（n = 18）。再次手术组的总体并发症发生率明显更高（RFA，n = 7;手术，n = 27; p < .001）。结论：RFA可能是治疗少数局部复发性甲状腺癌的一种有效和安全的重复手术替代方法。
Purpose: To compare the efficacy and complication rates of radiofrequency ablation (RFA) and repeat surgery in the treatment of locally recurrent thyroid cancers. Materials and methods: A total of 221 patients with locally recurrent thyroid cancers who underwent either RFA (n = 96) or repeat surgery (n = 125) between March 2008 and March 2017 were retrospectively enrolled (range of follow-up, 1-10 years). Each cohort consisted of 70 patients after propensity score adjustment. Patients with more than three recurrent lesions were excluded. The primary and secondary end points were recurrence-free survival and complication rates, respectively. Recurrence-free survival curves were compared via the log-rank test. The complications-voice changes, hypocalcemia, and immediate procedural complications-were compared between the groups. In addition, pretreatment serum thyroglobulin (T-g) levels and those at the last follow-up were also compared between the two groups to examine therapeutic efficacy. Results: After propensity score matching, both groups showed no significant differences in baseline characteristics. The recurrence-free survival rates were comparable between the RFA and surgery groups (p = .2). There were no significant differences in mean serum T-g levels and their mean decrease after treatment between the groups (p = .891 and p = .963, respectively). Immediate procedural complications and voice changes also showed no significant between-group differences (p = .316, p = .084, respectively). Hypocalcemia occurred only in the repeat surgery group (n = 18). Overall complications were significantly more frequent in the repeat surgery group (RFA, n = 7; surgery, n = 27; p < .001). Conclusion: RFA may be an effective and safe alternative to repeat surgery in the treatment of a small number of locally recurrent thyroid cancers.