Helena Levyn, Daniel W Scholfield, Alana Eagan, Lillian A Boe, Ashok R Shaha, Richard J Wong, Jatin P Shah, Ian Ganly, Luc G T Morris, R Michael Tuttle
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The median (IQR) postsurgical follow-up time was 40.3 (18.0-59.0) months. Patients were treated at a quaternary cancer referral center in the United States.</p><p><strong>Exposures: </strong>Surgery.</p><p><strong>Main outcomes and measures: </strong>Surgical complications, pathologic characteristics, overall survival (OS), and recurrence-free survival (RFS).</p><p><strong>Results: </strong>Of 550 patients who underwent AS, 55 (10.0%) had CS, of whom 39 (7.1%) had surgery due to suspected disease progression (median [IQR] age, 48 [39-56] years; 32 [82.1%] female). There were no clinically meaningful differences in rates of surgical sequalae between the progression CS group (12 of 39 [30.7%]) and the nonprogression CS group (7 of 16 [43.8%]) (Cramer V, 0.2; 95% CI, 0.01-0.5). The 5-year OS was 100% (95% CI, 100%-100%) in both the disease-progression CS cohort and the IS cohort. Although the cohort of patients undergoing CS after disease progression was by definition a subset with more aggressive tumor behavior, no clinically meaningful differences were observed in the rates of regional recurrence (2 of 39 [5.1%] vs 0 of 39 patients with IS), local recurrence (0 patients), distant metastasis (0 patients), or disease-specific mortality (0 patients) when compared with the matched IS group. Five-year RFS rates were similar: 100% in the IS group and 86% (95% CI, 70%-100%) in the CS group.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, CS for suspected disease progression was associated with surgical and oncologic outcomes similar to IS, supporting the feasibility and safety of AS for patients with low-risk papillary thyroid carcinoma.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"1058-1065"},"PeriodicalIF":6.0000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11097095/pdf/","citationCount":"0","resultStr":"{\"title\":\"Outcomes of Conversion Surgery for Patients With Low-Risk Papillary Thyroid Carcinoma.\",\"authors\":\"Helena Levyn, Daniel W Scholfield, Alana Eagan, Lillian A Boe, Ashok R Shaha, Richard J Wong, Jatin P Shah, Ian Ganly, Luc G T Morris, R Michael Tuttle\",\"doi\":\"10.1001/jamaoto.2024.1699\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>The outcomes of patients with low-risk thyroid cancer who undergo surgery following a period of active surveillance (AS) are not well-defined.</p><p><strong>Objective: </strong>To evaluate surgical, pathologic, and oncologic outcomes among patients undergoing conversion surgery (CS) following AS for low-risk papillary thyroid carcinoma.</p><p><strong>Design, setting, and participants: </strong>In this cohort study, patients who underwent CS for disease progression were compared with patients who underwent CS without disease progression and with a propensity score-matched cohort of patients who underwent initial surgery (IS). 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引用次数: 0
摘要
重要性：低风险甲状腺癌患者在积极监测期（AS）后接受手术治疗的结果尚不明确：评估低危甲状腺乳头状癌患者在接受主动监测后接受转换手术（CS）的手术、病理和肿瘤学结果：在这项队列研究中，因疾病进展而接受转换手术的患者与未出现疾病进展而接受转换手术的患者进行了比较，并与接受初始手术（IS）的倾向评分匹配患者队列进行了比较。术后随访时间的中位数（IQR）为 40.3（18.0-59.0）个月。患者在美国一家四级癌症转诊中心接受治疗：主要结果和测量指标手术并发症、病理特征、总生存期（OS）和无复发生存期（RFS）：在550名接受AS手术的患者中，55人（10.0%）患有CS，其中39人（7.1%）因怀疑疾病进展而接受手术（中位数[IQR]年龄，48[39-56]岁；32[82.1%]女性）。进展 CS 组（39 例中有 12 例 [30.7%]）和非进展 CS 组（16 例中有 7 例 [43.8%]）的手术后遗症发生率没有临床意义上的差异（Cramer V，0.2；95% CI，0.01-0.5）。疾病进展 CS 组和 IS 组的 5 年 OS 均为 100%（95% CI，100%-100%）。虽然根据定义，疾病进展后接受 CS 治疗的患者属于肿瘤侵袭性更强的亚组，但与匹配的 IS 组相比，在区域复发率（39 例中有 2 例 [5.1%] 与 39 例 IS 患者中的 0 例相比）、局部复发率（0 例患者）、远处转移率（0 例患者）或疾病特异性死亡率（0 例患者）方面没有观察到有临床意义的差异。五年RFS率相似：IS组为100%，CS组为86%（95% CI，70%-100%）：在这项队列研究中，针对疑似疾病进展的 CS 与 IS 的手术和肿瘤结果相似，支持 AS 用于低风险甲状腺乳头状癌患者的可行性和安全性。
Outcomes of Conversion Surgery for Patients With Low-Risk Papillary Thyroid Carcinoma.
Importance: The outcomes of patients with low-risk thyroid cancer who undergo surgery following a period of active surveillance (AS) are not well-defined.
Objective: To evaluate surgical, pathologic, and oncologic outcomes among patients undergoing conversion surgery (CS) following AS for low-risk papillary thyroid carcinoma.
Design, setting, and participants: In this cohort study, patients who underwent CS for disease progression were compared with patients who underwent CS without disease progression and with a propensity score-matched cohort of patients who underwent initial surgery (IS). The median (IQR) postsurgical follow-up time was 40.3 (18.0-59.0) months. Patients were treated at a quaternary cancer referral center in the United States.
Exposures: Surgery.
Main outcomes and measures: Surgical complications, pathologic characteristics, overall survival (OS), and recurrence-free survival (RFS).
Results: Of 550 patients who underwent AS, 55 (10.0%) had CS, of whom 39 (7.1%) had surgery due to suspected disease progression (median [IQR] age, 48 [39-56] years; 32 [82.1%] female). There were no clinically meaningful differences in rates of surgical sequalae between the progression CS group (12 of 39 [30.7%]) and the nonprogression CS group (7 of 16 [43.8%]) (Cramer V, 0.2; 95% CI, 0.01-0.5). The 5-year OS was 100% (95% CI, 100%-100%) in both the disease-progression CS cohort and the IS cohort. Although the cohort of patients undergoing CS after disease progression was by definition a subset with more aggressive tumor behavior, no clinically meaningful differences were observed in the rates of regional recurrence (2 of 39 [5.1%] vs 0 of 39 patients with IS), local recurrence (0 patients), distant metastasis (0 patients), or disease-specific mortality (0 patients) when compared with the matched IS group. Five-year RFS rates were similar: 100% in the IS group and 86% (95% CI, 70%-100%) in the CS group.
Conclusions and relevance: In this cohort study, CS for suspected disease progression was associated with surgical and oncologic outcomes similar to IS, supporting the feasibility and safety of AS for patients with low-risk papillary thyroid carcinoma.
期刊介绍：
JAMA Otolaryngology–Head & Neck Surgery is a globally recognized and peer-reviewed medical journal dedicated to providing up-to-date information on diseases affecting the head and neck. It originated in 1925 as Archives of Otolaryngology and currently serves as the official publication for the American Head and Neck Society. As part of the prestigious JAMA Network, a collection of reputable general medical and specialty publications, it ensures the highest standards of research and expertise. Physicians and scientists worldwide rely on JAMA Otolaryngology–Head & Neck Surgery for invaluable insights in this specialized field.
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