51
|
Pitoia F, Smulever A. Active surveillance in low risk papillary thyroid carcinoma. World J Clin Oncol 2020; 11:320-336. [PMID: 32874948 PMCID: PMC7450818 DOI: 10.5306/wjco.v11.i6.320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/07/2020] [Accepted: 05/05/2020] [Indexed: 02/06/2023] Open
Abstract
In recent decades, while the incidence of thyroid cancer has increased exponentially around the world, mortality has remained stable. The vast majority of this increase is attributable to the identification of intrathyroidal papillary microcarcinomas, which exhibit slow growth rates with indolent courses. A diagnosis of thyroid cancer based upon the presence of these small tumors could be considered as an overdiagnosis, as the majority of these tumors would not likely result in death if left untreated. Although surgical resection was the classical standard therapy for papillary microcarcinomas, active surveillance (AS) has emerged over the last three decades as an alternative approach that is aimed to recognize a minority group of patients who will clinically progress and would likely benefit from rescue surgery. Despite the encouraging results of AS, its implementation in clinical practice is strongly influenced by psychosocial factors. The aim of this review is to describe the epidemiology, clinical evolution, prognostic factors, and mortality of papillary thyroid microcarcinomas. We also summarize the AS strategy according to published evidence, characterize the criteria for selecting patients for AS according to risk factors and environmental characteristics, as well as analyze the current limitations for AS implementation.
Collapse
Affiliation(s)
- Fabian Pitoia
- Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Buenos Aires 1120, Argentina
| | - Anabella Smulever
- Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Buenos Aires 1120, Argentina
| |
Collapse
|
52
|
Lee YK, Hwangbo Y, Lee S, Lee DE, Lee EK, Yeom MS, Joo J, Kong SY. Aspirin Use Is Not Associated with Lower Thyroid Cancer Risk: A Nationwide Nested Case-Control Study. Thyroid 2020; 30:829-837. [PMID: 31950888 DOI: 10.1089/thy.2019.0641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: While aspirin use is known to be associated with reduced incidence of various cancer types, it is unclear whether this benefit extends to thyroid cancer. We aimed to evaluate the association between aspirin use and thyroid cancer development. Methods: This nested case-control study used nationwide data from the Korean National Health Insurance Service-National Sample Cohort 2002-2015. In total, 4547 individuals with newly developed thyroid cancer were matched with 13,641 controls based on age, sex, and follow-up period. Odds ratios (ORs) and 95% confidence intervals (CIs) for thyroid cancer development according to aspirin use were analyzed using a multivariable conditional logistic regression model. Results: The number of days for which patients with thyroid cancer used aspirin (the proportions of no use, <30 days/year, 30-90 days/year, and ≥90 days/year were 93.03%, 6.51%, 0.31%, and 0.15%, respectively) was comparable with that of the controls (p = 0.371, chi-squared test). The risk of thyroid cancer development was not associated with the duration of aspirin use (ORs [CI] for aspirin use <30 days/year, 30-90 days/year, and ≥90 days/year were 1.11 [0.96-1.28], 1.01 [0.54-1.88], and 1.23 [0.50-3.06], respectively, compared with no use) after adjusting for body mass index, smoking status, hypertension, Charlson comorbidity index, and number of outpatient visits per year. In addition, subgroup analyses stratified by age, sex, and follow-up duration did not reveal any significant association between aspirin use and thyroid cancer. Conclusions: Our findings suggest that even extended aspirin use may not impact the prevention or onset of thyroid cancer.
