Insights into the Management of Papillary Microcarcinoma of the Thyroid.
Insights into the Management of Papillary Microcarcinoma of the Thyroid.
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DOI：
10.1089/thy.2017.0227
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发表时间：
2018-01
期刊：
影响因子：
--
通讯作者：
Oda H
中科院分区：
文献类型：
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作者：
Miyauchi A;Ito Y;Oda H
背景：许多国家报道了甲状腺癌发病率的快速增加和死亡率的稳定，这些增加被认为主要是由于小乳头状甲状腺癌(PTCs)的增加，包括乳头状微癌(PMC；即PTCs≤10 mm)。一些研究人员认为，小型PTC被过度诊断和过度治疗。在日本，Kuma医院(1993)和东京癌症研究所医院(1995)发起了对低风险PMC患者的主动监测，因为与临床甲状腺癌的患病率相比，尸检研究中发现的潜伏性甲状腺癌和使用超声检查的大规模筛查研究中发现的小PTC的发病率极高。方法：总结上述两个机构在低风险私营医疗机构主动监测方面的资料，并对其未来的管理进行展望。结果：在Kuma医院对1235例患者的10年观察中，仅有8%和3.8%的患者表现出≥3 mm的体积增大和新的淋巴结转移。与临床PTC相比，PMC在老年患者(≥60岁)中最不可能生长。在Kuma医院的系列研究中，974名立即接受手术的患者的不良事件发生率显著高于选择积极监测的1179名患者。立即手术的总费用，包括挽救手术和10年术后护理的费用，是主动监测10年管理总费用的4.1倍。51例PMC患者中只有8%在孕期出现肿瘤增大，产后抢救手术成功。在肿瘤研究所医院230例患者的300个病灶中，仅有7%和1%的患者出现体积增大和新的淋巴结转移，该研究所的分析还显示，肉眼或边缘钙化和血管不良与非进展性疾病相关。在这两个系列中，在检测到进展体征后接受抢救手术的患者中，没有一例出现明显的复发或死于PTC。结论：积极监测低危PMC可作为一线治疗。有趣的是，患有低风险PMC的老年患者是积极监测的最佳候选者。
Background: Rapid increases in the incidence of thyroid carcinoma with stable mortality rates from thyroid carcinoma have been reported from many countries, and these increases are thought to be due mostly to the increased detection of small papillary thyroid carcinomas (PTCs), including papillary microcarcinomas (PMCs; i.e., PTCs ≤10 mm). Some researchers have suggested that small PTCs have been overdiagnosed and overtreated. In Japan, the active surveillance of patients with low-risk PMCs was initiated by Kuma Hospital (1993) and Tokyo's Cancer Institute Hospital (1995) based on the extremely higher incidences of both latent thyroid carcinomas in autopsy studies and small PTCs detected in mass screening studies using ultrasound examinations compared to the prevalence of clinical thyroid carcinomas. Methods: The above two institutions' data are summarized regarding the active surveillance of low-risk PMCs, and future prospects for their management are discussed. Results: At 10-year observations in the Kuma Hospital series of 1235 patients, only 8% and 3.8% of the PMC patients showed size enlargement by ≥3 mm and the novel appearance of node metastasis, respectively. In contrast to clinical PTC, PMCs are most unlikely to grow in older patients (≥60 years). In the Kuma Hospital series, the 974 patients who underwent immediate surgery had significantly higher incidences of unfavorable events than the 1179 patients who chose active surveillance. The total cost of immediate surgery, including the costs for salvage surgery and postoperative care for 10 years, was 4.1 times the total cost of 10-year management by active surveillance. Only 8% of the 51 PMC patients showed tumor enlargement during pregnancy, and the rescue surgeries after delivery were successful. In the Cancer Institute Hospital series of 230 patients with 300 lesions, only 7% and 1% of the patients showed size enlargement and novel node metastasis, respectively, and that institution's analysis also revealed that macroscopic or rim calcification and poor vascularity were correlated with non-progressing disease. In both series, none of the patients who underwent rescue surgery after progression signs were detected showed significant recurrence or died of PTC. Conclusion: Active surveillance of low-risk PMC can be the first-line management. Interestingly, older patients with low-risk PMCs are the best candidates for active surveillance.