甲状腺微小乳头状癌主动监测的初期结果及其进展相关因素分析  

Analysis of the initial results of active surveillance of the papillary thyroid microcarcinoma and related factors for its progress

作　　者：葛玉鑫 郑斌[1] 周建桥[1] 李成[1] 童建菁[1] 何永刚[1] Ge Yuxin;Zheng Bin;Zhou Jianqiao;Li Cheng;Tong Jianjing;He Yonggang(Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院普外科,上海200025

出　　处：《中华内分泌外科杂志（中英文）》2024年第4期500-504,共5页Chinese Journal of Endocrine Surgery

基　　金：上海市卫健委面上项目(202040019)。

摘　　要：目的本研究旨在探讨在我国对低风险甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)进行主动监测(active surveillance,AS)的可行性。观察低风险PTMC进展情况,分析疾病进展的相关因素。方法本研究为前瞻性观察研究,2018年6月至2022年8月将上海交通大学医学院附属瑞金医院普外科73例经细针穿刺细胞学诊断为低风险PTMC患者纳入AS研究。超声随访观察PTMC进展情况,并分析影响PTMC进展的相关因素。疾病进展被定义为病灶任意径增大超过3 mm,和(或)超声检查出现可疑淋巴结。结果中位随访时间为33个月,16例(21.9%)出现疾病进展,包括9例(12.3%)超声发现可疑淋巴结,8例(11.0%)病灶增大,其中1例(1.3%)同时出现两种进展情况。单因素χ2分析显示,有细钙化(P=0.032)、最大径更大(≥7 mm,P=0.003)、年轻患者(≤45岁,P=0.041)及甲状腺自身抗体水平升高(P=0.008)与疾病易发生进展有关。多因素回归分析显示,甲状腺自身抗体升高(OR=4.311,P=0.030)及较大的病灶(≥7 mm,OR=6.196,P=0.034)是PTMC进展的独立危险因素。结论在我国对低风险PTMC进行AS是一项可行性强且有效的处理方法。随访中超声检查出现可疑淋巴结和或病灶增大超过3 mm是终止AS的重要指标。对初始病灶最大径较大及甲状腺抗体升高的患者,因疾病进展可能更快,应予更密切的关注。ObjectiveTo investigate the feasibility of conducting active surveillance(AS)for low risk papillary thyroid microcarcinoma(PTMC)in China and to examine the factors in association with disease progression during AS.MethodsThis study was a prospective observational research conducted from Jun.2018 to Aug.2022 at Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine.Seventy-three patients with cytologically confirmed low-risk PTMC were enrolled in this study.They were followed up by ultrasonography,and the observed nodules were re-assessed whether or not to have disease progression.Disease progression was defined as having nodule enlarged more than 3 mm in any of diameters measured on ultrasound,or/and presence of suspicious lymph node metastasis.ResultsThe median follow-up time was 33 months.At the time of last follow-up,16 cases(21.9%)exhibited disease progression,including 9 cases(12.3%)with suspicious lymph nodes detected by ultrasound,and 8 cases(11.0%)with lesion enlargement;one case(1.3%)exhibited both situations.The univariate chi-square analysis revealed that young patients(≤45 years old,P=0.041),presence of microcalcifications(P=0.032),initial larger nodule(diameter greater than 7 mm,P=0.003),and elevated thyroid autoantibody levels(P=0.008)were associated with disease progression.Multiple regression analysis showed elevated thyroid autoantibodies(OR=4.311,P=0.030)and initial larger nodule(OR=6.196,P=0.034)were independent risk factors for PTMC progression,respectively.ConclusionsAS for low-risk PTMC is a feasible and effective.During the observation,ultrasound can reveal suspicious lymph nodes and nodule enlargement,which are crucial indicators for assessing disease progression.Patients with initially larger nodule size and elevated thyroid autoantibody level are more likely to exhibit disease progression and should receive closer attention.

关 键 词：甲状腺癌 甲状腺微小乳头状癌 主动监测 超声检查 疾病进展 

分 类 号：R736.1[医药卫生—肿瘤]