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Marked Decrease Over Time in Conversion Surgery After Active Surveillance of Low-Risk Papillary Thyroid Microcarcinoma
- Source :
- Thyroid
- Publication Year :
- 2021
- Publisher :
- Mary Ann Liebert, Inc., publishers, 2021.
-
Abstract
- Background: Active surveillance for low-risk papillary microcarcinoma (PMC) of the thyroid is an accepted and safe management strategy. However, some patients undergo conversion surgery after the initiation of active surveillance for various reasons. We investigated the reasons for conversion surgery and whether and how they changed over time. Methods: We enrolled 2288 patients with PMC who underwent active surveillance. Of these, 162 (7.1%) underwent conversion surgery >12 months after initiating active surveillance due to disease progression (57 patients), patient preference (43 patients), physician preference (31 patients), other associated thyroid or parathyroid diseases (24 patients), and other reasons (7 patients). We analyzed cumulative conversion rates not only in the whole cohort but also in the first three major subsets based on the reasons for surgery. We also divided our whole cohort into two groups based on the period of active surveillance commencement: the first-half group (February 2005-November 2011; 561 patients) and the second-half group (December 2011-June 2017; 1727 patients). Results: The criteria for PMC progression did not differ between the first- and second-half groups. The proportion of female patients in the physician preference group was significantly higher than that in the disease progression and the patient preference groups. Tumor size at surgery was larger, and tumor volume-doubling rate was higher in the disease progression group than in the other two groups. Patients in the second-half group were significantly less likely to undergo conversion surgery than those in the first-half group. Furthermore, conversion surgery rates in the second-half group were significantly lower than those in the first-half group in the patient preference, physician preference, and disease progression groups. Conclusions: Patients with PMC in the second-half group were significantly less likely to undergo conversion surgery than those in the first-half group regardless of the reason. This is probably because data accumulation of favorable outcomes with active surveillance significantly contributed to physicians' confidence and patients' trust and understanding of this disease.
- Subjects :
- Adult
Male
medicine.medical_specialty
Time Factors
Adolescent
Endocrinology, Diabetes and Metabolism
Papillary Thyroid Microcarcinoma
030209 endocrinology & metabolism
Disease
Thyroid Function Tests
Risk Assessment
03 medical and health sciences
Young Adult
0302 clinical medicine
Endocrinology
Risk Factors
medicine
Humans
papillary thyroid microcarcinoma
Thyroid Neoplasms
Watchful Waiting
Aged
Retrospective Studies
Ultrasonography
Tumor size
lymph node metastasis
business.industry
tumor size
Thyroid
Disease progression
active surveillance
Thyroid Cancer and Nodules
tumor volume-doubling rate
Middle Aged
Patient preference
Carcinoma, Papillary
Surgery
Tumor Burden
Management strategy
medicine.anatomical_structure
Treatment Outcome
conversion surgery
030220 oncology & carcinogenesis
Lymphatic Metastasis
Cohort
Disease Progression
Thyroidectomy
Female
business
Subjects
Details
- Language :
- English
- ISSN :
- 15579077 and 10507256
- Volume :
- 31
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Thyroid
- Accession number :
- edsair.doi.dedup.....82de92ab62462432e8717c2e5e23f76e