Active surveillance in low risk papillary thyroid carcinoma

Abstract

In recent decades, while the incidence of thyroid cancer has increased exponentially around the world, mortality has remained stable. The vast majority of this increase is attributable to the identification of intrathyroidal papillary microcarcinomas, which exhibit slow growth rates with indolent courses. A diagnosis of thyroid cancer based upon the presence of these small tumors could be considered as an overdiagnosis, as the majority of these tumors would not likely result in death if left untreated. Although surgical resection was the classical standard therapy for papillary microcarcinomas, active surveillance (AS) has emerged over the last three decades as an alternative approach that is aimed to recognize a minority group of patients who will clinically progress and would likely benefit from rescue surgery. Despite the encouraging results of AS, its implementation in clinical practice is strongly influenced by psychosocial factors. The aim of this review is to describe the epidemiology, clinical evolution, prognostic factors, and mortality of papillary thyroid microcarcinomas. We also summarize the AS strategy according to published evidence, characterize the criteria for selecting patients for AS according to risk factors and environmental characteristics, as well as analyze the current limitations for AS implementation.

WITHDRAWN: Association between XRCC3 rs861539(Thr241Met) polymorphism and thyroid cancer risk (a Meta-analysis)

“…The incidence of thyroid cancer has been increasing rapidly in recent years, and the largest increase in incidence of all cancers was seen for thyroid cancer in China [2] . The reason might due to the rapid development of imaging detection technologies and increasing awareness of people's health [3] , especially considering that thyroid cancer mortality remained stable at a rate of approximately 0.5 cases per 100000 persons [4] . Thyroid cancers are divided into four main sub-types(papillary, follicular, medullary, and undifferentiated cancers) [5] .To date, the mechanism of thyroid carcinogenesis remains incompletely understood, and the only well-established risk factor for thyroid cancer might be exposure to ionizing radiation [6] .…”

Efficacy and safety of ultrasound-guided radiofrequency ablation for low-risk papillary thyroid microcarcinoma in patients aged 55 years or older: a retrospective study

“…In another study of nonoperative management of elderly PTMC patients aged >65 years, the overall 5-year survival rate was lower, 23% [42]. In addition, in a recent study, Pitoia et al [8] summarized the clinical outcomes of active surveillance around the world, and the rate of tumor growth larger than 3 mm and lymph node metastasis could reach 22% and 3.8%, respectively. All these results suggested that even small-sized PTC tumors might require active therapeutic intervention, in particular for aged patients.…”

“…Papillary thyroid carcinoma (PTC) is a well-differentiated malignant thyroid tumor. PTC accounts for the majority of thyroid cancers, but it is an indolent tumor [4,5] with a good prognosis [6][7][8]. More than 50% of PTCs are less than 1 cm in size and are referred to as papillary thyroid microcarcinoma (PTMC) [5].…”

Ultrasound-Guided Radiofrequency Ablation Versus Surgical Resection for the Treatment of T1bN0M0 Papillary Thyroid Carcinoma in Different Age Groups

“…Presently, overdiagnosis and overtreatment of PTC is one of the most controversial issues in the management of thyroid carcinoma (11,12). Long-term active surveillance (AS) of patients with T1aN0M0 PTC performed in several institutions has revealed that the follow-up approach may constitute an appropriate, conservative management strategy (13)(14)(15). The 2015 ATA Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer also mentioned that AS may be employed as an alternative strategy in selected PTC patients (4).…”