Progress in active surveillance for adult low-risk papillary thyroid microcarcinoma
-
摘要: 甲状腺微小乳头状癌(PTMC)的发病率迅速增长，然而，流行病学和尸检研究结果显示，低危型PTMC(LR-PTMC)的人群患病率很高，但致死率很低，LR-PTMC存在一定程度的过度诊断和过度治疗。对LR-PTMC采取主动监测而非立即手术，70%以上的病灶在临床观察中保持稳定或缩小，于是，世界多个学术团体在临床诊疗指南中，将主动监测作为LR-PTMC的推荐方案之一。然而，甲状腺微小癌并不等于低危癌，主动监测的实施需要严格掌握适应证，并充分考虑人群特征，以保证患者的最大获益。本文就成人LR-PTMC临床主动监测的研究进展作一综述。Abstract: The incidence of papillary thyroid microcarcinoma (PTMC) increases rapidly. However, epidemiological and autopsy studies show that the prevalence of low-risk papillary thyroid microcarcinoma (LR-PTMC) is very high, but the mortality is very low. There is over-diagnosis and over-treatment for LR-PTMC. Active surveillance (AS) was adopted for LR-PTMCs instead of immediate surgery, and more than 70% of the lesions remained stable or shrank in clinical observation. Therefore, AS is recommended for LR-PTMCs in clinical guidelines of several academic organizations around the world. However, PTMC is not equal to low-risk cancer. The implementation of AS strategy requires a strict grasp of indications and full consideration of population characteristics to ensure the maximum benefit of patients. This paper summarizes the present clinical progress of active surveillance for adult LR-PTMC.
-
Key words:
- papillary thyroid microcarcinoma /
- active surveillance /
- qver-diagnosis /
- autopsy study
-
-
[1] Hwangbo Y, Choi JY, Lee EK, et al. A Cross-Sectional Survey of Patient Treatment Choice in a Multicenter Prospective Cohort Study on Active Surveillance of Papillary Thyroid Microcarcinoma(MAeSTro)[J]. Thyroid, 2022, 32(7): 772-780. doi: 10.1089/thy.2021.0619
[2] Kim K, Choi JY, Kim SJ, et al. Active Surveillance Versus Immediate Surgery for Low-Risk Papillary Thyroid Microcarcinoma Patients in South Korea: A Cost-Minimization Analysis from the MAeSTro Study[J]. Thyroid, 2022, 32(6): 648-656. doi: 10.1089/thy.2021.0679
[3] Liu W, Yan X, Cheng R. The active surveillance management approach for patients with low risk papillary thyroid microcarcinomas: is China ready?[J]. Cancer Biol Med, 2021, 19(5): 619-634. doi: 10.20892/j.issn.2095-3941.2021.0058
[4] Cernea CR, Matos LL, Eugênio C, et al. Active Surveillance of Thyroid Microcarcinomas: a Critical View[J]. Curr Oncol Rep, 2022, 24(1): 69-76. doi: 10.1007/s11912-021-01177-w
[5] Baek HS, Jeong CH, Ha J, et al. Cost-Effectiveness Analysis of Active Surveillance Compared to Early Surgery in Small Papillary Thyroid Cancer: A Systemic Review[J]. Cancer Manag Res, 2021, 13: 6721-6730. doi: 10.2147/CMAR.S317627
[6] 高明, 葛明华, 嵇庆海, 等. 甲状腺微小乳头状癌诊断与治疗中国专家共识(2016版)[J]. 中国肿瘤临床, 2016, 43(10): 405-411. doi: 10.3969/j.issn.1000-8179.2016.10.001
[7] Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer[J]. Thyroid, 2016, 26(1): 1-133. doi: 10.1089/thy.2015.0020
[8] Sugitani I, Ito Y, Takeuchi D, et al. Indications and Strategy for Active Surveillance of Adult Low-Risk Papillary Thyroid Microcarcinoma: Consensus Statements from the Japan Association of Endocrine Surgery Task Force on Management for Papillary Thyroid Microcarcinoma[J]. Thyroid, 2021, 31(2): 183-192. doi: 10.1089/thy.2020.0330
