Active surveillance of nodal metastasis in differentiated thyroid carcinoma: a systematic review and meta-analysis.

IF 3.7 3区 医学 Q2 Medicine
Endocrine Pub Date : 2024-10-01 Epub Date: 2024-05-07 DOI:10.1007/s12020-024-03837-w
Anita Lavarda Scheinpflug, Laura Marmitt, Leonardo Barbi Walter, Dimitris Varvaki Rados, Rafael Selbach Scheffel, André Borsatto Zanella, José Miguel Dora, Ana Luiza Maia
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引用次数: 0

Abstract

Purpose: Cervical lymph nodes (LN) represent the most common site of recurrence in differentiated thyroid cancer (DTC), frequently requiring repeated interventions that contribute to increase morbidity to a usually indolent disease. Data on active surveillance (AS) of nodal metastasis are limited. Therefore, we performed a systematic review and meta-analysis to evaluate AS in nodal metastasis of DTC patients.

Methods: MEDLINE, EMBASE, and Cochrane databases were searched up to July 2023 for studies including DTC patients with metastatic LN who were followed up with AS. The primary outcome was disease progression, according to the study's definition. Additional outcomes were LN enlargement ≥3 mm, occurrence of new cervical metastasis, and conversion from AS to surgical treatment.

Results: The search identified 375 studies and seven were included, comprising 486 patients with metastatic nodal DTC. Most were female (69.5%) and had papillary thyroid cancer (99.8%). The mean AS follow-up ranged from 28-86 months. Following each study's definition of progression, the pooled incidence was 28% [95% confidence interval (CI), 20-37%]. The pooled incidence of LN growth ≥ 3 mm was 21% [95% CI, 17-25%] and the emergence of new LN sites was 19% [95% CI, 14-25%]. Combining growth of 3 mm and the emergence of new LN criteria, we found an incidence of 26% [95% CI, 20-33%]. The incidence of neck dissection during AS was 18% [95% CI, 12-26%].

Conclusions: AS seems to be a suitable strategy for selected DTC patients with small nodal disease, avoiding or postponing surgical reintervention.

Prospero registration: CRD42023438293.

Abstract Image

分化型甲状腺癌结节转移的主动监测:系统回顾和荟萃分析。
目的:宫颈淋巴结(LN)是分化型甲状腺癌(DTC)最常见的复发部位,经常需要反复进行干预,从而增加了这种通常并不严重的疾病的发病率。有关结节转移的主动监测(AS)数据十分有限。因此,我们进行了一项系统性回顾和荟萃分析,以评估 DTC 患者结节转移中的 AS:方法:检索了MEDLINE、EMBASE和Cochrane数据库中截至2023年7月的研究,其中包括对转移性LN的DTC患者进行AS随访的研究。根据研究的定义,主要结果为疾病进展。其他结果包括LN增大≥3毫米、出现新的宫颈转移瘤以及从AS转为手术治疗:搜索发现了 375 项研究,其中 7 项被纳入,包括 486 名转移性结节 DTC 患者。大多数患者为女性(69.5%),患有甲状腺乳头状癌(99.8%)。平均AS随访时间为28-86个月。根据各研究对进展的定义,汇总的发病率为28%[95%置信区间(CI),20-37%]。LN生长≥3毫米的汇总发生率为21% [95% CI, 17-25%],新LN部位的出现率为19% [95% CI, 14-25%]。结合生长 3 毫米和出现新 LN 的标准,我们发现发生率为 26% [95% CI, 20-33%]。AS 期间颈部切除的发生率为 18% [95% CI, 12-26%]:AS似乎是一种适用于小结节病DTC患者的策略,可避免或推迟手术再干预:CRD42023438293。
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来源期刊
Endocrine
Endocrine 医学-内分泌学与代谢
CiteScore
6.40
自引率
5.40%
发文量
0
期刊介绍: Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.
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