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Survival benefit of active surveillance for papillary thyroid carcinoma: a propensity score matching analysis based on SEER database

BACKGROUND: Over-treatment of papillary thyroid microcarcinoma (PTMC) has become a common issue. Although active surveillance (AS) has been proposed as an alternative treatment to immediate surgery for PTMC, its inclusion criteria and mortality risk have not been clearly defined. The purpose of this...

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Autores principales: Bi, Jinzhe, Lyu, Peng-fei, Wang, Yu, Zhang, Hao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290187/
https://www.ncbi.nlm.nih.gov/pubmed/37361590
http://dx.doi.org/10.3389/fonc.2023.1185650
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author Bi, Jinzhe
Lyu, Peng-fei
Wang, Yu
Zhang, Hao
author_facet Bi, Jinzhe
Lyu, Peng-fei
Wang, Yu
Zhang, Hao
author_sort Bi, Jinzhe
collection PubMed
description BACKGROUND: Over-treatment of papillary thyroid microcarcinoma (PTMC) has become a common issue. Although active surveillance (AS) has been proposed as an alternative treatment to immediate surgery for PTMC, its inclusion criteria and mortality risk have not been clearly defined. The purpose of this study was to investigate whether surgery can achieve significant survival benefits in patients with larger tumor diameter of papillary thyroid carcinoma (PTC), in order to evaluate the feasibility of expanding the threshold for active surveillance. METHODS: This study retrospectively collected data of patients with papillary thyroid carcinoma from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2019. The propensity score matching (PSM) method was used to minimize confounding factors and selection bias between the surgery and non-surgery groups, and to compare the clinical and pathological characteristics between the two groups based on the SEER cohort. Meanwhile, the impact of surgery on prognosis was compared using Kaplan-Meier estimates and Cox proportional hazard models. RESULTS: A total of 175,195 patients were extracted from the database, including 686 patients who received non-surgical treatment, and were matched 1:1 with patients who received surgical treatment using propensity score matching. The Cox proportional hazard forest plot showed that age was the most important factor affecting overall survival (OS) of patients, while tumor size was the most important factor affecting disease-specific survival (DSS) of patients. In terms of tumor size, there was no significant difference in DSS between PTC patients with tumor size of 0-1.0cm who underwent surgical treatment and those who underwent non-surgical treatment, and the relative survival risk began to increase after the tumor size exceeded 2.0cm. Additionally, the Cox proportional hazard forest plot showed that chemotherapy, radioactive iodine, and multifocality were negative factors affecting DSS. Moreover, the risk of death increased over time, and no plateau phase was observed. CONCLUSION: For patients with papillary thyroid carcinoma (PTC) staged as T1N0M0, AS is a feasible management strategy. As the tumor diameter increases, the risk of death without surgical treatment gradually increases, but there may be a threshold. Within this range, a non-surgical approach may be a potentially viable management strategy. However, beyond this range, surgery may be more beneficial for patient survival. Therefore, it is necessary to conduct more large-scale prospective randomized controlled trials to further confirm these findings.
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spelling pubmed-102901872023-06-25 Survival benefit of active surveillance for papillary thyroid carcinoma: a propensity score matching analysis based on SEER database Bi, Jinzhe Lyu, Peng-fei Wang, Yu Zhang, Hao Front Oncol Oncology BACKGROUND: Over-treatment of papillary thyroid microcarcinoma (PTMC) has become a common issue. Although active surveillance (AS) has been proposed as an alternative treatment to immediate surgery for PTMC, its inclusion criteria and mortality risk have not been clearly defined. The purpose of this study was to investigate whether surgery can achieve significant survival benefits in patients with larger tumor diameter of papillary thyroid carcinoma (PTC), in order to evaluate the feasibility of expanding the threshold for active surveillance. METHODS: This study retrospectively collected data of patients with papillary thyroid carcinoma from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2019. The propensity score matching (PSM) method was used to minimize confounding factors and selection bias between the surgery and non-surgery groups, and to compare the clinical and pathological characteristics between the two groups based on the SEER cohort. Meanwhile, the impact of surgery on prognosis was compared using Kaplan-Meier estimates and Cox proportional hazard models. RESULTS: A total of 175,195 patients were extracted from the database, including 686 patients who received non-surgical treatment, and were matched 1:1 with patients who received surgical treatment using propensity score matching. The Cox proportional hazard forest plot showed that age was the most important factor affecting overall survival (OS) of patients, while tumor size was the most important factor affecting disease-specific survival (DSS) of patients. In terms of tumor size, there was no significant difference in DSS between PTC patients with tumor size of 0-1.0cm who underwent surgical treatment and those who underwent non-surgical treatment, and the relative survival risk began to increase after the tumor size exceeded 2.0cm. Additionally, the Cox proportional hazard forest plot showed that chemotherapy, radioactive iodine, and multifocality were negative factors affecting DSS. Moreover, the risk of death increased over time, and no plateau phase was observed. CONCLUSION: For patients with papillary thyroid carcinoma (PTC) staged as T1N0M0, AS is a feasible management strategy. As the tumor diameter increases, the risk of death without surgical treatment gradually increases, but there may be a threshold. Within this range, a non-surgical approach may be a potentially viable management strategy. However, beyond this range, surgery may be more beneficial for patient survival. Therefore, it is necessary to conduct more large-scale prospective randomized controlled trials to further confirm these findings. Frontiers Media S.A. 2023-06-09 /pmc/articles/PMC10290187/ /pubmed/37361590 http://dx.doi.org/10.3389/fonc.2023.1185650 Text en Copyright © 2023 Bi, Lyu, Wang and Zhang https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Bi, Jinzhe
Lyu, Peng-fei
Wang, Yu
Zhang, Hao
Survival benefit of active surveillance for papillary thyroid carcinoma: a propensity score matching analysis based on SEER database
title Survival benefit of active surveillance for papillary thyroid carcinoma: a propensity score matching analysis based on SEER database
title_full Survival benefit of active surveillance for papillary thyroid carcinoma: a propensity score matching analysis based on SEER database
title_fullStr Survival benefit of active surveillance for papillary thyroid carcinoma: a propensity score matching analysis based on SEER database
title_full_unstemmed Survival benefit of active surveillance for papillary thyroid carcinoma: a propensity score matching analysis based on SEER database
title_short Survival benefit of active surveillance for papillary thyroid carcinoma: a propensity score matching analysis based on SEER database
title_sort survival benefit of active surveillance for papillary thyroid carcinoma: a propensity score matching analysis based on seer database
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290187/
https://www.ncbi.nlm.nih.gov/pubmed/37361590
http://dx.doi.org/10.3389/fonc.2023.1185650
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