Active Surveillance for Locoregional Recurrent Differentiated Thyroid Cancer: A Systematic Review and Meta-Analysis.

Area of Science:

• Endocrinology
• Oncology
• Clinical Research

Background:

• Active surveillance (AS) is a proposed management option for recurrent thyroid cancer.
• Current evidence for AS is limited by retrospective designs, small sample sizes, and follow-up loss.

Purpose of the Study:

• To provide a reliable estimate of disease progression during AS for recurrent thyroid cancers through a systematic review and meta-analysis.

Main Methods:

• Systematic review and meta-analysis of 10 retrospective studies (n=841) including patients with recurrent thyroid cancer managed with AS.
• Searched MEDLINE, EMBASE, and COCHRANE databases.
• Calculated pooled progression rates using a random-effects model, with adjustments for follow-up loss.

Main Results:

• The overall pooled progression rate was 23% (95% CI, 12-34%), higher in biopsy-confirmed cases (32%).
• Progression was higher with shorter follow-up (<40 months) and in studies with more advanced stage patients.
• Elevated baseline serum thyroglobulin levels were associated with progression.
• Adjustment for follow-up loss increased the estimated pooled progression rate to 35-70%.

Conclusions:

• Reported AS progression rates for locoregional recurrent differentiated thyroid cancer (DTC) may be underestimated.
• AS should be used with caution, considering factors like baseline thyroglobulin and tumor stage for patient selection and monitoring.