Is Thyroid Cancer Required Immediate Surgery? New evidence for the JAMA sub-journal! Nearly half of the lesions in this group of patients have shrunk, and the survival rate is 100%.

▎Editor of WuXi AppTec content team

In recent decades, due to the increase in the detection rate of microcarcinoma of the thyroid gland (that is, subcentimeter lesions with a diameter of less than 1 cm), there is a more or less over-diagnosis of thyroid cancer in different countries around the

In order to curb this trend of overdiagnosis, it is necessary to redefine

Recently, JAMA Oncology published the results

Disease-specific survival and overall survival in patients with low-risk thyroid cancer are 100%,

Screenshot source: JAMA Oncol.

The paper points out that which part of thyroid cancer patients can adopt active monitoring strategies, and how these patients receive surgery or actively monitor the difference between the benefits and risk characteristics of the strategy remains to be explored

The current study prospectively explored the growth kinetics of patients in the active monitoring cohort for thyroid cancer and compared

The study included adult patients with thyroid nodules (lesion diameter ≤ 20 mm, Bethesda class 5 to 6)

The threshold for nodule growth recommended in the study for surgery was 5 mm in diameter or more than 100% increase in volume, and treatment decisions were made by endocrinologists and surgeons
.

Based on adequate communication between the patient and the physician, patients can choose thyroidectomy or total thyroidectomy
.

In addition, for patients who opted for active monitoring, prospective ultrasonography was monitored every 6 months for 2 years prior to the study, and every 12 months thereafter if nodule growth was not found
.

Overall, a total of 222 patients in the current study met the criteria for
active monitoring.

The vast majority of these patients had an incidental discovery
of thyroid nodules (63.
5%).

After exploring treatment options, 112 of the 222 patients (50.
5%) chose to undergo active monitoring
.

The mean time for prospective follow-up of patients receiving active monitoring was 37.
1 months, and the median tumor size was 11.
0 mm
.

Among them, cases with large lesions (10.
1 mm to 20 mm, T1b stage) accounted for 59.
8% of all cases, while cases with lesion size of 15.
1 mm to 20 mm accounted for 20.
6%
of all cases.

At the time of the last follow-up, 101 patients (90.
1%) chose to continue active monitoring
.

Image source: 123RF

Active monitoring of lesion growth during period:

Among the 112 patients, 9 (8.
0%) and 4 (3.
6%) increased the size of the lesion to 3 mm or more (P=0.
07).


The cumulative incidence of lesions growing to more than 5 mm in patients over 2 years was 1.
2%; The cumulative incidence of lesions growing to more than 5 mm over 5 years was 10.
8%.

In addition, 19 (17.
0%) and 8 (7.
1%) of the 112 patients increased the volume of the lesion by more than 50% or more than 100% (P=0.
003),
respectively.

The cumulative incidence of lesion volume growth of patients exceeding 100% over 2 years is 2.
2%; The cumulative incidence of lesion volume growth exceeding 100% over 5 years is 13.
7%.


No patients developed lymph node metastases or distant metastases
.

Notably, 46 patients had lesions (41.
1%) shrinking
in volume.

Further analysis showed that the large size of the lesion at the time of diagnosis was independent
of the growth or volume of its later lesions.

Similarly, being younger age at the time of diagnosis is equally unrelated to the growth or volume of later lesions
.

Differences in prognosis between immediate and delayed surgery:

In the immediate surgery group, 7 (6.
4%) and 0 of the 110 patients developed temporary or permanent hypoparathyroidism
.

In addition, 1 in 110 patients (0.
9%) and 0 patients developed temporary or permanent recurrent laryngeal nerve palsy
, respectively.

No patients developed wound infection or hematoma
.

In the delayed surgery group, no complications
were observed in patients.

In addition, based on post-operative pathological analysis, it was found that 19.
1% (21/110 patients) and 37.
5% (3/8 patients) of patients undergoing immediate surgery and patients with delayed surgery had ambiguous pathological risk types (eg, high cell type, spike type, eosinophilic papillary carcinoma),
respectively.

It is worth noting that the disease-specific survival and overall survival of patients in both the immediate and delayed surgery groups were 100%.


At the same time, patients who underwent immediate surgery had significantly higher baseline anxiety levels than actively monitored patients, and this difference persisted
even after the treatment intervention during the four-year follow-up.

Overall, the results of the current non-randomized controlled trial suggest that a more relaxed active surveillance strategy appears to be feasible in the vast majority of confirmed thyroid cancer cases (lesion diameter ≤ 20 mm) and does not significantly affect patient outcomes
.

In addition, it is worth noting that 19% of patients in the study who could take active monitoring but chose to undergo immediate surgery also did not indicate a significant risk
of surgical case results.

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