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

Abstract

PurposeWe aimed to compare the efficacy and safety of radiofrequency ablation (RFA) to that of surgical resection (SR) in patients with T1bN0M0 papillary thyroid carcinoma (PTC) in different age groups.MethodsTotally, 204 patients with an isolated, solitary, intrathyroidal T1bN0M0 PTC, who underwent either RFA (n=94) or SR (n=110) between April 2014 and December 2019, were retrospectively enrolled and were divided into two subgroups according to age (<45 years, ≧45 years). Patients with pathologically aggressive or advanced lesions were excluded from the study. Tumor progression and procedural complications were the primary and secondary endpoints, respectively. Tumor recurrence in situ, newly discovered tumors, lymph node involvement, or distant metastases indicated tumor progression. Complications included pain, fever, voice change, choking, numbness in the limbs, and cardiac events. Incidence rates of all endpoint events were compared between different age subgroups.ResultsThere were no significant differences in age, sex, and tumor size between the treatment groups. While the RFA group incurred less cost and experienced significantly shorter operative duration than the SR group, no significant differences were observed in incidences of both tumor progression and complications. Further, subgroup analysis of patients <45 years versus those ≧45 years showed no significant differences in the incidence of tumor progression and complications within or between different treatment groups. Older patients in the SR group incurred higher hospital costs than younger counterparts, but this difference was not observed in the RFA group.ConclusionsOur results indicated that RFA had a similar prognosis as that of SR but was associated with lower overall cost in both young (<45 years) and middle-aged patients (≧45 years) with T1bN0M0 PTC. Therefore, RFA may be an effective and safe alternative to surgery for the treatment of patients with T1bN0M0 PTC.

Research Review of Thermal Ablation in the Treatment of Papillary Thyroid Carcinoma

“…During a mean follow-up of 22 months, the nodule disappearance rate, the disease progression, and the complication rates were higher in the T1b group than in the T1a group; however, thermal ablation showed effectiveness and safety for T1N0M0 PTC. Studies comparing the efficacy and safety of RFA treatment and surgical resection in patients with T1bN0M0 PTC belonging to different age groups (59) showed that RFA was more cost effective and associated with a shorter operative time than the surgical group, but there was no significant difference in tumor progression and complication rates. In addition, subgroup analyses of patients older than fortyfive years and patients younger than forty-five years showed no significant differences in the incidence of tumor progression and complications.…”

“…In contrast, ablation techniques commonly use local infiltration anesthesia, which is associated with fewer complications and is safer. A comparison of the efficacy and safety of RFA and surgical resection in patients with T1bN0M0 PTC >45 years of age (59) showed that the prognosis was similar in both groups; however, the overall cost and complications were lower in the ablation group, indicating that RFA may be an effective and safe alternative to surgery for the treatment of patients with T1bN0M0 PTC. The effect of age on the results of thermal ablation needs to be validated over a longer period of time and in larger studies.…”

A systematic review and meta-analysis comparing tumor progression and complications between radiofrequency ablation and thyroidectomy for papillary thyroid carcinoma

“…A total of six studies were identified (34)(35)(36)(37)(38)(39). Details of these studies are shown in Tables 1, 2.…”

Ultrasound-Guided Thermal Ablation of Thyroid Nodules: Technicalities Progress and Clinical Applications, Especially in Malignant Thyroid Nodules

“…It is noteworthy that, thermal ablation may not be inferior to surgery oncologically, and it is a relatively safe and cost-effective treatment option for PTMC and single T1N0M0 stage PTC. Seven retrospective studies with a total of 867 patients were included in a systematic review and meta-analysis ( 79 ). Thermal ablation was found to reduce complication with a pooled odd ratio of 0.24(95% CI 0.13 to 0.43), postoperative length of stay with a pooled standardized mean difference of -3.14(95% CI -4.77 to -1.51), and cost during the perioperative period with a pooled standardized mean difference of -1.69(95% CI -3.18 to -0.20), according to the study ( 79 ).…”

“…Seven retrospective studies with a total of 867 patients were included in a systematic review and meta-analysis ( 79 ). Thermal ablation was found to reduce complication with a pooled odd ratio of 0.24(95% CI 0.13 to 0.43), postoperative length of stay with a pooled standardized mean difference of -3.14(95% CI -4.77 to -1.51), and cost during the perioperative period with a pooled standardized mean difference of -1.69(95% CI -3.18 to -0.20), according to the study ( 79 ). Also, researchers compared the efficacy and safety of RFA to surgery in patients with T1bN0M0 PTC of various ages.…”