谨慎建议:在主动监测下进行状甲状腺癌瘤进展的元分析
Peter P Issa1, Ruhul Munshi2, Aaron L Albuck3
1Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America; School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States of America.
American journal of otolaryngology
|August 22, 2023
概括
乳头甲状腺癌 (PTC) 的积极监测 (AS) 显示15%的进展率,没有确定的风险因素. 这表明AS对于精心挑选的患者来说是一个可行的选择,平衡低进展风险与潜在的治疗坚持问题.
科学领域:
- 在瘤学瘤学.
- 内分泌学 在内分泌学.
- 手术瘤学手术瘤学
背景情况:
- 乳头甲状腺癌 (PTC) 通常是惰的,结果很好.
- 积极监测 (AS) 为PTC提供了甲状腺切除术的非手术替代方案.
- 一部分PTC病例 (10-15%) 可能在AS下进展,需要识别预测因素.
研究的目的:
- 为了确定预测状腺癌患者状腺癌瘤进展的因素,患者进行主动监测.
- 在AS下评估PTC进展的速度和特征.
主要方法:
- 对AS期间PTC进展的研究进行了系统审查和元分析.
- 包括的研究是通过搜索主要科学数据库 (PubMed,Embase等) 来确定的. 在2022年1月.
- 提取的数据包括患者人口统计学,瘤特征,监测持续时间和进展事件,遵守PRISMA指南.
主要成果:
- 涉及4166名患者的9项研究显示,AS期间瘤进展率为15%.
- 进展主要是由于体积增加 (≥50%) 或直径增加 (≥3mm);淋巴结转移发生在13%的进展病例中 (总体2%).
- 在患者的年龄,性别,瘤大小和进展风险之间没有发现显著的关联. 12%的患者最终接受了手术,其中40%的患者出现了进展.
结论:
- 对PTC的积极监测表明15%的进展率,淋巴结转移的发病率很低.
- 没有发现瘤进展的显著风险或保护因素.
- 由于晚期进展风险较低,AS可能适合适当辅导的患者,而微创性除作为手术的替代方案.
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