低风险乳头状甲状腺癌的热消融与手术比较：一项前瞻性研究

Comparison between thermal ablation and surgery in low risk papillary thyroid carcinoma: a prospective study

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Frontiers in Endocrinology

影响因子:4.6

分区:医学3区 / 内分泌学与代谢3区

发表日期:2024

作者: Wenbo Gong, Runfang Zhang, Songtao Zhang, Yifei Zhai, Chen Zheng, Dongyan Zhang

DOI: 10.3389/fendo.2024.1398208

摘要

旨在比较热消融与手术在乳头状甲状腺癌（PTC）患者中的疗效、安全性及对生活质量的影响。本前瞻性研究招募了微小（≤5mm）PTC患者，接受射频消融（RFA）、激光消融（LA）或手术治疗，评估疗效和安全性。所有患者在治疗前及治疗后3、6、12个月均填写甲状腺癌相关生活质量问卷。共纳入162例符合条件的患者。RFA和LA组未出现重症并发症，手术组报告了5例，但差异无统计学意义。RFA、LA组的轻度并发症分别为2、3例，手术组为14例，差异亦无显著。热消融组的手术时间和住院时间明显短于手术组。随访末，RFA组和LA组的结节完全消失率分别为71.4%和71.0%，差异无统计学意义。两者对生活质量的影响相似，热消融技术在功能恢复方面优于手术。所有组在术后3个月的副作用最为明显，随后逐渐恢复至基础水平，热消融组的恢复快于手术组。对于PTC ≤5mm，RFA和LA均表现出与手术相当的肿瘤控制效果和更佳的生活质量，且并发症较少。这些结果支持RFA和LA作为小型PTC潜在的标准治疗方案，未来需进一步验证。

Abstract

To conduct a comparative analysis of the efficacy, safety, and impact on quality of life outcomes between thermal ablation and surgical interventions in patients diagnosed with papillary thyroid carcinoma (PTC).A prospective study was undertaken, enrolling patients with PTC ≤5mm who underwent radiofrequency ablation (RFA), laser ablation (LA), or surgery, for analysis of efficacy and safety outcomes. The Thyroid Cancer-Specific Quality of Life questionnaire was administered to all patients before treatment and at 3, 6, and 12 months post-treatment.A total of 162 eligible patients were included in the study. Major complications were not observed in the RFA and LA groups, while five cases were reported in the surgery group, although no statistically significant differences were observed. Minor complications were documented in two, three, and 14 patients in the RFA, LA, and surgery groups, respectively, with no significant variances noted. Surgical duration and hospitalization time were notably shorter in the thermal ablation groups. At the final follow-up, complete disappearance of nodules was seen in 71.4% of cases treated with RFA and 71.0% of cases managed with LA, with no significant disparities between the groups. Both RFA and LA exhibited similar effects on quality of life, with thermal ablation techniques showing better functional outcomes in comparison to surgery. Across all groups, adverse effects were most pronounced at the 3-month post-treatment mark but gradually reverted to baseline levels in the thermal ablation group, contrasting with the surgery group.For PTC ≤5mm, both RFA and LA exhibited similar cancer control outcomes and superior quality of life on par with surgery, while minimizing complications. These findings underscore the promise of RFA and LA as potential standard treatments for small PTCs, subject to further confirmation in future studies.