{"title":"Thermal Ablation for T1N0M0 Papillary Thyroid Carcinoma: A Long-term Multicenter Comparative Study with Subgroup Analysis.","authors":"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","doi":"10.1016/j.acra.2025.09.019","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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%).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":50928,"journal":{"name":"Academic Radiology","volume":" ","pages":""},"PeriodicalIF":3.9000,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Academic Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.acra.2025.09.019","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
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.
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.