低风险甲状腺乳头状微小癌患者主动监测与即刻肺叶切除术的患者报告结果比较：KoMPASS队列的初步研究结果。

IF 5.8 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Thyroid Pub Date : 2024-09-17 DOI:10.1089/thy.2024.0264

Min Joo Kim,Hojeong Won,Won Bae Kim,Eun Kyung Lee,Chang Yoon Lee,Sun Wook Cho,Han-Sang Baek,Yong Sang Lee,Yae Eun Kang,Sun Wook Kim,Ho Cheol Kang,Jeongmin Lee,Mijin Kim,Min Ji Jeon,Jae Hoon Moon

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引用次数: 0

摘要

背景确诊为低危甲状腺乳头状微癌（PTMC）的患者面临着甲状腺腺叶切除术和积极监测（AS）之间的抉择。本研究旨在调查影响低危甲状腺乳头状微癌（PTMC）患者治疗决策的因素，并根据治疗方案比较患者的生活质量（QoL）。比较了AS组和甲状腺叶切除术组的临床特征。结果本研究共纳入了927名低危PTMC患者（AS组453名，甲状腺叶切除术组474名）。平均年龄为 47.4 ± 12.2 岁，72.2% 的患者为女性。年龄较大（奇数比 [OR] 1.04，95% 置信区间 [CI] 1.02 - 1.05，P <0.001）、肿瘤大小较小（OR 0.78，95% CI 0.69 - 0.87，P <0.001）、有甲状腺癌家族史（OR 1.48，95% CI 1.03 - 2.12，p = 0.035）、先前对强直性脊柱炎的认识（OR 1.53，95% CI 1.16 - 2.02，p = 0.003）和较高的收入（OR 1.79，95% CI 1.13 - 2.83，p = 0.013）与选择强直性脊柱炎的可能性显著相关。强直性脊柱炎组的中位随访时间为 27.3 个月（23.9 - 43.9），肺叶切除组为 28.7 个月（20.4 - 44.5）。在随访期间，AS 组的 QoL 评分明显优于 Lobectomy 组（β 0.17，95% CI 0.02 - 0.33，P = 0.029）。虽然基线 QoL 评分明显优于 AS 组（7.1 ± 1.2 vs. 6.7 ± 1.2，p < 0.001），但 12 个月后未观察到明显差异（7.2 ± 1.2 vs. 7.1 ± 1.2，p =0.592）。虽然强直性脊柱炎组患者的 QoL 总分明显更高，但 12 个月后两组患者的 QoL 相近。

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Comparison of Patient Reported Outcomes between Active surveillance and Immediate Lobectomy in Patients with Low-risk Papillary Thyroid Microcarcinoma: Initial Findings from the KoMPASS cohort.

BACKGROUND Patients diagnosed with low-risk papillary thyroid microcarcinoma (PTMC) face the decision between thyroid lobectomy and active surveillance (AS). This study aimed to investigate the factors influencing treatment decisions in low-risk PTMC and to compare the quality of life (QoL) according to the treatment plan. METHODS The multicenter prospective cohort study comparing AS and thyroid lobectomy was conducted. Clinical characteristics were compared between the AS and Lobectomy groups. QoL questionnaires were administered every 6 months in the initial year and annually thereafter. RESULTS A total of 927 patients (453 in the AS group and 474 in the Lobectomy group) with low-risk PTMC were included in this study. The mean age was 47.4 ± 12.2 years, and 72.2% of the patients were women. Older age (odd ratio [OR] 1.04, 95% confidence interval [CI] 1.02 - 1.05, p <0.001), smaller tumor size (OR 0.78, 95% CI 0.69 - 0.87, p <0.001), family history of thyroid cancer (OR 1.48, 95% CI 1.03 - 2.12, p = 0.035), prior awareness of AS (OR 1.53, 95% CI 1.16 - 2.02, p = 0.003), and higher income (OR 1.79, 95% CI 1.13 - 2.83, p = 0.013) were significantly associated with a higher likelihood of choosing AS. The median follow-up was 27.3 months (23.9 - 43.9) in the AS group and 28.7 months (20.4 - 44.5) in the Lobectomy group. During the follow-up period, the AS group showed significantly better QoL scores compared to the Lobectomy group (β 0.17, 95% CI 0.02 - 0.33, p = 0.029). Although baseline QoL scores favored the AS group significantly (7.1 ± 1.2 vs. 6.7 ± 1.2, p < 0.001), no significant difference was observed after 12 months (7.2 ± 1.2 vs. 7.1 ± 1.2, p =0.592). CONCLUSIONS This study demonstrated that age, tumor size, family history of thyroid cancer, awareness of AS, and income were associated with patients' treatment choices. Although the overall QoL scores were significantly higher in the AS group, the QoL became similar between the two groups after 12 months.

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来源期刊

Thyroid 医学-内分泌学与代谢

CiteScore

12.30

自引率

6.10%

发文量

195

审稿时长

6 months

期刊介绍： This authoritative journal program, including the monthly flagship journal Thyroid, Clinical Thyroidology® (monthly), and VideoEndocrinology™ (quarterly), delivers in-depth coverage on topics from clinical application and primary care, to the latest advances in diagnostic imaging and surgical techniques and technologies, designed to optimize patient care and outcomes. Thyroid is the leading, peer-reviewed resource for original articles, patient-focused reports, and translational research on thyroid cancer and all thyroid related diseases. The Journal delivers the latest findings on topics from primary care to clinical application, and is the exclusive source for the authoritative and updated American Thyroid Association (ATA) Guidelines for Managing Thyroid Disease.