Thyroid-Stimulating Hormone, Age, and Tumor Size are Risk Factors for Progression During Active Surveillance of Low-Risk Papillary Thyroid Microcarcinoma in Adults
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 pati...
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| Veröffentlicht in: | World journal of surgery 2023-02, Vol.47 (2), p.392-401 |
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| creator | Ito, Yasuhiro Miyauchi, Akira Fujishima, Makoto Noda, Takuya Sano, Tsutomu Sasaki, Takahiro Kishi, Taketoshi Nakamura, Tomohiko |
| description | 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 ( |
| doi_str_mv | 10.1007/s00268-022-06770-z |
| format | Article |
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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.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-022-06770-z</identifier><identifier>PMID: 36182976</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Abdominal Surgery ; Adult ; Cardiac Surgery ; Chi-square test ; Enlargement ; General Surgery ; Graves' disease ; Humans ; Lymph nodes ; Medicine ; Medicine & Public Health ; Metastases ; Metastasis ; Multivariate analysis ; Original Scientific Report ; Rank tests ; Retrospective Studies ; Risk analysis ; Risk Factors ; Surgery ; Surveillance ; Thoracic Surgery ; Thyroid ; Thyroid gland ; Thyroid Neoplasms - pathology ; Thyroid Neoplasms - surgery ; Thyroid-stimulating hormone ; Thyrotropin ; Tumors ; Vascular Surgery ; Watchful Waiting</subject><ispartof>World journal of surgery, 2023-02, Vol.47 (2), p.392-401</ispartof><rights>The Author(s) 2022. corrected publication 2022</rights><rights>2023 The Author(s)</rights><rights>2022. The Author(s).</rights><rights>The Author(s) 2022. corrected publication 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2022, corrected publication 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5915-be2031b55a1c03103d0b5d21ce995a325e1f7a0dcf75d76c2c94fd41b00643203</citedby><cites>FETCH-LOGICAL-c5915-be2031b55a1c03103d0b5d21ce995a325e1f7a0dcf75d76c2c94fd41b00643203</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00268-022-06770-z$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-022-06770-z$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,41464,42533,45550,45551,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36182976$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ito, Yasuhiro</creatorcontrib><creatorcontrib>Miyauchi, Akira</creatorcontrib><creatorcontrib>Fujishima, Makoto</creatorcontrib><creatorcontrib>Noda, Takuya</creatorcontrib><creatorcontrib>Sano, Tsutomu</creatorcontrib><creatorcontrib>Sasaki, Takahiro</creatorcontrib><creatorcontrib>Kishi, Taketoshi</creatorcontrib><creatorcontrib>Nakamura, Tomohiko</creatorcontrib><title>Thyroid-Stimulating Hormone, Age, and Tumor Size are Risk Factors for Progression During Active Surveillance of Low-Risk Papillary Thyroid Microcarcinoma in Adults</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>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.</description><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Cardiac Surgery</subject><subject>Chi-square test</subject><subject>Enlargement</subject><subject>General Surgery</subject><subject>Graves' disease</subject><subject>Humans</subject><subject>Lymph nodes</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Multivariate analysis</subject><subject>Original Scientific Report</subject><subject>Rank tests</subject><subject>Retrospective Studies</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Surveillance</subject><subject>Thoracic Surgery</subject><subject>Thyroid</subject><subject>Thyroid gland</subject><subject>Thyroid Neoplasms - pathology</subject><subject>Thyroid Neoplasms - surgery</subject><subject>Thyroid-stimulating hormone</subject><subject>Thyrotropin</subject><subject>Tumors</subject><subject>Vascular Surgery</subject><subject>Watchful