针对局部区域性复发差异化甲状腺癌的积极监测:系统性审查和元分析
Hunjong Lim1, Se Jin Cho1, Jung Hwan Baek2
1Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
概括
对重复的甲状腺癌的积极监测显示,综合进展率为23%,由于随访损失可能被低估. 建议谨慎使用,特别是对于铁血球蛋白水平较高或晚期的患者.
科学领域:
- 内分泌学 在内分泌学.
- 在瘤学瘤学.
- 临床研究 临床研究
背景情况:
- 主动监测 (AS) 是一种针对甲状腺癌复发的管理方案.
- 目前对AS的证据受到追溯设计,小样本大小和随访损失的限制.
研究的目的:
- 通过系统性审查和元分析,通过系统性审查和元分析,为复发性甲状腺癌提供AS期间疾病进展的可靠估计.
主要方法:
- 10项回顾性研究 (n=841) 的系统综述和元分析,其中包括与AS治疗的甲状腺癌复发患者.
- 在 MEDLINE,EMBASE 和 COCHRANE 数据库中进行了搜索.
- 使用随机效应模型计算聚合的进展率,并对随访损失进行调整.
主要成果:
- 总的综合进展率为23% (95% CI,12-34%),在活检确认病例中 (32%) 更高.
- 随着更短的随访 (<40个月) 和与更晚期患者的研究中,进展率更高.
- 血清甲状腺蛋白基线水平升高与病情的进展有关.
- 对随访损失的调整将估计的综合进展率提高到35-70%.
结论:
- 报告的局部区域性复发差异化甲状腺癌 (DTC) 的AS进展率可能被低估.
- 应谨慎使用AS,考虑患者选择和监测的基线甲状腺蛋白和瘤阶段等因素.
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