Indications and Strategy for Active Surveillance of Adult Low-Risk Papillary Thyroid Microcarcinoma: Consensus Statements from the Japan Association of Endocrine Surgery Task Force on Management for Papillary Thyroid Microcarcinoma

被引:263
作者
Sugitani, Iwao [1 ]
Ito, Yasuhiro [2 ]
Takeuchi, Dai [4 ]
Nakayama, Hirotaka [5 ]
Masaki, Chie [6 ]
Shindo, Hisakazu [7 ]
Teshima, Masanori [8 ]
Horiguchi, Kazuhiko [9 ]
Yoshida, Yusaku [10 ]
Kanai, Toshiharu [11 ]
Hirokawa, Mitsuyoshi [3 ]
Hames, Kiyomi Y. [6 ]
Tabei, Isao [12 ]
Miyauchi, Akira [2 ]
机构
[1] Nippon Med Sch, Grad Sch Med, Dept Endocrine Surg, Tokyo, Japan
[2] Kuma Hosp, Dept Surg, Kobe, Hyogo, Japan
[3] Kuma Hosp, Dept Pathol, Kobe, Hyogo, Japan
[4] Nagoya Univ, Dept Breast & Endocrine Surg, Nagoya, Aichi, Japan
[5] Yokohama City Univ, Dept Surg, Yokohama, Kanagawa, Japan
[6] Ito Hosp, Dept Surg, Tokyo, Japan
[7] Yamashita Thyroid Hosp, Dept Surg, Fukuoka, Japan
[8] Kobe Univ, Dept Otolaryngol Head & Neck Surg, Kobe, Hyogo, Japan
[9] Gunma Univ, Dept Internal Med, Div Endocrinol & Metab, Maebashi, Gumma, Japan
[10] Tokyo Womens Med Univ, Dept Breast & Endocrine Surg, Tokyo, Japan
[11] Shinshu Univ, Dept Surg, Div Breast & Endocrine Surg, Sch Med, Matsumoto, Nagano, Japan
[12] Jikei Univ, Dept Surg, Sch Med, Tokyo, Japan
关键词
papillary thyroid microcarcinoma; active surveillance; indications; strategy; task force consensus statements; Japan Association of Endocrine Surgery; TERT PROMOTER MUTATIONS; QUALITY-OF-LIFE; RETROSPECTIVE ANALYSIS; CANCER INCIDENCE; NATURAL-HISTORY; UNITED-STATES; CARCINOMA; PROGRESSION; PROGNOSIS; COHORT;
D O I
10.1089/thy.2020.0330
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The question of how to manage patients with low-risk papillary thyroid microcarcinoma (PTMC; T1aN0M0) has recently become an important clinical issue. Two Japanese centers have conducted prospective clinical trials of active surveillance (AS) for low-risk PTMC since the 1990s, reporting favorable outcomes. This policy has thus seen gradual adoption worldwide to avoid overtreatment. Not all PTMCs are suitable for AS, however, and many physicians still hesitate to apply the management policy in daily clinical practice. A task force on management for PTMC created by the Japan Association of Endocrine Surgery collected and analyzed bibliographic evidence and has produced the present consensus statements regarding indications and concrete strategies for AS to facilitate the management of adult patients diagnosed with low-risk PTMC. Summary: These statements provide indications for AS in adult patients with T1aN0M0 low-risk PTMC. PTMCs with clinical lymph node metastasis, distant metastasis, recurrent laryngeal nerve (RLN) paralysis due to carcinoma invasion, or protrusion into the tracheal lumen warrant immediate surgery. Tumors suspected of aggressive subtypes on cytology are recommended for immediate surgery. Immediate surgery is also recommended for tumors adherent to the trachea or located along the course of the RLN. Practical strategies include diagnosis, decision-making, follow-up, and monitoring related to the implementation of AS. The rate of low-risk PTMC progression is lower in older patients. However, we recommend continuing AS as long as circumstances permit. Future tasks in optimizing management for low-risk PTMC are also described, including molecular markers and patient-reported outcomes. Conclusions: An appropriate multidisciplinary team is necessary to accurately evaluate primary tumors and lymph nodes at the beginning of and during AS, and to adequately reach a shared-decision with individual patients. If appropriately applied, AS of low-risk PTMC is a safe management strategy offering favorable outcomes and preserves quality of life at low cost.
引用
收藏
页码:183 / 192
页数:10
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