Collapse
Affiliation(s)
- Young Ki Lee
- Center for Thyroid Cancer; National Cancer Center, Goyang, Republic of Korea
| | - Yul Hwangbo
- Center for Thyroid Cancer; National Cancer Center, Goyang, Republic of Korea
| | - Sangwon Lee
- Cancer Data Center; National Cancer Center, Goyang, Republic of Korea
| | - Dong-Eun Lee
- Biostatistics Collaboration Team, Research Core Center, Research Institute; National Cancer Center, Goyang, Republic of Korea
| | - Eun Kyung Lee
- Center for Thyroid Cancer; National Cancer Center, Goyang, Republic of Korea
| | - Min Sun Yeom
- Center for Supercomputing Applications, Korea Institute of Science and Technology Information, Daejeon, Republic of Korea
| | - Jungnam Joo
- Division of Cancer Epidemiology and Management; National Cancer Center, Goyang, Republic of Korea
| | - Sun-Young Kong
- Department of Laboratory Medicine, National Cancer Center, Goyang, Republic of Korea
| |
Collapse
|
53
|
Sutton W, Genberg B, Prescott JD, Segev DL, Zeiger MA, Bandeen-Roche K, Mathur A. Understanding surgical decision-making in older adults with differentiated thyroid cancer: A discrete choice experiment. Surgery 2020; 169:14-21. [PMID: 32475718 DOI: 10.1016/j.surg.2020.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/12/2020] [Accepted: 03/30/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Prior studies demonstrated that older adults tend to undergo less surgery for thyroid cancer. Our objective was to use a discrete choice experiment to identify factors influencing surgical decision-making for older adults with thyroid cancer. METHODS Active and candidate members of the American Association of Endocrine Surgeons were invited to participate in a web-based survey. Multinomial logistic regression was utilized to assess patient and surgeon factors associated with treatment choices. RESULTS Complete survey response rate was 25.7%. Most respondents were high-volume surgeons (88.5%) at academic centers (76.9%). Multinomial logistic regression demonstrated that patient age was the strongest predictor of management. Increasing age and comorbidities were associated with the choice for active surveillance (P = .000), not performing a lymphadenectomy in patients with nodal metastases (relative-risk ratio: 2.5, 95% CI: 1.4-4.2, P = .002 and relative-risk ratio: 1.6, 95% CI: 1.2-2.1, P = .004, respectively), and recommending hemithyroidectomy versus total thyroidectomy for a cancer >4 cm (relative-risk ratio: 4.4, 95% CI: 2.5-7.9, P = .000 and relative-risk ratio: 3.4, 95% CI: 2.3-5.1, P = .000, respectively). Surgeons with ≥10 years of experience (relative-risk ratio: 3.3, 95% CI: 1.1-10.3, P = .039) favored total thyroidectomy for a cancer <4 cm, and nonfellowship trained surgeons (relative-risk ratio: 7.3, 95% CI: 1.3-42.2, P = .027) opted for thyroidectomy without lymphadenectomy for lateral neck nodal metastases. CONCLUSION This study highlights the variation in surgical management of older adults with thyroid cancer and demonstrates the influence of patient age, comorbidities, surgeon experience, and fellowship training on management of this population.
Collapse
Affiliation(s)
- Whitney Sutton
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Becky Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jason D Prescott
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Martha A Zeiger
- Surgical Oncology Program, National Cancer Institute, National Institute of Health, Bethesda, MD
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Aarti Mathur
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
54
|
Liu Y, Wang Y, Zhao K, Li D, Chen Z, Jiang R, Wang X, He X. Lymph node metastasis in young and middle-aged papillary thyroid carcinoma patients: a SEER-based cohort study. BMC Cancer 2020; 20:181. [PMID: 32131769 PMCID: PMC7057480 DOI: 10.1186/s12885-020-6675-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lymph node metastasis (LNM) occurs frequently in young papillary thyroid carcinoma (PTC) patients, though the mortality rates are low. We aimed to analyze the relationship between age at diagnosis and LNM in PTC at a population level to elucidate the clinical behavior of PTC. METHODS Data of adult patients with surgically treated PTC and follicular thyroid carcinoma (FTC) were identified from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015) to investigate the relationship between age and clinical characteristics by curve estimation. The adjusted odds ratio of age and LNM rate were determined. RESULTS A total of 50,347 PTC (48,166) and FTC (2181) (median age: 45 and 50 years, respectively) patients met the inclusion criteria; 44.5% of those with PTC (21,428) had LNM. Rank-sum test analysis indicated differences in distribution of age in LNM-positive and LNM-negative PTC. The relationship between age, tumor size and LNM showed a quadratic curve in PTC. The mean tumor diameter and LNM rate correlated linearly with age in 18-59-year-old patients. LNM rate decreased with age (R2 = 0.932, P < .0001), especially women (R2 = 0.951, P < .0001). CONCLUSION In young and middle-aged PTC patients, LNM may resolve spontaneously with delayed diagnosis and management. Active surveillance of low-risk PTC is justified.
