Active Surveillance in Early Thyroid Cancer: A Meta-Analysis

Area of Science:

• Oncology
• Endocrinology
• Surgical Oncology

Background:

• Active surveillance (AS) faces challenges in acceptance and standardization for early thyroid cancer.
• Tumor progression and outcomes in AS require updated evidence to address clinical concerns.

Purpose of the Study:

• To update evidence on tumor progression outcomes in early thyroid cancer patients undergoing AS.
• To examine the influence of follow-up duration, diagnostic techniques, and baseline tumor size on AS outcomes.

Main Methods:

• A systematic literature search was conducted on PubMed, Web of Science, and Embase until January 2024.
• A single-arm meta-analysis using a random-effects model was performed on 14 studies (7291 patients).
• Key outcomes included tumor growth (≥ 3 mm), lymph node metastasis, and conversion to delayed surgery.

Main Results:

• Pooled tumor growth >3 mm was 5.6%; cervical lymph node metastasis was 1.1% (clinical) and 3.6% (pathology).
• 12.7% of patients converted to delayed surgery, with 31.6% of these conversions attributed to tumor progression.
• Subgroup analyses indicated minimal impact of baseline tumor size and other factors on progression or surgery conversion rates.

Conclusions:

• This meta-analysis demonstrates long-term stability in tumor progression rates within active surveillance for early thyroid cancer.
• Outcomes in AS appear robust and less susceptible to external influences like follow-up duration or diagnostic advancements.