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怀孕期间低风险乳头甲状腺小癌的自然过程:一个前性的积极监测研究
Wen Liu1, Zhizhong Dong1, Weihan Cao2
1Department of Thyroid Surgery, Clinical Research Center for Thyroid Disease of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
概括
对乳头甲状腺小癌的积极监测对于生殖年龄患者来说是安全的. 怀孕可能会暂时增加瘤的生长,但通常会稳定或回归产后.
科学领域:
- 内分泌学 在内分泌学.
- 在瘤学瘤学.
- 生殖医学 生殖医学
背景情况:
- 主动监测 (AS) 是低风险的乳头状甲状腺微癌 (PTMC) 的标准管理方法.
- 怀孕可能会加速PTMC的生长,这引发了对生殖年龄人群AS的担忧.
- 这项研究评估了怀孕对AS下的PTMC瘤动态的影响.
研究的目的:
- 为了评估怀孕对瘤大小和生长速度的纵向影响,在患有低风险PTMC的患者中与AS一起管理.
- 为了验证AS的安全性和有效性,在孕期和孕后患有PTMC的生育年龄患者.
主要方法:
- 对260名患有AS低风险PTMC的女性患者进行前性队列研究.
- 对18名患者21次怀孕事件的纵向分析,比较怀孕前,怀孕期间和怀孕后的瘤动态.
- 瘤翻倍率 (TDR) 的计算和实质性扩大 (> 3 mm) 的定义.
主要成果:
- 瘤扩大 (>3毫米) 在最后一次随访时发生在19.0%的病例中.
- 在怀孕期间,76.2%的瘤呈现加速或中度生长.
- 产后,71.4%的瘤稳定或回归,TDR在分娩后显著下降 (0.39 /年对比 -0.01 /年,p=0.006).
结论:
- 怀孕可以暂时加速低风险的PTMC生长,但变化通常是自我限制的.
- 积极监测仍然是生育年龄患者的安全和有效策略,平衡瘤结果和生育能力的保护.
- 为了优化AS协议,需要进行进一步的研究,包括延长后续和先进的成像.
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