Active surveillance of low-risk papillary thyroid cancer: A meta-analysis.
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
29
01
2019
revised:
12
03
2019
accepted:
16
03
2019
pubmed:
19
9
2019
medline:
6
5
2020
entrez:
19
9
2019
Statut:
ppublish
Résumé
This study evaluates the safety and efficacy of active surveillance for low-risk papillary thyroid carcinoma. MEDLINE, EMBASE, and PubMed were searched from inception for relevant studies of active surveillance for low-risk papillary thyroid carcinoma, defined as T1a or T1b, N0, M0 disease. Main outcomes of interest were growth of primary tumor, metastatic spread, thyroid cancer-related mortality, and disease recurrence after delayed thyroid surgery. Nine publications with 4,156 patients were included. Primary analysis of the 9 studies revealed pooled proportion of tumor growth during active surveillance to be 4.4% (95% confidence interval 3.2-5.8%). The pooled rate of metastatic spread to cervical nodes was 1.0% (95% confidence interval 0.7-1.4%), and pooled mortality due to thyroid cancer was 0.03% (95% confidence interval 0.0005-0.2%). Eight studies assessed incidence of delayed thyroid surgery with pooled proportion of 9.9% (95% confidence interval 6.4-14.0%). The main indication for surgery was patient preference, not disease progression, at 51.9% (95% confidence interval 44.9-58.9%). The pooled proportion of recurrence after delayed thyroid surgery was 1.1% (95% confidence interval 0.1-3.8%). Active surveillance appears to be a safe alternative to surgery for the management of low-risk papillary thyroid carcinoma, without increased risk of recurrence or death. This strategy allows for avoidance of exposure to surgical risk and need for subsequent thyroid replacement therapy.
Sections du résumé
BACKGROUND
This study evaluates the safety and efficacy of active surveillance for low-risk papillary thyroid carcinoma.
METHODS
MEDLINE, EMBASE, and PubMed were searched from inception for relevant studies of active surveillance for low-risk papillary thyroid carcinoma, defined as T1a or T1b, N0, M0 disease. Main outcomes of interest were growth of primary tumor, metastatic spread, thyroid cancer-related mortality, and disease recurrence after delayed thyroid surgery.
RESULTS
Nine publications with 4,156 patients were included. Primary analysis of the 9 studies revealed pooled proportion of tumor growth during active surveillance to be 4.4% (95% confidence interval 3.2-5.8%). The pooled rate of metastatic spread to cervical nodes was 1.0% (95% confidence interval 0.7-1.4%), and pooled mortality due to thyroid cancer was 0.03% (95% confidence interval 0.0005-0.2%). Eight studies assessed incidence of delayed thyroid surgery with pooled proportion of 9.9% (95% confidence interval 6.4-14.0%). The main indication for surgery was patient preference, not disease progression, at 51.9% (95% confidence interval 44.9-58.9%). The pooled proportion of recurrence after delayed thyroid surgery was 1.1% (95% confidence interval 0.1-3.8%).
CONCLUSION
Active surveillance appears to be a safe alternative to surgery for the management of low-risk papillary thyroid carcinoma, without increased risk of recurrence or death. This strategy allows for avoidance of exposure to surgical risk and need for subsequent thyroid replacement therapy.
Identifiants
pubmed: 31526581
pii: S0039-6060(19)30561-6
doi: 10.1016/j.surg.2019.03.040
pii:
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
46-55Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.