甲状腺切除术与完全甲状腺切除术对于患有差异化甲状腺癌的患者:系统审查和元分析
Qiang Hao1, Joel E Segel1,2,3, David J Vanness1
1Department of Health Policy and Administration, Pennsylvania State University, University Park, PA, USA.
Gland surgery
|December 11, 2025
概括
甲状腺切除术和全甲状腺切除术在差异化甲状腺癌 (DTC) 复发,整体存活率和疾病特异性存活率方面显示了类似的结果. 完全甲状腺切除术在无疾病生存方面提供了边际的好处,支持甲状腺切除术作为安全的DTC治疗选择.
科学领域:
- 内分泌学 在内分泌学.
- 手术瘤学手术瘤学
- 基于证据的医学基于证据的医学.
背景情况:
- 2015年美国甲状腺协会 (ATA) 的指导方针支持对差异化甲状腺癌 (DTC) 瘤进行甲状腺切除术,其尺寸为1-4厘米.
- 本研究调查了2015年指导方针之前支持甲状腺切除术的证据,并将手术结果与全甲状腺切除术进行比较.
研究的目的:
- 追踪2015年之前的DTC治疗中甲状腺切除术的证据积累.
- 综合数据,比较甲状腺切除术和全甲状腺切除术的结果.
主要方法:
- 一项系统的PubMed搜索发现了对成人DTC患者 (≥1厘米) 甲状腺切除术和全甲状腺切除术进行比较的研究.
- 分析的结果包括复发率,整体存活率 (OS),无病存活率 (DFS) 和疾病特异性存活率 (DSS).
- 进行了包括累积分析在内的元分析,以汇集和跟踪估计.
主要成果:
- 对14项研究 (176,238名患者) 的分析显示,甲状腺切除术和全甲状腺切除术之间的复发率,OS或DSS没有显著差异.
- 与甲状腺切除术相比,全甲状腺切除术显示DFS略有改善 (RR:0.980,95%CI:0.963-0.997).
- 甲状腺切除术在11.6%的病例中进行,平均随访时间为8年.
结论:
- 甲状腺切除术和全甲状腺切除术对DTC在复发,OS和DSS方面表现出可比的疗效.
- 越来越多的证据基础可能影响了ATA的指导方针,促进甲状腺切除术作为DTC的安全手术选择.
- 整体甲状腺切除术在DFS中提供了轻微的优势,在治疗决策中需要考虑.
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