An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid
An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid
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DOI：
10.1089/105072503321669875
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发表时间：
2003-04-01
期刊：
影响因子：
6.6
通讯作者：
Miyauchi, A
中科院分区：
文献类型：
--
作者：
Ito, Y;Uruno, T;Miyauchi, A
最近流行的超声引导下细针穿刺活检已导致显着增加的患者数量与乳头状微小癌（最大直径，小于或等于10毫米）的甲状腺检测到这个复杂的工具。另一方面，乳头状微小癌患者在确诊后是否总是应该接受手术治疗是有争议的，因为在尸检研究中观察到隐匿性乳头状癌的发病率很高。因此，我们建议在1993年至2001年的732例经上述技术诊断为乳头状微小癌的患者中进行非手术治疗的观察。162例患者选择观察，分为观察组。在观察组患者的随访期间，超过70%的肿瘤与诊断时的初始大小相比没有变化或缩小。10.2%的患者肿瘤扩大超过10 mm，随访期间仅1.2%的患者出现外侧间室淋巴结转移。另一方面，570例患者在诊断时选择手术治疗，观察组中56例患者在随访一段时间后接受手术治疗，被归类为手术治疗组。在这626例患者中，594例患者进行了淋巴结清扫，50.5%的患者经组织学证实有转移。在42.8%的患者中观察到多发性肿瘤形成。在该组中，术后5年和8年的复发率分别为2.7%和5.0%。我们的初步数据表明，乳头状微小癌并不经常成为临床上明显的，病人可以选择观察，而他们的肿瘤没有进展，虽然他们是病理多灶性，并涉及淋巴结的发病率很高。
The recent prevalence of ultrasound-guided fine-needle aspiration biopsy has resulted in a marked increase in the number of patients with papillary microcarcinoma (maximum diameter, less than or equal to 10 mm) of the thyroid detected by this sophisticated tool. On the other hand, it is debatable whether patients with papillary microcarcinoma should always undergo surgery after diagnosis, because a high incidence of occult papillary carcinoma has been observed in autopsy studies. Thus, we proposed observation without surgical therapy as a treatment option in 732 patients diagnosed with papillary microcarcinoma by the above technique from 1993 to 2001. One hundred sixty-two patients chose observation and were classified as the observation group. During the followup period for patients in the observation group, more than 70% of tumors either did not change or decreased in size compared to their initial size at diagnosis. They enlarged by more than 10 mm. in 10.2%, and lymph node metastasis in the lateral compartments appeared in only 1.2% of patients during follow-up. On the other hand, 570 patients chose surgical treatment at diagnosis and 56 patients in the observation group who underwent surgery after a period of follow-up were classified as the surgical treatment group. Of these 626 patients, lymph node dissection was performed in 594 patients, and metastasis was confirmed histologically in 50.5%. Multiple tumor formation was seen in 42.8% of patients. In this group, the rate of recurrence was 2.7% at 5 years and 5.0% at 8 years after surgery. Our preliminary data suggest that papillary microcarcinomas do not frequently become clinically apparent, and that patients can choose observation while their tumors are not progressing, although they are pathologically multifocal and involve lymph nodes in high incidence.