Collapse
Affiliation(s)
- Yuanchao Liu
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Yizeng Wang
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Ke Zhao
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Dongyang Li
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Zuoyu Chen
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Ruoyu Jiang
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Xiaoning Wang
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Xianghui He
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China.
| |
Collapse
|
55
|
Lohia S, Hanson M, Tuttle RM, Morris LGT. Active surveillance for patients with very low-risk thyroid cancer. Laryngoscope Investig Otolaryngol 2020; 5:175-182. [PMID: 32128446 PMCID: PMC7042648 DOI: 10.1002/lio2.356] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/07/2020] [Accepted: 01/25/2020] [Indexed: 01/03/2023] Open
Abstract
Over the past 30 years in the United States, increasing identification of small thyroid nodules has led to a dramatic rise in the detection of small thyroid cancers, many of which are unlikely to progress to overt clinical disease. Because autopsy studies reveal that up to 30% of people harbor clinically occult thyroid cancers, the growing use of diagnostic technologies has identified an increasing number of small, clinically low risk papillary thyroid cancers (PTCs). In recent years, clinical practice has evolved to de-intensify the treatment for PTCs, with fewer total thyroidectomy and nodal dissection procedures being performed, in favor of more limited operations. In addition, vigilant observation of selected low risk cancers has demonstrated outcomes comparable to those patients who undergo immediate surgical intervention. Active surveillance has emerged as a new option within the treatment algorithm of PTCs. There is now robust data from cancer centers in Japan and Korea which have reported excellent oncologic outcomes among patients undergoing active surveillance for PTC, as well as more recent, similar data from the United States. American Thyroid Association guidelines now include the option of active surveillance for appropriately selected patients with low-risk PTC. With active surveillance now one option within the standard of care for patients with certain thyroid cancers, surgeons have become critical to facilitating shared decision-making for patients facing this diagnosis.
Collapse
Affiliation(s)
- Shivangi Lohia
- Department of Surgery, Head and Neck ServiceMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Martin Hanson
- Department of Surgery, Head and Neck ServiceMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - R. Michael Tuttle
- Department of Medicine, Endocrine ServiceMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Luc G. T. Morris
- Department of Surgery, Head and Neck ServiceMemorial Sloan Kettering Cancer CenterNew YorkNew York
| |
Collapse
|
56
|
Zhang H, Zheng X, Liu J, Gao M, Qian B. Active surveillance as a management strategy for papillary thyroid microcarcinoma. Cancer Biol Med 2020; 17:543-554. [PMID: 32944389 PMCID: PMC7476094 DOI: 10.20892/j.issn.2095-3941.2019.0470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 04/20/2020] [Indexed: 12/28/2022] Open
Abstract
Active surveillance (AS) can be considered as a treatment strategy for low risk papillary thyroid microcarcinoma (PTMC), with the absence of clinically apparent lymph nodes, extrathyroidal extensions, and distant metastasis. After reviewing the reports on AS of low risk PTMCs worldwide, we introduced AS, and discussed the selection criteria for active surveillance candidates based on different guidelines and the follow-up schedules. Moreover, the requirement of cytological diagnosis, progression evaluation methods, necessity of thyrotropin suppression, and medical costs were issues that both clinicians and patients considered. The usefulness of AS for low risk PTMC patients depended on accurate and confidential evaluation of patient risk. Clinicians may adopt measures like dynamic monitoring, risk stratification, and making personal follow-up schedules to minimize these potential risks. By appropriately selecting PTMC patients, AS can be an effective alternative treatment to immediate surgery.
Collapse
Affiliation(s)
- Huan Zhang
- Cancer Prevention Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xiangqian Zheng
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Juntian Liu
- Cancer Prevention Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Ming Gao
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Biyun Qian
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and Faculty of Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| |
Collapse
|
57
|
Ito Y, Miyauchi A. Active surveillance of low-risk papillary thyroid microcarcinomas in Japan and other countries: a review. Expert Rev Endocrinol Metab 2020; 15:5-12. [PMID: 31902250 DOI: 10.1080/17446651.2020.1707078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/17/2019] [Indexed: 12/30/2022]
Abstract
Introduction: Active surveillance of low-risk papillary thyroid microcarcinomas (PTMCs) was initiated in Japan in 1993 and has since been adopted in many countries, especially after its approval by the American Thyroid Association in 2015.Areas covered: We performed a literature review in Medline/PubMed to identify studies that used active surveillance for PTMCs. Moreover, we performed a literature review about the increased incidence of thyroid microcarcinomas in relation to the relative stability of deaths due to thyroid carcinomas.Expert opinion: No patients showed life-threatening metastasis/recurrence or died of thyroid carcinoma during active surveillance or after conversion surgery following PTMC progression. Thus, active surveillance should be the first-line management of PTMCs without high-risk features. In the future, molecular testing of actively growing PTMCs using cytology specimens could be useful to guide the treatment plan.
