Active Surveillance for T1bN0M0 Papillary Thyroid Carcinoma
Active Surveillance for T1bN0M0 Papillary Thyroid Carcinoma
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DOI：
10.1089/thy.2018.0462
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发表时间：
2019-01-01
期刊：
影响因子：
6.6
通讯作者：
Yamada, Keiko
中科院分区：
文献类型：
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作者：
Sakai, Toshihiko;Sugitani, Iwao;Yamada, Keiko
背景资料：自20世纪90年代以来，主动监测无症状乳头状微小癌（T1 aN 0 M0）的前瞻性试验显示，进展率仅为5- 10%。进展后晚期补救手术对死亡率和发病率没有不利影响。2015年美国甲状腺协会指南批准对极低风险的甲状腺乳头状癌（PTC）进行积极监测，作为立即手术的替代方法。然而，没有研究评估T1 b肿瘤的长期主动监测。方法：自1995年以来，对360例极低危PTC（T1 aN 0 M0）患者进行了前瞻性主动监测试验。在392例T1 bN 0 M0患者中，61例选择了主动监测而非手术，并最终参加了本试验，而其余331例患者接受了手术。为寻找T1 bN 0 M0 PTC患者的适当治疗策略，对T1 bN 0 M0至T1 aN 0 M0 PTC的主动监测结果进行了调查和比较，并对T1 bN 0 M0 PTC的手术结果进行了研究。结果：经过平均7.4年的主动监测，29例（8%）T1 aN 0 M0肿瘤和4例（7%）T1 bN 0 M0肿瘤的大小增加（p = 0.69）。分别在3例（0.8%）患者和2例（3%）患者中观察到淋巴结转移（p = 0.10）。两组之间的进展率无显著差异。在T1 bN 0 M0肿瘤中，弱钙化和丰富的血管是肿瘤大小增加的危险因素，年轻是淋巴结转移的预测因素。接受即刻手术的T1 bN 0 M0患者的平均初始肿瘤大小（14.5 ± 2.8 mm）显著大于选择观察的患者（11.7 ± 1.1 mm; p < 0.0001）。肿瘤患者术后无复发。结论：对于选定的T1 bN 0 M0 PTC患者，主动监测是一种选择。
Background: Prospective trials of active surveillance for asymptomatic papillary microcarcinoma (T1aN0M0) since the 1990s have shown progression rates of only 5-10%. Late rescue surgery after progression had no deleterious effects on mortality and morbidity. The 2015 American Thyroid Association guidelines approved active surveillance for very low-risk papillary thyroid carcinoma (PTC) as an alternative method to immediate surgery. However, there is no study that evaluates long-term active surveillance for T1b tumors. Methods: A prospective trial of active surveillance with 360 very low-risk PTC (T1aN0M0) patients has been conducted since 1995. Of the 392 T1bN0M0 patients, 61 selected active surveillance over surgery and eventually participated in this trial, while the remaining 331 patients underwent surgery. To find an appropriate management strategy for patients with T1bN0M0 PTC, the outcomes of active surveillance for T1bN0M0 to T1aN0M0 PTC were investigated and compared, and the outcomes of surgery for T1bN0M0 PTC were studied. Results: After a mean of 7.4 years of active surveillance, 29 (8%) T1aN0M0 tumors and four (7%) T1bN0M0 tumors had increased in size (p = 0.69). Development of lymph node metastasis was seen in three (0.8%) patients and two (3%) patients, respectively (p = 0.10). No significant difference in progression rate was seen between groups. Among T1bN0M0 tumors, weak calcification and rich vascularity were risk factors for tumor-size increase, and younger age was a predictor for the development of lymph node metastasis. Mean initial tumor size was significantly greater in T1bN0M0 patients who underwent immediate surgery (14.5 +/- 2.8 mm) than it was in patients who chose observation (11.7 +/- 1.1 mm; p < 0.0001). No postoperative recurrence was seen in patients with tumor Conclusions: Active surveillance is an option for selected patients with T1bN0M0 PTC.