目的:根据2015年荷兰甲状腺癌指南(NL-15)和美国甲状腺协会指南(ATA-15)评估分化型甲状腺癌(DTC)当前降阶梯的治疗结果。
方法:回顾,对NL-15和ATA-15指南的建议进行了评估,以估计潜在的足够,2007年至2017年在格罗宁根大学医学中心接受治疗的患者中DTC治疗不足和过度。
方法:共有240例cT1-T3aN0-1aM0DTC患者符合纳入标准。
方法:经过实际治疗,根据这两个指南,患者再次被分类为低,中间,或基于肿瘤状态的高风险。接下来,他们被归类为一致的低风险(n=60),一致高风险(n=73),或不一致风险组(n=107)。后续数据用于估计潜在足够的比例,under-,和过度治疗根据这两个指南。
结果:比较NL-15和ATA-15推荐的治疗方法显示,当遵循NL-15推荐时,治疗过度和充分,ATA-15之后的治疗更少(全部:p<.001)。低风险组的亚分析显示,在遵循NL-15指南时,有64%的人过度治疗(p<.001)。在相同的高风险组中没有发现治疗差异。在ATA-15之后,治疗不足最常见于不一致风险组(p<.001)。
结论:在遵循NL-15建议时,低风险患者的治疗过于积极,较不积极的ATA-15方法似乎更合适。中危DTC患者的治疗差异很大,根据ATA-15的建议,治疗不足的发生率相对较高,主张进一步完善该患者组的风险分类。
Assessment of treatment outcome in current de-escalation for differentiated thyroid cancer (DTC) according to the 2015 Dutch thyroid cancer guidelines (NL-15) and American Thyroid Association
guidelines (ATA-15).
Retrospectively, the recommendations of the NL-15 and ATA-15
guidelines were evaluated to estimate potentially adequate, under- and overtreatment of DTC in patients treated in the University Medical Center Groningen between 2007 and 2017.
A total of 240 patients with a cT1-T3aN0-1aM0 DTC fulfilled the inclusion criteria.
After actual treatment was given, patients were again categorized according to both guidelines into low, intermediate, or high-risk based on tumour status. Next, they were categorized into a congruent low-risk (n = 60), congruent high-risk (n = 73), or incongruent risk group (n = 107). Follow-up data were used to estimate the proportion of potentially adequate, under-, and overtreatment according to both guidelines.
Comparing treatment recommended by NL-15 and ATA-15 showed significantly more over- and adequate treatment when following NL-15 recommendations, and more
undertreatment following ATA-15 (all: p < .001). Subanalysis of the congruent low-risk group showed overtreatment in 64% when following NL-15 guidelines (p < .001). No treatment differences were found in the congruent high-risk group.
Undertreatment was most often seen in the incongruent risk group when following ATA-15 (p < .001).
Low-risk patients were treated too aggressively when following NL-15 recommendations, where the less aggressive ATA-15 approach seemed more adequate. Treatment of intermediate risk DTC patients varies greatly, with a relative higher rate of
undertreatment according to the recommendations of the ATA-15, advocating further refining of the risk classification in this patient group.