Kinetic Analysis of Growth Activity in Enlarging Papillary Thyroid Microcarcinomas
Kinetic Analysis of Growth Activity in Enlarging Papillary Thyroid Microcarcinomas
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DOI：
10.1089/thy.2019.0396
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发表时间：
2019-11-21
期刊：
影响因子：
6.6
通讯作者：
Miya, Akihiro
中科院分区：
文献类型：
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作者：
Ito, Yasuhiro;Miyauchi, Akira;Miya, Akihiro
背景资料：虽然乳头状甲状腺微小癌（PMC）通常是稳定的积极监测，转换手术是推荐扩大肿瘤。然而，目前尚不清楚哪种扩大阈值应被认为足以触发手术。本研究分析了PMC在扩大前后的生长活性变化。研究方法：我们招募了824例PMC患者，在2005年至2011年期间开始主动监测（中位随访时间：6.04年）。评价最大肿瘤大小和肿瘤体积的变化。扩大点（PE）定义为最大肿瘤大小或肿瘤体积分别增加≥ 3 mm（PE-M）或≥ 50%（PE-V）的时间。在研究期间接受至少三次超声检查的PMC患者中，我们比较了PE前后的肿瘤倍增率（TDR，指定为倍增时间的倒数）。结果：根据最大肿瘤大小和肿瘤体积计算的10年无扩大生存率分别为86.9%和54.9%。PE后中位TDR显著低于PE前（PE-M为-0.091/年vs. 0.509/年[p < 0.001]，PE-V为-0.058/年vs. 0.370/年[p < 0.001]），表明PE后肿瘤生长减少。PE-M和PE-V后，分别只有6例（7.7%）和11例（3.8%）患者的PMC继续快速扩大（TDR >0.5/年），10例（12.8%）和35例（12.1%）患者的PMC中度扩大（TDR 0.1-0.5/年）。相反，分别有37名（47.4%）和105名（36.1%）患者的肿瘤缩小（TDR < -0.1/年），分别有25名（32.1%）和140名（48.1%）患者的肿瘤保持稳定（TDR范围在0.1/年和-0.1/年之间）。结论：由于大多数PMC在增大后表现出生长活性显著降低，因此在PE后立即进行手术可能为时过早。
Background: Although papillary thyroid microcarcinoma (PMC) is generally stable on active surveillance, conversion surgery is recommended for enlarging tumors. However, it remains unclear which enlargement threshold should be considered sufficient to trigger surgery. This study analyzed changes in the growth activity of PMC, before and after enlargement. Methods: We enrolled 824 patients with PMC, in whom active surveillance was initiated between 2005 and 2011 (median duration of follow-up: 6.04 years). Changes in the maximal tumor size and tumor volume were evaluated. Point of enlargement (PE) was defined as the time at which maximal tumor size or tumor volume had increased by >= 3 mm (PE-M) or by >= 50% (PE-V), respectively. In patients with PMC who underwent at least three ultrasound examinations during the study period, we compared the tumor doubling rates (TDRs, designated as the inverse of doubling time) between pre- and post-PEs. Results: Ten-year enlargement-free survival rates based on maximal tumor size and tumor volume were 86.9% and 54.9%, respectively. The median post-PE TDRs was significantly lower than that of pre-PEs (-0.091/year vs. 0.509/year [p < 0.001] for PE-M, and -0.058/year vs. 0.370/year [p < 0.001] for PE-V), indicating decreased tumor growth after PEs. After PE-M and PE-V, the PMCs continued to rapidly enlarge (TDR >0.5/year) in only 6 (7.7%) and 11 (3.8%) patients and moderately enlarge (TDR 0.1-0.5/year) in 10 (12.8%) and 35 (12.1%) patients, respectively. Conversely, tumors shrank (TDR < -0.1/year) in 37 (47.4%) and 105 (36.1%) patients, respectively, and remained stable (TDR ranged between 0.1/year and -0.1/year) in 25 (32.1%) and 140 (48.1%) patients, respectively. Conclusion: Since most PMCs demonstrate a significant decrease in growth activity after enlargement, performing surgery immediately after the PE may be premature.