Collapse
Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Hyogo, Japan
| | | |
Collapse
|
58
|
Ito Y, Miyauchi A, Kudo T, Higashiyama T, Masuoka H, Kihara M, Miya A. Kinetic Analysis of Growth Activity in Enlarging Papillary Thyroid Microcarcinomas. Thyroid 2019; 29:1765-1773. [PMID: 31650907 PMCID: PMC6918870 DOI: 10.1089/thy.2019.0396] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Although papillary thyroid microcarcinoma (PMC) is generally stable on active surveillance, conversion surgery is recommended for enlarging tumors. However, it remains unclear which enlargement threshold should be considered sufficient to trigger surgery. This study analyzed changes in the growth activity of PMC, before and after enlargement. Methods: We enrolled 824 patients with PMC, in whom active surveillance was initiated between 2005 and 2011 (median duration of follow-up: 6.04 years). Changes in the maximal tumor size and tumor volume were evaluated. Point of enlargement (PE) was defined as the time at which maximal tumor size or tumor volume had increased by ≥3 mm (PE-M) or by ≥50% (PE-V), respectively. In patients with PMC who underwent at least three ultrasound examinations during the study period, we compared the tumor doubling rates (TDRs, designated as the inverse of doubling time) between pre- and post-PEs. Results: Ten-year enlargement-free survival rates based on maximal tumor size and tumor volume were 86.9% and 54.9%, respectively. The median post-PE TDRs was significantly lower than that of pre-PEs (-0.091/year vs. 0.509/year [p < 0.001] for PE-M, and -0.058/year vs. 0.370/year [p < 0.001] for PE-V), indicating decreased tumor growth after PEs. After PE-M and PE-V, the PMCs continued to rapidly enlarge (TDR >0.5/year) in only 6 (7.7%) and 11 (3.8%) patients and moderately enlarge (TDR 0.1-0.5/year) in 10 (12.8%) and 35 (12.1%) patients, respectively. Conversely, tumors shrank (TDR < -0.1/year) in 37 (47.4%) and 105 (36.1%) patients, respectively, and remained stable (TDR ranged between 0.1/year and -0.1/year) in 25 (32.1%) and 140 (48.1%) patients, respectively. Conclusion: Since most PMCs demonstrate a significant decrease in growth activity after enlargement, performing surgery immediately after the PE may be premature.
