Abstract

To evaluate the therapeutic effects of microwave ablation (MWA) versus surgery in treating low-risk papillary thyroid microcarcinoma (PTMC), and to assess recurrence-free survival (RFS) in patients with and without the BRAFV600E mutation. Totally 158 patients with low-risk PTMC treated with MWA and 288 patients who underwent surgical treatment were retrospectively analyzed. Local tumor progression (LTP), RFS, and adverse events associated with both treatments were monitored. Following propensity score matching (PSM), comparisons were made regarding LTP, RFS, complications, and treatment variables. Prior to matching, MWA patients were younger than those in the surgery group. Tumors treated with MWA had smaller maximum diameters [5.7 (4.6, 7.0) vs. 6.9 (5.8, 8.6), P=0.000] and volumes [70.7 (35.2, 120.9) vs.122.0 (63.9, 228.8), P=0.000]. After 1:1 PSM, each group contained 141 patients with comparable baseline characteristics. During the follow-up, LTP developed in 9 patients: 6 in the MWA group and 3 in the surgery group. There were no cases of distant metastasis or cancer-related deaths. Adjusting for age, sex, tumor location, and largest diameter, there was no significant association between treatment modality and recurrence [HR=3.75, 95%CI: 0.94 -14.98, P=0.062]. There were no significant differences in RFS between patients with and without the BRAFV600E mutation in both groups (P=0.45 and 0.74, respectively). The incidence of complications was comparable between treatments. Both MWA and surgical treatment offer similar efficacy and safety profiles for managing low-risk PTMC. MWA may represent a viable alternative to conventional surgical approaches, especially for patients harboring the BRAFV600E mutation.

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