ETA2024 Oral Presentations Oral Session 12: Clinical thyroid cancer research (7 abstracts)
Insights from active surveillance: patterns of papillary thyroid carcinoma growth and conversion surgery outcomes
Iwao Sugitani 1 , Tomoo Jikuzono 2 , Ryuta Nagaoka 2 , Marie Saitou 2 , Masaomi Sen 2 , Hiroko Kazusaka 2 , Mami Matsui 2 , Takeshi Abe 2 , Ryo Ito 2 , Tetsuji Morita 2 , Kazuhisa Toda 3 , Reimi Asaka 4 & Tomohiro Chiba 4
1Nippon Medical School Graduate School of Medicine, Department of Endocrine Surgery, Tokyo, Japan; 2Department of Endocrine Surgery, Nippon Medical School; 3Division of Head and Neck, Cancer Institute Hospital; 4Department of Pathology, Cancer Institute Hospital
Objectives: Studies on active surveillance (AS) for low-risk papillary thyroid carcinoma (PTC) have shown that tumors typically enlarge to some degree during youth but stabilize thereafter. However, concerns still exist regarding cases exhibiting rapid progression during observation. The present study reviewed AS outcomes since the 1990s and investigated tumor growth patterns alongside delayed conversion surgery results.
Methods: Patients with low-risk PTC (all T1a, occasional T1b, N0M0) autonomously selected their preferred management option (AS or immediate surgery). Tumor enlargement was defined as a ≥3 mm increase in maximal diameter from the initiation. Changes in tumor size were categorized into five groups: A (stable), B (early increase, ≤5 years of follow-up), C (late increase, >5 years of follow-up), D (rapid increase after stability, ≥5 mm increase per year), and E (decrease). Conversion surgery was generally performed when the tumor diameter reached 13 mm, concerns about extrathyroidal extension (ETE) arose, lymph node metastasis (LNM) appeared, or patient preference changed.
Results: AS involved 705 patients with a mean age at presentation of 53.4 ± 12.8 years and a median follow-up duration of 8 years (range, 1-29). Group distribution was as follows: 561 patients in group A (79.6%), 71 in group B (10.0%), 32 in group C (4.5%), 4 in group D (0.6%) and 37 in group E (5.2%). Conversion surgery rates were 4.8% (n = 27), 36.6% (n = 26), 15.6% (n = 5), 100% (n = 4), and 2.7% (n = 1) for each group, respectively. Notably, one case in group B was poorly differentiated thyroid carcinoma, and one in group D exhibited PTC with nodular fasciitis-like stroma. The remainder were conventional (n = 59) or follicular-variant (n = 2) PTC. Although six cases had minimal ETE and 12 had LNM, no recurrence has been observed in those who underwent conversion surgery thus far. Thirty-three patients (46.5%) in group B and 14 (43.8%) in group C who continued AS subsequently showed halted growth. Cases with cystic components displayed significantly greater variability in tumor size compared to those without (P = 0.039).
Conclusions: Long-term AS data indicate that most tumor enlargement occurs within 5 years, with over 40% experiencing growth cessation during observation. Rapid enlargements are rare. Moreover, identifying high-risk cases is exceedingly uncommon. Tumors with cystic changes exhibit significant variability in tumor diameter. AS can be considered a safe management approach for low-risk PTC.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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