[9] Griffin A, Brito JP, Bahl M, et al. Applying Criteria of Active Surveillance to Low-Risk Papillary Thyroid Cancer Over a Decade: How Many Surgeries and Complications Can Be Avoided?[J]. Thyroid, 2017, 27(4): 518-523. doi: 10.1089/thy.2016.0568
[10] Ahn HS, Welch HG. South Korea's Thyroid-Cancer "Epidemic"——Turning the Tide[J]. N Engl J Med, 2015, 373(24): 2389-2390. doi: 10.1056/NEJMc1507622
[11] Vaccarella S, Franceschi S, Bray F, et al. Worldwide Thyroid-Cancer Epidemic? The Increasing Impact of Overdiagnosis[J]. N Engl J Med, 2016, 375(7): 614-617. doi: 10.1056/NEJMp1604412
[12] Powers AE, Marcadis AR, Lee M, et al. Changes in Trends in Thyroid Cancer Incidence in the United States, 1992 to 2016[J]. JAMA, 2019, 322(24): 2440-2441. doi: 10.1001/jama.2019.18528
[13] Du L, Zhao Z, Zheng R, et al. Epidemiology of Thyroid Cancer: Incidence and Mortality in China, 2015[J]. Front Oncol, 2020, 10: 1702. doi: 10.3389/fonc.2020.01702
[14] Li M, Delafosse P, Meheus F, et al. Temporal and geographical variations of thyroid cancer incidence and mortality in France during 1986-2015: The impact of overdiagnosis[J]. Cancer Epidemiol, 2021, 75: 102051. doi: 10.1016/j.canep.2021.102051
[15] Ahn HS, Kim HJ, Welch HG. Korea's thyroid-cancer "epidemic"——screening and overdiagnosis[J]. N Engl J Med, 2014, 371(19): 1765-1767. doi: 10.1056/NEJMp1409841
[16] Vaccarella S, Dal Maso L, Laversanne M, et al. The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence: A Population-Based Study in Selected High-Resource Countries[J]. Thyroid, 2015, 25(10): 1127-1136. doi: 10.1089/thy.2015.0116
[17] Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for Thyroid Cancer: US Preventive Services Task Force Recommendation Statement[J]. JAMA, 2017, 317(18): 1882-1887. doi: 10.1001/jama.2017.4011
[18] Vanderlaan WP. The occurrence of carcinoma of the thyroid gland in autopsy material[J]. N Engl J Med, 1947, 237(7): 221. doi: 10.1056/NEJM194708142370703
[19] Heitz P, Moser H, Staub JJ. Thyroid cancer: a study of 573 thyroid tumors and 161 autopsy cases observed over a thirty-year period[J]. Cancer, 1976, 37(5): 2329-2337. doi: 10.1002/1097-0142(197605)37:5<2329::AID-CNCR2820370523>3.0.CO;2-7
[20] Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A "normal" finding in Finland. A systematic autopsy study[J]. Cancer, 1985, 56(3): 531-538. doi: 10.1002/1097-0142(19850801)56:3<531::AID-CNCR2820560321>3.0.CO;2-3
[21] Furuya-Kanamori L, Bell KJL, Clark J, et al. Prevalence of Differentiated Thyroid Cancer in Autopsy Studies Over Six Decades: A Meta-Analysis[J]. J Clin Oncol, 2016, 34(30): 3672-3679. doi: 10.1200/JCO.2016.67.7419
[22] Robenshtok E, Neeman B, Reches L, et al. Adverse Histological Features of Differentiated Thyroid Cancer Are Commonly Found in Autopsy Studies: Implications for Treatment Guidelines[J]. Thyroid, 2022, 32(1): 37-45.
