PDF(Pubmed)
Abstract：
UNASSIGNED: Over-treatment of papillary thyroid microcarcinoma (PTMC) has become a common issue. Although active surveillance (AS) has been proposed as an alternative treatment to immediate surgery for PTMC, its inclusion criteria and mortality risk have not been clearly defined. The purpose of this study was to investigate whether surgery can achieve significant survival benefits in patients with larger tumor diameter of papillary thyroid carcinoma (PTC), in order to evaluate the feasibility of expanding the threshold for active surveillance.
UNASSIGNED: This study retrospectively collected data of patients with papillary thyroid carcinoma from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2019. The propensity score matching (PSM) method was used to minimize confounding factors and selection bias between the surgery and non-surgery groups, and to compare the clinical and pathological characteristics between the two groups based on the SEER cohort. Meanwhile, the impact of surgery on prognosis was compared using Kaplan-Meier estimates and Cox proportional hazard models.
UNASSIGNED: A total of 175,195 patients were extracted from the database, including 686 patients who received non-surgical treatment, and were matched 1:1 with patients who received surgical treatment using propensity score matching. The Cox proportional hazard forest plot showed that age was the most important factor affecting overall survival (OS) of patients, while tumor size was the most important factor affecting disease-specific survival (DSS) of patients. In terms of tumor size, there was no significant difference in DSS between PTC patients with tumor size of 0-1.0cm who underwent surgical treatment and those who underwent non-surgical treatment, and the relative survival risk began to increase after the tumor size exceeded 2.0cm. Additionally, the Cox proportional hazard forest plot showed that chemotherapy, radioactive iodine, and multifocality were negative factors affecting DSS. Moreover, the risk of death increased over time, and no plateau phase was observed.
UNASSIGNED: For patients with papillary thyroid carcinoma (PTC) staged as T1N0M0, AS is a feasible management strategy. As the tumor diameter increases, the risk of death without surgical treatment gradually increases, but there may be a threshold. Within this range, a non-surgical approach may be a potentially viable management strategy. However, beyond this range, surgery may be more beneficial for patient survival. Therefore, it is necessary to conduct more large-scale prospective randomized controlled trials to further confirm these findings.
UNASSIGNED: This study retrospectively collected data of patients with papillary thyroid carcinoma from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2019. The propensity score matching (PSM) method was used to minimize confounding factors and selection bias between the surgery and non-surgery groups, and to compare the clinical and pathological characteristics between the two groups based on the SEER cohort. Meanwhile, the impact of surgery on prognosis was compared using Kaplan-Meier estimates and Cox proportional hazard models.
UNASSIGNED: A total of 175,195 patients were extracted from the database, including 686 patients who received non-surgical treatment, and were matched 1:1 with patients who received surgical treatment using propensity score matching. The Cox proportional hazard forest plot showed that age was the most important factor affecting overall survival (OS) of patients, while tumor size was the most important factor affecting disease-specific survival (DSS) of patients. In terms of tumor size, there was no significant difference in DSS between PTC patients with tumor size of 0-1.0cm who underwent surgical treatment and those who underwent non-surgical treatment, and the relative survival risk began to increase after the tumor size exceeded 2.0cm. Additionally, the Cox proportional hazard forest plot showed that chemotherapy, radioactive iodine, and multifocality were negative factors affecting DSS. Moreover, the risk of death increased over time, and no plateau phase was observed.
UNASSIGNED: For patients with papillary thyroid carcinoma (PTC) staged as T1N0M0, AS is a feasible management strategy. As the tumor diameter increases, the risk of death without surgical treatment gradually increases, but there may be a threshold. Within this range, a non-surgical approach may be a potentially viable management strategy. However, beyond this range, surgery may be more beneficial for patient survival. Therefore, it is necessary to conduct more large-scale prospective randomized controlled trials to further confirm these findings.
摘要：
■甲状腺乳头状微小癌（PTMC）的过度治疗已成为普遍问题。尽管主动监测（AS）已被提议作为PTMC立即手术的替代疗法，其纳入标准和死亡风险尚未明确定义.目的探讨肿瘤直径较大的甲状腺乳头状癌(PTC)患者手术治疗能否取得显著的生存获益,以评估扩大主动监测阈值的可行性。
■本研究回顾性地收集了甲状腺乳头状癌患者的监测数据，流行病学,和2000年至2019年的最终结果(SEER)数据库。倾向评分匹配(PSM)方法用于最小化手术组和非手术组之间的混杂因素和选择偏差,并根据SEER队列比较两组之间的临床和病理特征。同时,使用Kaplan-Meier估计值和Cox比例风险模型比较手术对预后的影响.
■从数据库中提取了175,195名患者，包括686名接受非手术治疗的患者，与接受手术治疗的患者使用倾向评分匹配1:1匹配。Cox比例风险森林图显示年龄是影响患者总生存期(OS)的最重要因素,而肿瘤大小是影响患者疾病特异性生存率（DSS）的最重要因素。就肿瘤大小而言，肿瘤大小为0-1.0cm的PTC患者接受手术治疗与接受非手术治疗的患者的DSS差异无统计学意义,肿瘤大小超过2.0cm后，相对生存风险开始增加。此外,Cox比例危险森林图显示化疗，放射性碘,多灶性是影响DSS的负面因素。此外，死亡的风险随着时间的推移而增加,没有观察到平台期。
■对于分期为T1N0M0的甲状腺乳头状癌（PTC）患者，AS是一种可行的管理策略。随着肿瘤直径的增加，未经手术治疗的死亡风险逐渐增加，但可能有一个门槛。在这个范围内,非手术方法可能是一种潜在可行的管理策略.然而,超出这个范围,手术可能更有利于患者的生存。因此,有必要进行更多的大规模前瞻性随机对照试验以进一步证实这些发现。
■本研究回顾性地收集了甲状腺乳头状癌患者的监测数据，流行病学,和2000年至2019年的最终结果(SEER)数据库。倾向评分匹配(PSM)方法用于最小化手术组和非手术组之间的混杂因素和选择偏差,并根据SEER队列比较两组之间的临床和病理特征。同时,使用Kaplan-Meier估计值和Cox比例风险模型比较手术对预后的影响.
■从数据库中提取了175,195名患者，包括686名接受非手术治疗的患者，与接受手术治疗的患者使用倾向评分匹配1:1匹配。Cox比例风险森林图显示年龄是影响患者总生存期(OS)的最重要因素,而肿瘤大小是影响患者疾病特异性生存率（DSS）的最重要因素。就肿瘤大小而言，肿瘤大小为0-1.0cm的PTC患者接受手术治疗与接受非手术治疗的患者的DSS差异无统计学意义,肿瘤大小超过2.0cm后，相对生存风险开始增加。此外,Cox比例危险森林图显示化疗，放射性碘,多灶性是影响DSS的负面因素。此外，死亡的风险随着时间的推移而增加,没有观察到平台期。
■对于分期为T1N0M0的甲状腺乳头状癌（PTC）患者，AS是一种可行的管理策略。随着肿瘤直径的增加，未经手术治疗的死亡风险逐渐增加，但可能有一个门槛。在这个范围内,非手术方法可能是一种潜在可行的管理策略.然而,超出这个范围,手术可能更有利于患者的生存。因此,有必要进行更多的大规模前瞻性随机对照试验以进一步证实这些发现。
