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Patient-Reported Outcomes Across Treatment Strategies in Papillary Thyroid Microcarcinoma: A Meta-Analysis
Sam P J van Dijk1,2, Matthew M K Blanco1, Jessica Liu McMullin3
1Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston.
JAMA Otolaryngology-- Head & Neck Surgery
|December 26, 2025
Summary
Active surveillance for papillary thyroid microcarcinoma (PTMC) offers equal or better health-related quality of life (HRQOL) compared to surgery. Patient-reported outcomes (PROs) are crucial for shared decision-making in low-risk thyroid cancer management.
Area of Science:
- Endocrinology and Oncology
- Health Services Research
Background:
- Papillary thyroid microcarcinoma (PTMC) has a favorable prognosis, shifting treatment focus towards patient-reported outcomes (PROs) like health-related quality of life (HRQOL).
- Limited comparative HRQOL data exists for active surveillance, thermal ablation, and surgery in PTMC patients.
Purpose of the Study:
- To compare HRQOL among adult PTMC patients undergoing active surveillance, thermal ablation, or surgery.
- To inform shared decision-making by providing comparative HRQOL data.
Main Methods:
- Systematic review and meta-analysis of studies comparing HRQOL in PTMC patients.
- Searched Embase, MEDLINE, Web of Science, Cochrane, and Google Scholar.
- Included 13 studies with 5793 patients; assessed HRQOL using validated instruments.
Main Results:
- Active surveillance was consistently linked to better PROs than surgery across multiple thyroid-specific HRQOL domains.
- Generic HRQOL instruments corroborated these findings.
- Thermal ablation showed potential HRQOL benefits over surgery in the short term (3-6 months), diminishing by 12 months.
Conclusions:
- Active surveillance for PTMC is associated with equal or superior HRQOL compared to surgical intervention.
- PROs, particularly HRQOL, should be integrated into shared decision-making for low-risk thyroid cancer.
- Findings highlight the importance of patient preferences in PTMC management strategies.
