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

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 2,652 QoL surveys from 1,055 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 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 compared to 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.

Papillary Thyroid Microcarcinoma: Active Surveillance Against Surgery. Considerations of an Italian Working Group From a Systematic Review

“…Both agree in the improvement of this parameter in subjects undergoing AS compared to the control group (patients undergoing thyroidectomy). However, it should be highlighted that both studies lack randomisation and have a short follow-up ( 18 , 19 ).…”

Health-Related Quality of Life following Total Thyroidectomy and Lobectomy for Differentiated Thyroid Carcinoma: A Systematic Review

“…In this review, we identified 20 studies reporting on physical HrQoL following TT or HT [ 18 , 34 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 64 , 65 , 67 , 68 , 70 , 73 ] ( Table 5 ). Eight studies compared postoperative TT HrQoL with community reference values using seven different QoL instruments (i.e., SF-36, MFI-20, ThyPRO, PSQI, Billewicz Score, visual analog scale, and 15D) [ 18 , 34 , 51 , 53 , 55 , 58 , 61 , 68 ].…”

“…Three studies assessed postoperative physical-related HrQoL in comparison with patients undergoing active surveillance (AS) [ 54 , 60 , 67 ]. All three studies found a significant impairment in physical-related HrQoL for patients undergoing HT versus patients undergoing AS for at least one of the following items: global physical subscale ( n = 1), voice symptoms ( n = 1), trouble with concentration ( n = 2), neuromuscular symptoms ( n = 1), throat or mouth symptoms ( n = 2), feeling chilly ( n = 1), or problems with scar ( n = 2) [ 54 , 60 , 67 ].…”

“…Three studies assessed postoperative physical-related HrQoL in comparison with patients undergoing active surveillance (AS) [ 54 , 60 , 67 ]. All three studies found a significant impairment in physical-related HrQoL for patients undergoing HT versus patients undergoing AS for at least one of the following items: global physical subscale ( n = 1), voice symptoms ( n = 1), trouble with concentration ( n = 2), neuromuscular symptoms ( n = 1), throat or mouth symptoms ( n = 2), feeling chilly ( n = 1), or problems with scar ( n = 2) [ 54 , 60 , 67 ]. For the two studies comparing postoperative TT HrQoL with AS, significant impairments were found in the surgery group for global physical subscale ( n = 1), weight gain ( n = 1), problems with scar ( n = 1), and vocal symptoms ( n = 1) [ 60 , 67 ].…”

“…Finally, nine studies directly compared physical-related HrQoL for patients undergoing TT versus HT using six different questionnaires (EORTC-QLQ-C30, EORTC-QLQ-THY34, SF-36, THYCA-QoL, FoP-Q-SF, and KT-QoL) [ 52 , 56 , 57 , 59 , 60 , 62 , 64 , 65 , 67 ]. Four of these studies found decreased physical-related HrQoL following TT compared with HT for at least one of the following items: global physical subscale ( n = 1), voice symptoms ( n = 1), sensory symptoms ( n = 1), neuromuscular symptoms ( n = 1), vitality ( n = 1), and problems with scar ( n = 1) [ 57 , 59 , 64 , 67 ].…”