The Impact of the Extent of Surgery on the Long-Term Outcomes of Patients with Low-Risk Differentiated Non-Medullary Thyroid Cancer: A Systematic Meta-Analysis

Journal of Clinical Medicine

Johannes Smit¹  Romana Netea-Maier¹  Petronella Ottevanger²  Johannes de Wilt³  Johannes Bonenkamp³  Andreea Bojoga⁴  Anna Koot⁵  Peep Stalmeier⁵  Joanna IntHout⁵  Rosella Hermens⁶ 

[1] Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;Department of Internal Medicine, Division of Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;Department of Surgical Oncology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands;National Institute of Endocrinology “C.I. Parhon”, 011863 Bucharest, Romania;Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;

关键词: low-risk thyroid cancer;    thyroid lobectomy;    total thyroidectomy;    shared decision making;   

DOI  :  10.3390/jcm9072316

来源: DOAJ

【 摘 要 】

Recently, the management of patients with low-risk differentiated non-medullary thyroid cancer (DTC), including papillary and follicular thyroid carcinoma subtypes, has been critically appraised, questioning whether these patients might be overtreated without a clear clinical benefit. The American Thyroid Association (ATA) guideline suggests that thyroid lobectomy (TL) could be a safe alternative for total thyroidectomy (TT) in patients with DTC up to 4 cm limited to the thyroid, without metastases. We conducted a meta-analysis to assess the clinical outcomes in patients with low-risk DTC based on the extent of surgery. The risk ratio (RR) of recurrence rate, overall survival (OS), disease-free survival (DFS) and disease specific survival (DSS) were estimated. In total 16 studies with 175,430 patients met the inclusion criteria. Overall, low recurrence rates were observed for both TL and TT groups (7 vs. 7%, RR 1.10, 95% CI 0.61–1.96, I²  = 72%), and no statistically significant differences for OS (TL 94.1 vs. TT 94.4%, RR 0.99, CI 0.99–1.00, I² = 53%), DFS (TL 87 vs. TT 91%, RR 0.96, CI 0.89–1.03, I² = 85%), and DSS (TL 97.2 vs. TT 95.4%, RR 1.01, CI 1.00–1.01, I² = 74%). The high degree of heterogeneity of the studies is a notable limitation. Conservative management and appropriate follow-up instead of bilateral surgery would be justifiable in selected patients. These findings highlight the importance of shared-decision making in the management of patients with small, low-risk DTC.

【 授权许可】

Unknown