Analysis of the initial results of active surveillance of the papillary thyroid microcarcinoma and related factors for its progress
10.3760/cma.j.cn115807-20231211-00185
- VernacularTitle:甲状腺微小乳头状癌主动监测的初期结果及其进展相关因素分析
- Author:
Yuxin GE
1
;
Bin ZHENG
;
Jianqiao ZHOU
;
Cheng LI
;
Jianjing TONG
;
Yonggang HE
Author Information
1. 上海交通大学医学院附属瑞金医院普外科，上海 200025
- Keywords:
Thyroid carcinoma;
Papillary thyroid microcarcinoma;
Active surveillance;
Ultrasonography;
Disease progression
- From:
Chinese Journal of Endocrine Surgery
2024;18(4):500-504
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the feasibility of conducting active surveillance (AS) for low risk papillary thyroid microcarcinoma (PTMC) in China and to examine the factors in association with disease progression during AS.Methods:This study was a prospective observational research conducted from Jun. 2018 to Aug. 2022 at Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine. Seventy-three patients with cytologically confirmed low-risk PTMC were enrolled in this study. They were followed up by ultrasonography, and the observed nodules were re-assessed whether or not to have disease progression. Disease progression was defined as having nodule enlarged more than 3 mm in any of diameters measured on ultrasound, or/and presence of suspicious lymph node metastasis.Results:The median follow-up time was 33 months. At the time of last follow-up, 16 cases (21.9%) exhibited disease progression, including 9 cases (12.3%) with suspicious lymph nodes detected by ultrasound, and 8 cases (11.0%) with lesion enlargement; one case (1.3%) exhibited both situations. The univariate chi-square analysis revealed that young patients (≤45 years old, P=0.041), presence of microcalcifications ( P=0.032), initial larger nodule (diameter greater than 7 mm, P=0.003), and elevated thyroid autoantibody levels ( P=0.008) were associated with disease progression. Multiple regression analysis showed elevated thyroid autoantibodies ( OR=4.311, P=0.030) and initial larger nodule ( OR=6.196, P=0.034) were independent risk factors for PTMC progression,respectively. Conclusions:AS for low-risk PTMC is a feasible and effective. During the observation, ultrasound can reveal suspicious lymph nodes and nodule enlargement, which are crucial indicators for assessing disease progression. Patients with initially larger nodule size and elevated thyroid autoantibody level are more likely to exhibit disease progression and should receive closer attention.