Collapse
Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe, Japan
- Address correspondence to: Yasuhiro Ito, MD, PhD, Department of Surgery, Kuma Hospital, 8-2-35, Shimoyamate-dori, Chuo-ku, Kobe 650-0011, Japan
| | | | - Takumi Kudo
- Department of Internal Medicine, Kuma Hospital, Kobe, Japan
| | | | | | | | - Akihiro Miya
- Department of Surgery, Kuma Hospital, Kobe, Japan
| |
Collapse
|
59
|
Takano T. Natural history of thyroid cancer suggests beginning of the overdiagnosis of juvenile thyroid cancer in the United States. Cancer 2019; 125:4107-4108. [PMID: 31355907 DOI: 10.1002/cncr.32424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Toru Takano
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Biomedical Research Center, Suita, Japan
| |
Collapse
|
60
|
Sugitani I, Ito Y, Miyauchi A, Imai T, Suzuki S. Active Surveillance Versus Immediate Surgery: Questionnaire Survey on the Current Treatment Strategy for Adult Patients with Low-Risk Papillary Thyroid Microcarcinoma in Japan. Thyroid 2019; 29:1563-1571. [PMID: 31441377 PMCID: PMC6862943 DOI: 10.1089/thy.2019.0211] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Two Japanese prospective trials of active surveillance (AS) for adult patients with low-risk papillary thyroid carcinoma (PTC) ≤1 cm (cT1aN0M0 PTMC) have verified the safety of AS in oncological control and its superiority over immediate surgery with respect to unfavorable outcomes. Thus, AS has been accepted as an alternative to immediate surgery for asymptomatic papillary thyroid microcarcinomas (PTMCs). However, the real-world clinical approach for PTMC is unknown. Thus, this study aimed to investigate the current state of management of asymptomatic PTMCs in Japan. Methods: We conducted a questionnaire survey on the actual treatment patterns for adult patients with low-risk PTMCs. The subjects were member institutions of the Japan Association of Endocrine Surgery (JAES) or Japanese Society of Thyroid Surgery (JSTS), including the departments of surgery and head and neck surgery (HNS). Results: Responses were obtained from 134 institutes, where 72.4% of Japanese thyroid cancer cases operated by surgeons were treated. For suspicious tumors on ultrasound, 18 responders (13.4%) conducted cytological examination routinely, while 69 (51.5%) and 40 (27.8%) conducted it only for tumors >5 and >10 mm, respectively. After the diagnosis, 42 responders (31.3%) recommend AS, 35 (26.1%) recommend immediate surgery as the management, and 52 (38.8%) allowed patients to decide the treatment course. The present responders tended to recommend surgery for PTMCs that were located adjacent to the dorsal surface of the thyroid, were multiple, or measured almost 10 mm in size. At these institutions, 1176 patients with PTMC underwent surgery in 2017, accounting for 18.1% of surgeries for PTC. During the succeeding three months, 310 of 576 (53.8%) PTMC patients underwent AS. The treatment strategies did not differ between the departments (Surgery or HNS). The institutions that have six or more surgeons, that were located in metropolitan areas, or that were certified by JAES or JSTS performed AS more actively. Conclusion: More than 50% of low-risk PTMCs are on AS in Japan. However, the indication and recommendation for AS vary significantly between institutions. To improve the implementation of this management modality, physicians and patients should be further educated, and the sociomedical environment should be improved.
Collapse
Affiliation(s)
- Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
- Research Group for the Management of Papillary Thyroid Microcarcinoma, Japan Association of Endocrine Surgery & Japanese Society of Thyroid Surgery, Tokyo, Japan
- Address correspondence to: Iwao Sugitani, MD, PhD, Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Yasuhiro Ito
- Research Group for the Management of Papillary Thyroid Microcarcinoma, Japan Association of Endocrine Surgery & Japanese Society of Thyroid Surgery, Tokyo, Japan
- Department of Surgery, Kuma Hospital, Kobe, Japan
| | - Akira Miyauchi
- Research Group for the Management of Papillary Thyroid Microcarcinoma, Japan Association of Endocrine Surgery & Japanese Society of Thyroid Surgery, Tokyo, Japan
- Department of Surgery, Kuma Hospital, Kobe, Japan
| | - Tsuneo Imai
- Research Group for the Management of Papillary Thyroid Microcarcinoma, Japan Association of Endocrine Surgery & Japanese Society of Thyroid Surgery, Tokyo, Japan
- Department of Surgery, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan
| | - Shinichi Suzuki
- Research Group for the Management of Papillary Thyroid Microcarcinoma, Japan Association of Endocrine Surgery & Japanese Society of Thyroid Surgery, Tokyo, Japan
- Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine, Fukushima, Japan
| |
Collapse
|
61
|
Takano T. Overdiagnosis of Juvenile Thyroid Cancer: Time to Consider Self-Limiting Cancer. J Adolesc Young Adult Oncol 2019; 9:286-288. [PMID: 31657663 PMCID: PMC7187964 DOI: 10.1089/jayao.2019.0098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Toru Takano
- Thyroid Center, Rinku General Medical Center, Izumisano, Osaka, Japan.,Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of Laboratory Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| |
