Thermal Ablation for T1N0M0 Papillary Thyroid Carcinoma: A Long-term Multicenter Comparative Study with Subgroup Analysis.

IF 3.9 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Han-Xiao Zhao, Shu-Rong Wang, Li-Hong Liu, Zhi-Bin Cong, Song-Song Wu, Jin-Ke Li, Lu Zhou, Sheng-Nan Huo, Li-Li Shi, Zhong-Hua Wang, Ying Wei, Zhen-Long Zhao, Li-Li Peng, Yan Li, Ming-An Yu
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引用次数: 0

Abstract

Objective: To evaluate the long-term efficacy of thermal ablation (TA) for T1N0M0 papillary thyroid carcinoma (PTC) and compare outcomes between unifocal T1a PTC and unifocal T1b PTC and between unifocal T1a PTC and multifocal (≤3 nodules) T1a PTC.

Materials and methods: This multicenter retrospective study included 495 patients with T1N0M0 PTC from eight hospitals with a median follow-up of 79 months, including 397 unifocal T1a, 49 unifocal T1b, and 49 multifocal T1a patients. The primary outcomes were disease progression and disease-free survival. Secondary outcomes included the technical success rate, volume reduction rate (VRR), complete disappearance rate, and complications. Univariate and multivariate Cox regression analyses were performed to identify risk factors for disease progression.

Results: The disease progression rates were 4.3% (17/397) for unifocal T1a, 8.2% (4/49) for unifocal T1b, and 14.3% (7/49) for multifocal T1a PTC, with median follow-up durations of 81, 75, and 64 months, respectively. No significant differences were observed between the unifocal T1a and T1b groups (p=0.394), whereas progression was significantly higher for patients with multifocal T1a PTC than for patients with unifocal T1a PTC (p=0.010). New tumor development (4.4%) was more common than lymph node metastasis (LNMs) (1.8%) in the overall cohort. Among the 28 patients with disease progression, 25 underwent a second TA, with successful disease control in 96% (24/25) of the patients during a median follow-up of 40 months after retreatment. Multifocal tumors were the only independent risk factor for disease progression (HR: 5.601; p=0.001). Secondary outcomes included a 100% technical success rate, a 100% median VRR, and 99.0% complete tumor disappearance. The overall complication rate was 2.8%, with transient hoarseness being the most common major complication (2.2%).

Conclusion: This long-term multicenter study demonstrated that TA is a safe and effective treatment for T1N0M0 PTC. Although multifocality was identified as an independent risk factor for disease progression, second ablation therapy can effectively control new tumors or LNM.

热消融治疗T1N0M0甲状腺乳头状癌:一项长期多中心亚组分析比较研究。
目的:评价热消融(TA)治疗T1N0M0型甲状腺乳头状癌(PTC)的长期疗效,比较单灶性T1a型PTC与单灶性T1b型PTC、单灶性T1a型PTC与多灶性(≤3个结节)T1a型PTC的疗效。材料和方法:本多中心回顾性研究纳入了来自8家医院的495例T1N0M0型PTC患者,中位随访79个月,其中单灶性T1a患者397例,单灶性T1b患者49例,多灶性T1a患者49例。主要结局是疾病进展和无病生存期。次要结果包括技术成功率、体积缩小率(VRR)、完全消失率和并发症。进行单因素和多因素Cox回归分析以确定疾病进展的危险因素。结果:单焦点T1a的疾病进展率为4.3%(17/397),单焦点T1b的疾病进展率为8.2%(4/49),多焦点T1a PTC的疾病进展率为14.3%(7/49),中位随访时间分别为81、75和64个月。单焦点T1a组和T1b组之间无显著差异(p=0.394),而多焦点T1a PTC患者的进展明显高于单焦点T1a PTC患者(p=0.010)。在整个队列中,新肿瘤发展(4.4%)比淋巴结转移(1.8%)更常见。在28名疾病进展的患者中,25名患者接受了第二次TA治疗,96%(24/25)的患者在再治疗后中位随访40个月期间成功控制了疾病。多灶性肿瘤是疾病进展的唯一独立危险因素(HR: 5.601; p=0.001)。次要结果包括100%的技术成功率、100%的中位VRR和99.0%的肿瘤完全消失。总并发症发生率为2.8%,短暂性声音嘶哑是最常见的主要并发症(2.2%)。结论:这项长期的多中心研究表明,TA是一种安全有效的治疗T1N0M0 PTC的方法。虽然多灶性被认为是疾病进展的独立危险因素,但二次消融治疗可以有效控制新发肿瘤或LNM。
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
Academic Radiology
Academic Radiology 医学-核医学
CiteScore
7.60
自引率
10.40%
发文量
432
审稿时长
18 days
期刊介绍: Academic Radiology publishes original reports of clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, image-guided interventions and related techniques. It also includes brief technical reports describing original observations, techniques, and instrumental developments; state-of-the-art reports on clinical issues, new technology and other topics of current medical importance; meta-analyses; scientific studies and opinions on radiologic education; and letters to the Editor.
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