Yasuhiro Ito1, Akira Miyauchi2, Makoto Fujishima2, Takuya Noda3,4, Tsutomu Sano3,5, Takahiro Sasaki3, Taketoshi Kishi6,7, Tomohiko Nakamura6. 1. Department of Surgery, Kuma Hospital, 8-2-35, Shimoyamate-dori, Kobe, Hyogo, 650-0011, Japan. ito01@kuma-h.or.jp. 2. Department of Surgery, Kuma Hospital, 8-2-35, Shimoyamate-dori, Kobe, Hyogo, 650-0011, Japan. 3. Department of Head and Neck Surgery, Kuma Hospital, Kobe, Hyogo, 650-0011, Japan. 4. Department of Head and Neck Surgery, Kanazawa Medical University, Uchinada, Ishikawa, 920-0293, Japan. 5. Department of Otorhinolaryngology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, 662-0918, Japan. 6. Department of Internal Medicine, Kuma Hospital, Kobe, Hyogo, 650-0011, Japan. 7. Department of Internal Medicine, Shiroyama Hospital, Habikino, Osaka, 583-0872, Japan.
Abstract
BACKGROUND: Active surveillance (AS) of low-risk papillary thyroid microcarcinoma (PTMC) was initiated at Kuma Hospital in 1993 and is gradually spreading worldwide. We assessed the effect of thyroid-stimulating hormone (TSH) levels on PTMC enlargement in patients on AS. METHODS: We enrolled 2705 patients with cytologically diagnosed PTMC who had undergone AS between January 2005 and July 2019. Patients with Graves disease were excluded. The median AS period was 5.5 years (range 1.0-15.7 years). Tumor enlargement was defined as a size increase ≥3 mm. Chi-square test, Kaplan-Meier method, log-rank test, Cox proportional hazard, and logistic regression were used to compare variables. RESULTS: Ninety-two patients (3.4%) experienced tumor enlargement; the 5-, 10-, and 15-year enlargement rates were 3.0%, 5.5%, and 6.2%, respectively. Young age (<40 years, p < 0.001), large tumor size (≥9 mm, p = 0.017), and high detailed TSH score (≥3, higher than the lower normal limit, p = 0.011) were significant factors relating to tumor enlargement in the multivariate analysis. In a subset of patients aged <40 years, a low detailed TSH score (<3) was an independent factor against tumor enlargement (p = 0.039). Only 22 patients (0.8%) experienced novel lymph node metastasis; the 5-, 10-, and 15-year node metastasis rates were very low, at 0.9%, 1.1%, and 1.1%, respectively. CONCLUSIONS: Young patients with PTMC are more likely to experience tumor growth. Mild TSH suppression to achieve a low normal range may prevent carcinoma enlargement; however, prospective studies are needed to draw more reliable conclusions.
BACKGROUND: Active surveillance (AS) of low-risk papillary thyroid microcarcinoma (PTMC) was initiated at Kuma Hospital in 1993 and is gradually spreading worldwide. We assessed the effect of thyroid-stimulating hormone (TSH) levels on PTMC enlargement in patients on AS. METHODS: We enrolled 2705 patients with cytologically diagnosed PTMC who had undergone AS between January 2005 and July 2019. Patients with Graves disease were excluded. The median AS period was 5.5 years (range 1.0-15.7 years). Tumor enlargement was defined as a size increase ≥3 mm. Chi-square test, Kaplan-Meier method, log-rank test, Cox proportional hazard, and logistic regression were used to compare variables. RESULTS: Ninety-two patients (3.4%) experienced tumor enlargement; the 5-, 10-, and 15-year enlargement rates were 3.0%, 5.5%, and 6.2%, respectively. Young age (<40 years, p < 0.001), large tumor size (≥9 mm, p = 0.017), and high detailed TSH score (≥3, higher than the lower normal limit, p = 0.011) were significant factors relating to tumor enlargement in the multivariate analysis. In a subset of patients aged <40 years, a low detailed TSH score (<3) was an independent factor against tumor enlargement (p = 0.039). Only 22 patients (0.8%) experienced novel lymph node metastasis; the 5-, 10-, and 15-year node metastasis rates were very low, at 0.9%, 1.1%, and 1.1%, respectively. CONCLUSIONS: Young patients with PTMC are more likely to experience tumor growth. Mild TSH suppression to achieve a low normal range may prevent carcinoma enlargement; however, prospective studies are needed to draw more reliable conclusions.
Authors: Bryan R Haugen; Erik K Alexander; Keith C Bible; Gerard M Doherty; Susan J Mandel; Yuri E Nikiforov; Furio Pacini; Gregory W Randolph; Anna M Sawka; Martin Schlumberger; Kathryn G Schuff; Steven I Sherman; Julie Ann Sosa; David L Steward; R Michael Tuttle; Leonard Wartofsky Journal: Thyroid Date: 2016-01 Impact factor: 6.568
Authors: R Michael Tuttle; James A Fagin; Gerald Minkowitz; Richard J Wong; Benjamin Roman; Snehal Patel; Brian Untch; Ian Ganly; Ashok R Shaha; Jatin P Shah; Mark Pace; Duan Li; Ariadne Bach; Oscar Lin; Adrian Whiting; Ronald Ghossein; Inigo Landa; Mona Sabra; Laura Boucai; Stephanie Fish; Luc G T Morris Journal: JAMA Otolaryngol Head Neck Surg Date: 2017-10-01 Impact factor: 6.223