Active surveillance vs. surgery in low-risk papillary thyroid microcarcinoma patients and the risk of loss to follow-up

IF 2.9 2区医学 Q2 ONCOLOGY

Cancer Medicine Pub Date : 2024-08-28 DOI:10.1002/cam4.70123

Yoshiyuki Saito, Kenichi Matsuzu, Hiroshi Takami, Ai Matsui, Yoko Kuga, Ryoji Ohara, Kana Yoshioka, Chie Masaki, Junko Akaishi, Kiyomi Y. Hames, Ritsuko Okamura, Chisato Tomoda, Akifumi Suzuki, Wataru Kitagawa, Mitsuji Nagahama, Kiminori Sugino, Koichi Ito

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引用次数: 0

Abstract

Background

Papillary thyroid microcarcinoma (PTMC) management has evolved, with active surveillance (AS) gaining prominence as a management option. However, a key concern for both clinicians and patients is the potential for patient loss to follow-up during AS.

Aims

This study aimed to determine adherence and loss-to-follow-up rates in low-risk PTMC patients undergoing AS versus surgical intervention, in order to gain insights into clinical pathways and safety profiles.

Materials and Methods

This cohort study analyzed the 2016 data from a single registered institution of Japan's public National Cancer Registry.

Results

We identified and retrospectively analyzed the cases of 327 patients diagnosed with low-risk PTMC; 227 patients chose to undergo AS while the other 100 underwent PTMC surgery. Main outcomes were the adherence rate and loss-to-follow-up rate of each group, factors influencing discontinuation, and safety considerations. The rate of AS adoption was substantial in the complete series of 327 low-risk PTMC patients (69.4%). There was a significantly higher loss-to-follow-up rate at 5 years in the AS group (28.6%) compared to the Surgery group (17.8%) (HR 1.62, 95% CI: 1.01–2.61; p = 0.046). Both univariate and multivariate analyses confirmed the significantly higher loss-to-follow-up rate in the AS group as well as in older patients. No deaths due to PTMC progression were observed in the cases lost to follow-up.

Conclusion

Despite concerns about loss to follow-up, active surveillance remains a safe option for low-risk PTMCs. Consistent follow-up strategies are crucial, and further research is needed to enhance patient counseling and care for the management of patients with PTMC.

Abstract Image

查看原文本刊更多论文

低风险甲状腺乳头状微癌患者的主动监测与手术治疗以及随访丧失的风险。

背景：甲状腺乳头状微小癌（PTMC）的治疗已发生了变化，主动监测（AS）作为一种治疗方案日益受到重视。目的：本研究旨在确定接受主动监测与手术治疗的低风险甲状腺乳头状微癌（PTMC）患者的随访依从率和随访丢失率，以深入了解临床路径和安全性概况：这项队列研究分析了日本公共国家癌症登记处一家注册机构2016年的数据：我们确定并回顾性分析了327例确诊为低风险PTMC患者的病例，其中227例患者选择了AS手术，另外100例患者接受了PTMC手术。主要结果是每组患者的坚持率和失访率、影响终止治疗的因素以及安全性考虑。在327名低风险PTMC患者的完整系列中，AS的采用率很高（69.4%）。与手术组（17.8%）相比，AS 组（28.6%）的 5 年随访丧失率明显更高（HR 1.62，95% CI：1.01-2.61；P = 0.046）。单变量和多变量分析均证实，强直性脊柱炎组和老年患者的随访丧失率明显较高。在失去随访的病例中，没有发现因PTMC进展而死亡的病例：结论：尽管存在失去随访的担忧，但对于低风险的 PTMC 来说，主动监测仍然是一种安全的选择。持续的随访策略至关重要，还需要进一步的研究来加强对 PTMC 患者的咨询和护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.