2015年美国甲状腺协会低至中等风险的小胞甲状腺癌
Ryan Seng Hong Wong1, Trishan Manav Sri Ram1, Yuelin Xia1
1Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
概括
对于低至中等风险的乳头甲状腺癌 (PTC),甲状腺叶切除术提供与全甲状腺切除术相比的无复发存活率. 这表明脑叶切除术足以减少手术致病率.
科学领域:
- 内分泌学
- 外科瘤学
- 基于证据的医学
背景情况:
- 2015年美国甲状腺协会的指导方针倡导风险分层管理乳头甲状腺癌 (PTC).
- 关于中等风险PTC的最佳手术方法存在持续的辩论,特别是在生存效益方面比较前期的全甲状腺切除术和带切除术.
- 这项研究解决了需要综合证据来指导风险分层PTC的外科决策.
研究的目的:
- 综合皮质甲状腺癌 (PTC) 的复发和生存数据,以制定最佳的手术治疗策略.
- 在风险分层的PTC队列中,比较甲状腺叶切除与全甲状腺切除的预后结果.
- 根据目前的证据评估不同手术方法的疗效和安全性.
主要方法:
- 在PubMed,Embase和Cochrane图书馆数据库中进行了系统的文献搜索.
- 两位独立审稿人选了2015年1月1日至2025年4月26日期间发表的文章,重点关注PTC的带切除和全甲状腺切除的比较预后结果.
- 在低至中等风险的PTC群体中进行了基于复发的结局的聚合分析,并补充了复发和死亡率的敏感性和定性分析.
主要成果:
- 这项元分析包括10项研究,涉及17082名患者. 对于中等风险的PTC,五年无复发的存活率在皮切除术 (96%) 和全甲状腺切除术 (95%) 之间是可比的.
- 对低至中等风险的PTC群体的综合分析显示复发率相似:小叶切除术为3%,整体甲状腺切除术为4%.
- 对所有风险组的疾病特异性存活率的系统审查发现,与状腺切除术相比,完全切除术没有死亡益处.
结论:
- 甲状腺叶切除术对于低至中等风险的乳头甲状腺癌是足够的手术治疗选择.
- 选择叶切除术可以帮助减少与前期全甲状腺切除术相关的发病率.
- 这些发现支持基于风险分层的选择性PTC患者群体的更保守的手术方法.
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