Endocrine Abstracts

Objectives: Active surveillance (AS) for low-risk papillary thyroid carcinoma (PTC) has been adopted as a reasonable approach to management worldwide. In our previous cross-sectional study, patients who chose AS had better mental patient-reported outcomes (PRO) compared to those who underwent immediate surgery. This prospective, longitudinal study aimed to compare PROs between patients who chose AS and those who underwent surgery, during a one-year follow-up from the time of decision-making.

Methods: Among 78 patients with low-risk PTC (T < 15 mm, no extrathyroidal extension or metastasis), 58 chose AS and 20 chose immediate surgery, including conventional surgery (n =11) and video-assisted neck surgery (n =9). The SF-36v2 questionnaire was used to measure physical, mental, and role-social PRO. The survey was conducted at the next decision-making consultation and the one-year follow-up visit.

Results: In the entire cohort, mean age was 52.6 ± 12.4 years and 62 patients (79.4%) were women. Patients in the AS group were significantly older compared to the surgery group (58.8 ± 11.4 years vs. 46.0 ± 13.0 years, P = 0.011). In the initial survey, the surgery group had better scores for physical functioning (PF) and physical component summary (PCS) compared to the AS group. At one year after decision-making, the surgery group had better PF scores, but worse vitality (VT) and mental component summary (MCS) scores compared to the AS group. During the one-year follow-up, the AS group showed an improvement in general health (GH) but had a worsening in social functioning (SF) scores and role-social component summary (RCS). However, no significant changes were seen in other subscales in either group. In comparing the component summary scores of each management type with Japanese norm-based scores, the surgery group had better PCS, whereas the AS group had better MCS and RCS than the Japanese population norms. No subscale showed significantly worse outcomes compared to Japanese norm-based scores in either group during the survey.

Conclusions: This prospective, longitudinal study showed no inferiority in PROs compared to the Japanese norm-based scores, regardless of whether patients chose AS or immediate surgery, and some subscales had better scores. At one year after decision-making, patients who chose AS felt better mentally than those who underwent surgery; however, their role-social PRO deteriorated during follow-up. Longer follow-up is necessary to elucidate optimal management for individual patients with low-risk PTC in terms of aspects of PRO.