低危型甲状腺微小乳头状癌主动监测的可行性研究  被引量:2

Feasibility study of active surveillance for low-risk papillary thyroid microcarcinoma

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作  者:李悦 陈东宁[2] 周晶[1] 陈晓红[1] Li Yue;Chen Dongning;Zhou Jing;Chen Xiaohong(Department of Thyroid and Head and Neck Surgery,Beijing Tongren Hospital Affiliated to Capital Medical University,Beijing 100730,China;Health Management Centre,Beijing Tongren Hospital Affiliated to Capital Medical University,Beijing 100730,China)

机构地区:[1]首都医科大学附属北京同仁医院甲状腺头颈外科,北京100730 [2]首都医科大学附属北京同仁医院健康管理中心,北京100730

出  处:《中华健康管理学杂志》2023年第12期932-935,共4页Chinese Journal of Health Management

摘  要:目的探讨低危型甲状腺微小乳头状癌主动监测的可行性。方法本研究为横断面研究,选取2013至2017年间61例病理确诊为甲状腺微小乳头状癌的患者进行动态随访观察,记录结节增长情况、新发病灶情况以及新增淋巴结转移情况,上述3种情况作为疾病进展的定义,并以疾病进展作为生存分析的结局事件。根据患者确诊年龄中位数将全部患者分为2组(<43岁和≥43岁组),不同年龄分组中有关疾病进展的影响因素的单因素分析采用Cox比例风险回归,使用Kaplan-Meier方法和Log Rank检验比较不同年龄分组的疾病进展的差异。结果61例患者中有男性9例,女性52例;发病年龄23~74岁,中位数年龄43岁;随访时间2~7年,中位随访时间2年。肿瘤直径增大≥3 mm者22例(36.1%),其中男性5例,女性17例。出现新发癌灶者13例(21.3%),男2例,女11例。出现淋巴结转移者3例(5%),均为女性,总进展人数24例(39.3%),男性5例,女性19例。在年龄<43岁组发生疾病进展的情况明显多于≥43岁组。结论对于低危型甲状腺微小乳头状癌患者,严格控制符合主动监测治疗的指征并充分结合患者意愿,首先考虑主动监测作为肿瘤管理方式是可行的。Objective To investigate the feasibility of active surveillance for low-risk papillary thyroid microcarcinoma.Methods This is a cross-sectional study.From 2013 to 2017,61 patients with pathologically confirmed papillary thyroid microcarcinoma were followed-up dynamically.The growth of nodules,newly-developed nodules and lymph node metastasis were recorded and were set as the criteria for disease progression.And the disease progression was the outcome event of survival analysis.The patients were divided into two groups based on the median age at diagnosis.Univariate analysis of factors influencing disease progression in different age groups was performed using Cox proportional hazards regression.The differences in disease progression between different age groups were compared using the Kaplan-Meier method and the log-rank test.Results Of the 61 patients,there were 9 males and 52 females.The median age of disease onset was 43 years(ranged 23-74 years).The median follow-up time was 2 years(ranged 2-7 years),and 22(36.1%)patients with tumor diameter increased by≥3 mm,including 5 males and 17 females.A total of 22 cases(36.1%)showed an increase in tumor diameter of≥3 mm,including 5 males and 17 females.Thirteen cases(21.3%)developed new malignancies,including 2 males and 11 females.Three cases(5%)had lymph node metastasis,all of which were females.In total,24 cases(39.3%)showed disease progression,including 5 males and 19 females.Disease progression was more frequent in the<43 years age group compared to the≥43 years age group.Conclusions For patients with low-risk papillary thyroid microcarcinoma,strict adherence to the indications for active surveillance and consideration of patient preferences make active surveillance a feasible tumor management approach.

关 键 词:甲状腺微小乳头状癌 主动监测 非手术治疗 

分 类 号:R736.1[医药卫生—肿瘤]

 

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