Study Protocol of Expanded Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro-EXP).

IF 3.9 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrinology and Metabolism Pub Date : 2025-02-18 DOI:10.3803/EnM.2024.2136

Jae Hoon Moon, Eun Kyung Lee, Wonjae Cha, Young Jun Chai, Sun Wook Cho, June Young Choi, Sung Yong Choi, A Jung Chu, Eun-Jae Chung, Yul Hwangbo, Woo-Jin Jeong, Yuh-Seog Jung, Kyungsik Kim, Min Joo Kim, Su-Jin Kim, Woochul Kim, Yoo Hyung Kim, Chang Yoon Lee, Ji Ye Lee, Kyu Eun Lee, Young Ki Lee, Hunjong Lim, Do Joon Park, Sue K Park, Chang Hwan Ryu, Junsun Ryu, Jungirl Seok, Young Shin Song, Ka Hee Yi, Hyeong Won Yu, Eleanor White, Katerina Mastrocostas, Roderick J Clifton-Bligh, Anthony Glover, Matti L Gild, Ji-Hoon Kim, Young Joo Park

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引用次数: 0

Abstract

Background: Active surveillance (AS) has emerged as a viable management strategy for low-risk papillary thyroid microcarcinoma (PTMC), following pioneering trials at Kuma Hospital and the Cancer Institute Hospital in Japan. Numerous prospective cohort studies have since validated AS as a management option for low-risk PTMC, leading to its inclusion in thyroid cancer guidelines across various countries. From 2016 to 2020, the Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) enrolled 1,177 patients, providing comprehensive data on PTMC progression, sonographic predictors of progression, quality of life, surgical outcomes, and cost-effectiveness when comparing AS to immediate surgery. The second phase of MAeSTro (MAeSTro-EXP) expands AS to low-risk papillary thyroid carcinoma (PTC) tumors larger than 1 cm, driven by the hypothesis that overall risk assessment outweighs absolute tumor size in surgical decision-making.

Methods: This protocol aims to address whether limiting AS to tumors smaller than 1 cm may result in unnecessary surgeries for low-risk PTCs detected during their rapid initial growth phase. By expanding the AS criteria to include tumors up to 1.5 cm, while simultaneously refining and standardizing the criteria for risk assessment and disease progression, we aim to minimize overtreatment and maintain rigorous monitoring to improve patient outcomes.

Conclusion: This study will contribute to optimizing AS guidelines and enhance our understanding of the natural course and appropriate management of low-risk PTCs. Additionally, MAeSTro-EXP involves a multinational collaboration between South Korea and Australia. This cross-country study aims to identify cultural and racial differences in the management of low-risk PTC, thereby enriching the global understanding of AS practices and their applicability across diverse populations.

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主动监测甲状腺乳头状微癌（maesto - exp）的扩展多中心前瞻性队列研究方案。

背景：主动监测（AS）已成为低风险甲状腺乳头状微癌（PTMC）的一种可行的管理策略，在日本熊马医院和癌症研究所医院进行了开创性的试验。此后，许多前瞻性队列研究证实AS是低风险PTMC的一种治疗选择，导致其被纳入各国甲状腺癌指南。从2016年到2020年，多中心前瞻性队列研究主动监测甲状腺乳头状微癌（MAeSTro）纳入了1177例患者，提供了PTMC进展，超声预测进展，生活质量，手术结果以及与即时手术相比的成本效益的综合数据。第二阶段的MAeSTro （mastro - exp）将AS扩展到大于1cm的低风险甲状腺乳头状癌（PTC）肿瘤，其驱动假设是总体风险评估大于手术决策中的绝对肿瘤大小。方法：本方案旨在解决将AS限制在小于1cm的肿瘤中是否会导致在其快速初始生长阶段检测到的低风险ptc的不必要手术。通过将AS标准扩大到包括1.5 cm以内的肿瘤，同时完善和标准化风险评估和疾病进展的标准，我们的目标是尽量减少过度治疗，并保持严格的监测，以改善患者的预后。结论：本研究将有助于优化AS指南，提高我们对低风险ptc的自然病程和适当管理的认识。此外，MAeSTro-EXP涉及韩国和澳大利亚之间的跨国合作。这项跨国研究旨在确定低风险PTC管理中的文化和种族差异，从而丰富对AS实践及其在不同人群中的适用性的全球理解。

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

Endocrinology and Metabolism Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

6.60

自引率

5.90%

发文量

145

审稿时长

24 weeks

期刊介绍： The aim of this journal is to set high standards of medical care by providing a forum for discussion for basic, clinical, and translational researchers and clinicians on new findings in the fields of endocrinology and metabolism. Endocrinology and Metabolism reports new findings and developments in all aspects of endocrinology and metabolism. The topics covered by this journal include bone and mineral metabolism, cytokines, developmental endocrinology, diagnostic endocrinology, endocrine research, dyslipidemia, endocrine regulation, genetic endocrinology, growth factors, hormone receptors, hormone action and regulation, management of endocrine diseases, clinical trials, epidemiology, molecular endocrinology, neuroendocrinology, neuropeptides, neurotransmitters, obesity, pediatric endocrinology, reproductive endocrinology, signal transduction, the anatomy and physiology of endocrine organs (i.e., the pituitary, thyroid, parathyroid, and adrenal glands, and the gonads), and endocrine diseases (diabetes, nutrition, osteoporosis, etc.).