Abstract
Screening out patients who do not require immediate surgery is a growing trend in the field of thyroid research. In this study, we retrospectively compared the application of two surveillance selection criteria in 1001 patients who had undergone surgical treatment of papillary thyroid microcarcinoma (PTMC): low-risk PTMC characteristics defined by Kuma Hospital and CATO consensus on PTMC management of active surveillance. Treatment outcomes were compared between groups. We then analyzed the prognostic indicators of patients who could be managed by surveillance. A total of 724 patients met Kuma screening criteria and 135 met CATO screening criteria. The Kuma low-risk group had a lower incidence of multifocal lesions and CLNM than Kuma high-risk group. We also found more obvious differences in multifocal lesions, CLNM and extrathyroidal extension when evaluating the CATO low-risk criteria in the same manner. On the other hand, patients in the CATO low-risk group had a lower disease progression rate and longer disease-free survival than those in CATO high-risk group. There was no significant difference in prognosis between the Kuma low-risk group and Kuma high-risk group. Our logistic regression analysis showed that a preoperative ultrasound size of >5 mm, male sex, younger age, and malignant lesions without concurrent benign nodules could be predictors of CLNM. In conclusion, patients classified in CATO low-risk criteria had lower proportion of clinicopathological risk factors than the ones in Kuma low-risk criteria. We also found more risk factors may not be suitable for surveillance, such as tumors without concurrent benign nodules.
Highlights
Papillary thyroid microcarcinoma (PTMC) is defined as papillary thyroid cancer (PTC) of ≤10 mm regardless of the existence of distant metastasis [1]
We retrospectively compared the application of two surveillance selection criteria in 1001 patients who had undergone surgical treatment of papillary thyroid microcarcinoma (PTMC): lowrisk PTMC characteristics defined by Kuma Hospital and Chinese Association of Thyroid Oncology (CATO) consensus on PTMC management of active surveillance
Using the Kaplan–Meier method, we found that the CATO low-risk PTMC group had significantly longer disease-free survival (DFS) than the CATO high-risk PTMC group, while there was no significant difference in DFS between the Kuma low- and high-risk PTMC groups (Figure 2A and 2B)
Summary
Papillary thyroid microcarcinoma (PTMC) is defined as papillary thyroid cancer (PTC) of ≤10 mm regardless of the existence of distant metastasis [1]. The greatest contribution to this increase in thyroid cancer is the increase in PTMC [5]. The characteristics of PTMC, such as its low distant metastasis rate, high survivability, and inevitable incision scars and surgical complications have caused surgeons to suspect that surgical treatment is necessary for patients with PTMC. Is small-volume PTC equivalent to low-risk lesions? We identified a non-negligible proportion of patients with PTMC www.impactjournals.com/oncotarget who had cervical lymph node metastasis and other risk factors likely to promote progression of the disease if not surgically treated [6,7]
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