[23] Ito Y, Uruno T, Nakano K, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid[J]. Thyroid, 2003, 13(4): 381-387. doi: 10.1089/105072503321669875
[24] Kwon H, Oh HS, Kim M, et al. Active Surveillance for Patients With Papillary Thyroid Microcarcinoma: A Single Center's Experience in Korea[J]. J Clin Endocrinol Metab, 2017, 102(6): 1917-1925. doi: 10.1210/jc.2016-4026
[25] Ito Y, Miyauchi A, Inoue H, et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients[J]. World J Surg, 2010, 34(1): 28-35. doi: 10.1007/s00268-009-0303-0
[26] Davies L, Welch HG. Thyroid cancer survival in the United States: observational data from 1973 to 2005[J]. Arch Otolaryngol Head Neck Surg, 2010, 136(5): 440-444. doi: 10.1001/archoto.2010.55
[27] Liu W, Cao W, Dong Z, et al. Can Active Surveillance Management be Developed for Patients With Low-Risk Papillary Thyroid Microcarcinoma? A Preliminary Investigation in a Chinese Population[J]. Endocr Pract, 2022, 28(4): 391-397. doi: 10.1016/j.eprac.2022.01.013
[28] Miyauchi A, Kudo T, Ito Y, et al. Estimation of the lifetime probability of disease progression of papillary microcarcinoma of the thyroid during active surveillance[J]. Surgery, 2018, 163(1): 48-52. doi: 10.1016/j.surg.2017.03.028
[29] 田文, 孙辉, 贺青卿. 超声引导下甲状腺结节细针穿刺活检专家共识及操作指南(2018版)[J]. 中国实用外科杂志, 2018, 38(3): 241-244. doi: 10.19538/j.cjps.issn1005-2208.2018.03.01
[30] Filetti S, Durante C, Hartl D, et al. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2019, 30(12): 1856-1883. doi: 10.1093/annonc/mdz400
[31] Song RY, Kim HS, Kang KH. Minimal extrathyroidal extension is associated with lymph node metastasis in single papillary thyroid microcarcinoma: a retrospective analysis of 814 patients[J]. World J Surg Oncol, 2022, 20(1): 170. doi: 10.1186/s12957-022-02629-8
[32] Yin Y, Xu X, Shen L, et al. Influencing Factors and Cumulative Risk Analysis of Cervical Lymph Node Metastasis of Papillary Thyroid Microcarcinoma[J]. Front Oncol, 2021, 11: 644645. doi: 10.3389/fonc.2021.644645
[33] Yang F, Zhong Q, Huang Z, et al. Survival in Papillary Thyroid Microcarcinoma: A Comparative Analysis Between the 7th and 8th Versions of the AJCC/UICC Staging System Based on the SEER Database[J]. Front Endocrinol(Lausanne), 2019, 10: 10. doi: 10.3389/fendo.2019.00010
[34] Shi Y, Yang Z, Heng Y, et al. Clinicopathological Findings Associated With Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Study in China[J]. Cancer Control, 2022, 29: 10732748221084926.
[35] Wang W, Ding Y, Jiang W, et al. Can Cervical Lymph Node Metastasis Increase the Risk of Distant Metastasis in Papillary Thyroid Carcinoma?[J]. Front Endocrinol(Lausanne), 2022, 13: 917794. doi: 10.3389/fendo.2022.917794
[36] Back K, Kim JS, Kim JH, et al. Superior Located Papillary Thyroid Microcarcinoma is a Risk Factor for Lateral Lymph Node Metastasis[J]. Ann Surg Oncol, 2019, 26(12): 3992-4001. doi: 10.1245/s10434-019-07587-2
[37] Xue S, Han Z, Lu Q, et al. Clinical and Ultrasonic Risk Factors for Lateral Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Systematic Review and Meta-Analysis[J]. Front Oncol, 2020, 10: 436. doi: 10.3389/fonc.2020.00436
[38] 雷霆, 舒凯. 听神经瘤的治疗与展望[J]. 临床外科杂志, 2021, 29(10): 901-902. doi: 10.3969/j.issn.1005-6483.2021.10.001
[39] Sugitani I, Ito Y, Miyauchi A, et al. Active Surveillance Versus Immediate Surgery: Questionnaire Survey on the Current Treatment Strategy for Adult Patients with Low-Risk Papillary Thyroid Microcarcinoma in Japan[J]. Thyroid, 2019, 29(11): 1563-1571. doi: 10.1089/thy.2019.0211
[40] Yoshida Y, Horiuchi K, Okamoto T. Patients' View on the Management of Papillary Thyroid Microcarcinoma: Active Surveillance or Surgery[J]. Thyroid, 2020, 30(5): 681-687. doi: 10.1089/thy.2019.0420
[41] Baloch ZW, Asa SL, Barletta JA, et al. Overview of the 2022 WHO Classification of Thyroid Neoplasms[J]. Endocr Pathol, 2022, 33(1): 27-63. doi: 10.1007/s12022-022-09707-3
-
计量
- 文章访问数: 1299
- PDF下载数: 1248
- 施引文献: 0
下载: