scholarly journals Active Surveillance Versus Immediate Surgery: Questionnaire Survey on the Current Treatment Strategy for Adult Patients with Low-Risk Papillary Thyroid Microcarcinoma in Japan

Thyroid ◽  
2019 ◽  
Vol 29 (11) ◽  
pp. 1563-1571 ◽  
Author(s):  
Iwao Sugitani ◽  
Yasuhiro Ito ◽  
Akira Miyauchi ◽  
Tsuneo Imai ◽  
Shinichi Suzuki
Keyword(s):  
Active Surveillance ◽  
Treatment Strategy ◽  
Questionnaire Survey ◽  
Current Treatment ◽  
Low Risk ◽  
Adult Patients ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Current Treatment Strategy ◽  
Immediate Surgery

QUALITY OF LIFE IN PATIENTS WITH LOW-RISK PAPILLARY THYROID MICROCARCINOMA: ACTIVE SURVEILLANCE VERSUS IMMEDIATE SURGERY

2020 ◽  
Vol 26 (12) ◽  
pp. 1451-1457 ◽  
Author(s):  
Tomohiko Nakamura ◽  
Akira Miyauchi ◽  
Yasuhiro Ito ◽  
Mitsuru Ito ◽  
Takumi Kudo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Active Surveillance ◽  
Depression Scale ◽  
Low Risk ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Health Related ◽  
Immediate Surgery ◽  
Specific Health

Objective: This study aimed to compare the quality of life (QoL) and psychological issues of patients with papillary thyroid microcarcinoma (PMC) who were under active surveillance (AS) and those who underwent immediate surgery (OP). Methods: This was a cross-sectional study conducted on 347 patients with low-risk PMC who were under AS (n = 298) or who underwent OP (n = 49). They were asked to complete two questionnaires (thyroid cancer–specific health-related QoL [THYCA-QoL] and the Hospital Anxiety and Depression Scale [HADS]). The results between the AS and OP groups were compared. Results: The mean ages of patients in the AS and OP groups were 58.6 ± 12.5 and 58.4 ± 13.1 years ( P = .94), respectively, and the male ratios were 34/298 (11%) and 2/49 (4.1%) ( P = .14), respectively. The median follow-up periods from diagnosis in the AS and OP groups were 56.5 months (interquartile range [IQR], 32 to 88 months) and 84 months (IQR, 64 to 130 months) ( P<.001), respectively. In the THYCA-QoL questionnaire, the OP group had more complaints about “voice” ( P<.001), “psychological” ( P = .025), “problems with scar” ( P<.001), and “gained weight” ( P = .047) than the AS group. Other scales of the THYCA-QoL were comparable in the two groups. In the HADS questionnaire, the AS group had significantly better anxiety ( P = .020), depression ( P = .027), and total scores ( P = .014) than the OP group. Conclusion: PMC patients in the OP group had more complaints and were more anxious and depressed than the AS group. These findings suggest that AS is a reasonable alternative to surgery for patients with low-risk PMC from the point of view of QoL and psychology. Abbreviations: AS = active surveillance; CI = confidence interval; HADS = Hospital Anxiety and Depression Scale; LT4 = levothyroxine; OP = immediate surgery; PMC = papillary microcarcinoma; PTC = papillary thyroid carcinoma; QoL = quality of life; STAI = State-Trait Anxiety Inventory; THYCA-QoL = thyroid cancer–specific health-related quality of life; TSH = thyrotropin

Effect of Initial Treatment Choice on 2-year Quality of Life in Patients with Low-risk Papillary Thyroid Microcarcinoma

2020 ◽  
Author(s):  
Jae Hoon Moon ◽  
Chang Hwan Ryu ◽  
Sun Wook Cho ◽  
June Young Choi ◽  
Eun-Jae Chung ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Disease Progression ◽  
Active Surveillance ◽  
Initial Treatment ◽  
Low Risk ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Immediate Surgery

Abstract Context The long-term quality of life (QoL) in patients with low-risk papillary thyroid microcarcinoma (PTMC) underwent active surveillance (AS) and immediate surgery is unclear. Objective The aim of this study was to investigate the effect of initial treatment choice on 2-year QoL in patients with low-risk PTMC Design, Setting, and Participants We analyzed 2652 QoL surveys from 1055 subjects enrolled in ongoing multicenter prospective cohort study on active surveillance of PTMC, in which the median follow-up duration was 24.4 months. Major Outcome Measure We evaluated QoL of patients with low-risk PTMC according to their treatment modality using generalized estimating equation. Results Six hundred and seventy-four subjects (male = 161; mean age = 48.8 ± 11.9 years) with low-risk PTMC chose AS while 381 subjects (male = 75; mean age = 45.7 ± 10.4 years) chose immediate surgery, including lobectomy/isthmusectomy (L/I) and total thyroidectomy (TT). Among the 817 subjects who completed baseline QoL surveys, 2-year QoL was good in order of AS (n = 500), L/I (n = 238), and TT (n = 79) groups after adjustment for age, sex, baseline tumor size, and baseline QoL scores. Among the 101 subjects who changed their treatment from AS to surgery during the follow-up period, 35 subjects who changed treatment due to disease progression had better QoL than 66 subjects who had no disease progression. Conclusions This study identified QoL as a major issue in choosing an initial treatment of low-risk PTMC and highlighted the possibility of using AS as the primary treatment.

Active Surveillance as First-Line Management of Papillary Microcarcinoma

2019 ◽  
Vol 70 (1) ◽  
pp. 369-379 ◽  
Author(s):  
Yasuhiro Ito ◽  
Akira Miyauchi
Keyword(s):  
Thyroid Carcinoma ◽  
Active Surveillance ◽  
Distant Metastasis ◽  
Clinical Evidence ◽  
The United States ◽  
Papillary Thyroid ◽  
Extrathyroid Extension ◽  
First Line ◽  
Thyroid Microcarcinoma ◽  
Immediate Surgery

Papillary thyroid microcarcinoma (PMC) is defined as papillary thyroid carcinoma ≤10 mm. Active surveillance of PMC without high-risk features, such as clinical node metastasis, distant metastasis, and clinical evidence of significant extrathyroid extension, was initiated in two Japanese hospitals in the mid-1990s. This strategy was incorporated into guidelines in Japan in 2010 and in the United States in 2015. In studies conducted by the two hospitals, most PMCs grew very slowly or did not grow, and none of the patients during active surveillance showed distant metastasis or died of thyroid carcinoma. Furthermore, none of the patients who underwent surgery after progression signs were detected showed significant recurrence. Therefore, we conclude that active surveillance should be the first line in management of low-risk PMC, because it is safer and less costly than immediate surgery. Active surveillance helps in avoiding adverse events of surgery and is an economical strategy.

scholarly journals Active Surveillance of Papillary Thyroid Microcarcinoma: Where Do We Stand?

2019 ◽  
Vol 8 (6) ◽  
pp. 298-306 ◽  
Author(s):  
Min Ji Jeon ◽  
Won Gu Kim ◽  
Ki-Wook Chung ◽  
Jung Hwan Baek ◽  
Won Bae Kim ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Surgical Intervention ◽  
Three Dimensional ◽  
Volume Measurement ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Major Drawback ◽  
Thyroid Microcarcinoma ◽  
Immediate Surgery

The recent sharp increase in thyroid cancer incidence is mainly due to increased detection of small papillary thyroid microcarcinoma (PTMC). Due to the indolent nature of the disease, active surveillance (AS) of low-risk PTMCs is suggested as an alternative to immediate surgery to reduce morbidity from surgery. For appropriately selected PTMC patients, AS can be a good management option and surgical intervention can be safely delayed until progression occurs. Many considerations must be taken into account at the time of initiation of AS, including radiological tumor characteristics and clinical characteristics of the patient. A specialized medical team should be assembled to monitor patients during AS with an appropriate follow-up protocol. The fact that some patients require surgery for disease progression after long-term follow-up is a major drawback of the current AS protocol. Evaluation of tumor kinetics by three-dimensional tumor volume measurement during the initial 2–3 years of AS may be helpful for discrimination of PTMCs that need early surgical intervention. In this review, we will discuss the clinical outcomes of surgical intervention and AS, considerations during AS, and unresolved questions about AS.

scholarly journals Low-risk papillary thyroid carcinoma

2019 ◽  
Vol 98 (6) ◽  
pp. 403-407
Author(s):  
Caio Nassuo Furukawa ◽  
Leonardo André Hage Fabri ◽  
Flávio Carneiro Hojaij
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Active Surveillance ◽  
Hormone Replacement ◽  
Good Alternative ◽  
Low Risk ◽  
Papillary Thyroid ◽  
Risk Patients ◽  
Immediate Surgery

Introduction: A epidemic increase in the incidence of papillary thyroid carcinoma (PTC) has been happening within the last 25 years. The majority of those tumors are low-risk, and some studies reported low progression rates of low-risk PTC. It suggests that immediate surgery may not be the best option, specially when considering the intrinsic risk to a thyroidectomy and inconvenience of lifelong hormone replacement. In this systematic review we compare the outcomes of active surveillance for the primary management of low-risk PTC. Methods: The review was conducted based on three studies selected from specific databases. These studies followed up low-risk patients nonoperatively and surgery was performed if needed. Results: All studies reported low percentages of tumor growth and metastatic disease during active surveillance. Furthermore, no significant differences between immediate surgery and late rescue surgery were reported, and active surveillance appears to be cheaper than the tradicional conduct. Conclusions: Active surveillance seems to be a good alternative for low-risk PTC management, yet, more long-term and bigger research is still needed, specially outside of a japanese population.

Active Surveillance of Low-Risk Papillary Thyroid Microcarcinoma: A Multi-Center Cohort Study in Korea

Thyroid ◽  
2018 ◽  
Vol 28 (12) ◽  
pp. 1587-1594 ◽  
Author(s):  
Hye-Seon Oh ◽  
Jeonghoon Ha ◽  
Hye In Kim ◽  
Tae Hyuk Kim ◽  
Won Gu Kim ◽  
...  
Keyword(s):  
Cohort Study ◽  
Active Surveillance ◽  
Low Risk ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma
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