Waiting</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>24P</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNUk2P0zAUjBCI7S78AQ7IEhcOG3i2Y7vhgFQWyoKKWNEijpbjOF0vSVzspKv27_BHcTZl-TggLrblNzOa994kySMMzzCAeB4ACJ-mQEgKXAhI93eSCc4oSQkl9G4yAcqz-Mb0KDkO4QoACw78fnJEOZ6SXPBJ8n11ufPOlumys01fq862a3TufONac4pm63iotkSrvnEeLe3eIOUN-mTDVzRXunM-oCpWLrxbexOCdS163ftBZKY7uzVo2futsXWtWm2Qq9DCXac39Au1Gb79Dh0soA9We6eV17Z1jUK2RbOyr7vwILlXqTqYh4f7JPk8f7M6O08XH9--O5stUs1yzNLCEKC4YExhHR9ASyhYSbA2ec4UJczgSigodSVYKbgmOs-qMsMFAI9DA3qSvBx1N33RmFKbtvOqlhtvm2hTOmXln5XWXsq128p8ClQwHAWeHgS8-9ab0MnGBm2G5o3rgySCQEYyPhUR-uQv6JXrfRvbiyiWZwOMRxQZUXEwIXhT3ZrBIIcMyDEDMmZA3mRA7iPp8e9t3FJ-Lj0CXoyAa1ub3X9Iyi_vl6_mMT05i2Q6ksNmWLPxv4z_w9MPwpjRMQ</recordid><startdate>202302</startdate><enddate>202302</enddate><creator>Ito, Yasuhiro</creator><creator>Miyauchi, Akira</creator><creator>Fujishima, Makoto</creator><creator>Noda, Takuya</creator><creator>Sano, Tsutomu</creator><creator>Sasaki, Takahiro</creator><creator>Kishi, Taketoshi</creator><creator>Nakamura, Tomohiko</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>202302</creationdate><title>Thyroid-Stimulating Hormone, Age, and Tumor Size are Risk Factors for Progression During Active Surveillance of Low-Risk Papillary Thyroid Microcarcinoma in Adults</title><author>Ito, Yasuhiro ; Miyauchi, Akira ; Fujishima, Makoto ; Noda, Takuya ; Sano, Tsutomu ; Sasaki, Takahiro ; Kishi, Taketoshi ; Nakamura, Tomohiko</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5915-be2031b55a1c03103d0b5d21ce995a325e1f7a0dcf75d76c2c94fd41b00643203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Cardiac Surgery</topic><topic>Chi-square test</topic><topic>Enlargement</topic><topic>General Surgery</topic><topic>Graves' disease</topic><topic>Humans</topic><topic>Lymph nodes</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Multivariate analysis</topic><topic>Original Scientific Report</topic><topic>Rank tests</topic><topic>Retrospective Studies</topic><topic>Risk analysis</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Surveillance</topic><topic>Thoracic Surgery</topic><topic>Thyroid</topic><topic>Thyroid gland</topic><topic>Thyroid Neoplasms - pathology</topic><topic>Thyroid Neoplasms - surgery</topic><topic>Thyroid-stimulating hormone</topic><topic>Thyrotropin</topic><topic>Tumors</topic><topic>Vascular Surgery</topic><topic>Watchful Waiting</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ito, Yasuhiro</creatorcontrib><creatorcontrib>Miyauchi, Akira</creatorcontrib><creatorcontrib>Fujishima, Makoto</creatorcontrib><creatorcontrib>Noda, Takuya</creatorcontrib><creatorcontrib>Sano, Tsutomu</creatorcontrib><creatorcontrib>Sasaki, Takahiro</creatorcontrib><creatorcontrib>Kishi, Taketoshi</creatorcontrib><creatorcontrib>Nakamura, Tomohiko</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ito, Yasuhiro</au><au>Miyauchi, Akira</au><au>Fujishima, Makoto</au><au>Noda, Takuya</au><au>Sano, Tsutomu</au><au>Sasaki, Takahiro</au><au>Kishi, Taketoshi</au><au>Nakamura, Tomohiko</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Thyroid-Stimulating Hormone, Age, and Tumor Size are Risk Factors for Progression During Active Surveillance of Low-Risk Papillary Thyroid Microcarcinoma in Adults</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2023-02</date><risdate>2023</risdate><volume>47</volume><issue>2</issue><spage>392</spage><epage>401</epage><pages>392-401</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>36182976</pmid><doi>10.1007/s00268-022-06770-z</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | World journal of surgery, 2023-02, Vol.47 (2), p.392-401 |
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| source | MEDLINE; Springer Nature - Complete Springer Journals; Wiley Online Library Journals Frontfile Complete |
| subjects | Abdominal Surgery Adult Cardiac Surgery Chi-square test Enlargement General Surgery Graves' disease Humans Lymph nodes Medicine Medicine & Public Health Metastases Metastasis Multivariate analysis Original Scientific Report Rank tests Retrospective Studies Risk analysis Risk Factors Surgery Surveillance Thoracic Surgery Thyroid Thyroid gland Thyroid Neoplasms - pathology Thyroid Neoplasms - surgery Thyroid-stimulating hormone Thyrotropin Tumors Vascular Surgery Watchful Waiting |
| title | Thyroid-Stimulating Hormone, Age, and Tumor Size are Risk Factors for Progression During Active Surveillance of Low-Risk Papillary Thyroid Microcarcinoma in Adults |
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