Collapse
|
62
|
Cernea CR. Active surveillance of thyroid microcarcinomas. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:454-455. [PMID: 31621768 PMCID: PMC10522271 DOI: 10.20945/2359-3997000000181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/19/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Claudio R. Cernea
- Departamento de CirurgiaFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Departamento de Cirurgia , Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP , Brasil
| |
Collapse
|
63
|
Cho SJ, Suh CH, Baek JH, Chung SR, Choi YJ, Chung KW, Shong YK, Lee JH. Active Surveillance for Small Papillary Thyroid Cancer: A Systematic Review and Meta-Analysis. Thyroid 2019; 29:1399-1408. [PMID: 31368412 DOI: 10.1089/thy.2019.0159] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: The rapid increase in the incidence of small papillary thyroid carcinoma (PTC) appears to be caused by the detection of small thyroid cancers. Active surveillance (AS) was therefore suggested to overcome this problem. As the results were favorable with low rates of size enlargement and lymph metastasis, the 2015 American Thyroid Association Management Guidelines endorsed AS as an alternative to immediate surgery. As the clinical value of AS is a subject of ongoing active discussions and surveys, we considered a systematic review and meta-analysis to be timely and necessary. Methods: Ovid-MEDLINE and EMBASE databases were searched up to January 5, 2019, for studies reporting patients who were followed up with AS for PTC. Data extraction and methodological quality assessment were performed independently by two radiologists. The primary outcomes were to identify the annual pooled proportions of size enlargement of 3 mm or more and the detection of lymph node metastases at a 5-year follow-up period. These were calculated using an inverse-variance weighting model. An additional outcome was evaluation of the reasons for surgery during AS. Results: The pooled proportion of size enlargement occurring at 5 years was 5.3% [95% confidence interval (CI), 4.4-6.4%], and the pooled proportion of 5-year lymph node metastasis was 1.6% [CI, 1.1-2.4%]. In many subjects undergoing delayed operations, the reasons for operation were often other than those of size enlargement or lymph node metastasis. Conclusions: AS is effective for the management of small PTC, with a low proportion of size enlargement or lymph node metastasis occurring at 5 years. However, a substantial proportion of the causes of delayed surgery were other than size enlargement or lymph node metastasis, and these situations need to be optimally managed.
Collapse
Affiliation(s)
- Se Jin Cho
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ki-Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Kee Shong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
64
|
Smulever A, Pitoia F. Active surveillance in papillary thyroid carcinoma: not easily accepted but possible in Latin America. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:462-469. [PMID: 31482955 PMCID: PMC10522272 DOI: 10.20945/2359-3997000000168] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/19/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine the percentage of patients with papillary thyroid carcinoma (PTC) who accepted active surveillance as an alternative to surgery in our clinical practice and to describe the clinical characteristics and outcomes of patients with Bethesda category V and VI thyroid nodules who chose active surveillance. SUBJECTS AND METHODS We included 136 PTC patients from the Hospital de Clínicas, University of Buenos Aires without (i) US extrathyroidal extension, (ii) tumors adjacent to the recurrent laryngeal nerve or trachea, and/or (iii) US regional lymph-node metastasis or clinical distant metastasis. PTC progression was defined as the presence of i) a tumor larger than ≥ 3 mm, ii) novel appearance of lymph-node metastasis, and iii) serum thyroglobulin doubling time in less than one year. For patients with these features, surgery was recommended. RESULTS Only 34 (25%) of 136 patients eligible for active surveillance accepted this approach, and around 10% of those who accepted abandoned it due to anxiety. The frequency of patients with tumor enlargement was 17% after a median of 4.6 years of follow-up without any evidence of nodal or distant metastases. Ten patients who underwent surgical treatment after a median time of 4 years of active surveillance (AS) had no evidence of disease after a median of 3.8 years of follow-up after surgery. CONCLUSION Although not easily accepted in our cohort of patients, AS would be safe and easily applicable in experienced centers.
Collapse
Affiliation(s)
- Anabella Smulever
- Universidad de Buenos AiresDivision of EndocrinologyHospital de ClinicasUniversity of Buenos AiresBuenos AiresArgentinaDivision of Endocrinology, Hospital de Clinicas, University of Buenos Aires Buenos Aires, Argentina
| | - Fabián Pitoia
- Universidad de Buenos AiresDivision of EndocrinologyHospital de ClinicasUniversity of Buenos AiresBuenos AiresArgentinaDivision of Endocrinology, Hospital de Clinicas, University of Buenos Aires Buenos Aires, Argentina
| |
Collapse
|