低风险乳头甲状腺癌的演变实践:2015年ATA指南的影响
Benard Gjeloshi1, Leonardo Rossi1, Carlo Enrico Ambrosini1
1Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56124 Pisa, Italy.
Current oncology (Toronto, Ont.)
|January 27, 2026
概括
甲状腺叶切除术 (TL) 用于低风险的乳头甲状腺癌在2015年ATA指导方针后显著增加. 这种转变减少了术后并发症,特别是甲状腺功能低下症,这表明人们越来越接受不那么激进的外科手术方法.
科学领域:
- 内分泌学 在内分泌学.
- 手术瘤学手术瘤学
- 公共卫生 公共卫生
背景情况:
- 对于低风险的乳头甲状腺癌 (PTC) 进行首次手术的最佳程度仍在争论中,传统上偏爱全甲状腺切除术 (TT),而不是甲状腺叶切除术 (TL).
- 2015年美国甲状腺协会 (ATA) 的指导方针建议在特定的低风险PTC病例中采取更保守的外科手术方法,但现实世界的采用仍然不清楚.
- 评估这些指南对手术实践和高体积中心患者结果的影响对于了解PTC管理当前趋势至关重要.
研究的目的:
- 根据2015年美国甲状腺协会 (ATA) 的指导方针,评估低风险乳头甲状腺癌 (PTC) 手术治疗的时间趋势.
- 分析采用较不激进的外科手术策略,特别是甲状腺叶切除术 (TL) 与全甲状腺切除术 (TT) 对术后结果的影响.
- 在现实临床环境中确定甲状腺切除术完成率和TL后的相关并发症.
主要方法:
- 对1644名局部低风险乳头甲状腺癌 (PTC) 患者的回顾性分析,其尺寸小于4厘米,在2014年至2023年期间接受治疗.
- 在选择全甲状腺切除术 (TT) 和甲状腺叶切除术 (TL) 之间进行初始手术切除时,根据瘤大小和患者人口统计学分层评估时间趋势.
- 评估完成甲状腺切除术的发生率和术后并发症,包括甲状腺功能低下症,手术时间和住院时间,比较TT和TL组.
主要成果:
- 在低风险的PTC中,甲状腺叶切除术 (TL) 的使用率从2014年的0%大幅增加到2023年的59.4%,反映出准则的采用.
- 对于小瘤,TL使用率从2016年的17.5%升至2023年的78%;在研究期间,完成甲状腺切除术的比例从32%降至4%.
- 与TL相比,全甲状腺切除术 (TT) 与术后并发症的发生率明显增加,包括过渡性和永久性甲状腺功能低下症,更长的手术时间和延长的住院时间.
结论:
- 2015年美国甲状腺协会 (ATA) 的指导方针逐渐影响了手术实践,导致甲状腺叶切除术 (TL) 对低风险的乳头甲状腺癌 (PTC) 的采用增加.
- 这种转向不那么激进的外科手术管理与术后并发症的整体负担大幅减少有关,特别是甲状腺功能低下症.
- 目前的趋势表明,在日常临床实践中,保守的外科手术策略越来越受欢迎,用于管理低风险的PTC,改善患者的治疗结果.
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