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Management of Low-Risk Thyroid Cancers: Is Active Surveillance a Valid Option? A Systematic Review of the Literature

Thyroid cancer is the most common endocrine malignancy, representing 2.9% of all new cancers in the United States. It has an excellent prognosis, with a five-year relative survival rate of 98.3%.Differentiated Thyroid Carcinomas (DTCs) are the most diagnosed thyroid tumors and are characterized by a...

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Autores principales: Patrone, Renato, Velotti, Nunzio, Masone, Stefania, Conzo, Alessandra, Flagiello, Luigi, Cacciatore, Chiara, Filardo, Marco, Granata, Vincenza, Izzo, Francesco, Testa, Domenico, Avenia, Stefano, Sanguinetti, Alessandro, Polistena, Andrea, Conzo, Giovanni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397017/
https://www.ncbi.nlm.nih.gov/pubmed/34441866
http://dx.doi.org/10.3390/jcm10163569
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author Patrone, Renato
Velotti, Nunzio
Masone, Stefania
Conzo, Alessandra
Flagiello, Luigi
Cacciatore, Chiara
Filardo, Marco
Granata, Vincenza
Izzo, Francesco
Testa, Domenico
Avenia, Stefano
Sanguinetti, Alessandro
Polistena, Andrea
Conzo, Giovanni
author_facet Patrone, Renato
Velotti, Nunzio
Masone, Stefania
Conzo, Alessandra
Flagiello, Luigi
Cacciatore, Chiara
Filardo, Marco
Granata, Vincenza
Izzo, Francesco
Testa, Domenico
Avenia, Stefano
Sanguinetti, Alessandro
Polistena, Andrea
Conzo, Giovanni
author_sort Patrone, Renato
collection PubMed
description Thyroid cancer is the most common endocrine malignancy, representing 2.9% of all new cancers in the United States. It has an excellent prognosis, with a five-year relative survival rate of 98.3%.Differentiated Thyroid Carcinomas (DTCs) are the most diagnosed thyroid tumors and are characterized by a slow growth rate and indolent course. For years, the only approach to treatment was thyroidectomy. Active surveillance (AS) has recently emerged as an alternative approach; it involves regular observation aimed at recognizing the minority of patients who will clinically progress and would likely benefit from rescue surgery. To better clarify the indications for active surveillance for low-risk thyroid cancers, we reviewed the current management of low-risk DTCs with a systematic search performed according to a PRISMA flowchart in electronic databases (PubMed, Web of Science, Scopus, and EMBASE) for studies published before May 2021. Fourteen publications were included for final analysis, with a total number of 4830 patients under AS. A total of 451/4830 (9.4%) patients experienced an increase in maximum diameter by >3 mm; 609/4830 (12.6%) patients underwent delayed surgery after AS; metastatic spread to cervical lymph nodes was present in 88/4213 (2.1%) patients; 4/3589 (0.1%) patients had metastatic disease outside of cervical lymph nodes. Finally, no subject had a documented mortality due to thyroid cancer during AS. Currently, the American Thyroid Association guidelines do not support AS as the first-line treatment in patients with PMC; however, they consider AS to be an effective alternative, particularly in patients with high surgical risk or poor life expectancy due to comorbid conditions. Thus, AS could be an alternative to immediate surgery for patients with very-low-risk tumors showing no cytologic evidence of aggressive disease, for high-risk surgical candidates, for those with concurrent comorbidities requiring urgent intervention, and for patients with a relatively short life expectancy.
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spelling pubmed-83970172021-08-28 Management of Low-Risk Thyroid Cancers: Is Active Surveillance a Valid Option? A Systematic Review of the Literature Patrone, Renato Velotti, Nunzio Masone, Stefania Conzo, Alessandra Flagiello, Luigi Cacciatore, Chiara Filardo, Marco Granata, Vincenza Izzo, Francesco Testa, Domenico Avenia, Stefano Sanguinetti, Alessandro Polistena, Andrea Conzo, Giovanni J Clin Med Review Thyroid cancer is the most common endocrine malignancy, representing 2.9% of all new cancers in the United States. It has an excellent prognosis, with a five-year relative survival rate of 98.3%.Differentiated Thyroid Carcinomas (DTCs) are the most diagnosed thyroid tumors and are characterized by a slow growth rate and indolent course. For years, the only approach to treatment was thyroidectomy. Active surveillance (AS) has recently emerged as an alternative approach; it involves regular observation aimed at recognizing the minority of patients who will clinically progress and would likely benefit from rescue surgery. To better clarify the indications for active surveillance for low-risk thyroid cancers, we reviewed the current management of low-risk DTCs with a systematic search performed according to a PRISMA flowchart in electronic databases (PubMed, Web of Science, Scopus, and EMBASE) for studies published before May 2021. Fourteen publications were included for final analysis, with a total number of 4830 patients under AS. A total of 451/4830 (9.4%) patients experienced an increase in maximum diameter by >3 mm; 609/4830 (12.6%) patients underwent delayed surgery after AS; metastatic spread to cervical lymph nodes was present in 88/4213 (2.1%) patients; 4/3589 (0.1%) patients had metastatic disease outside of cervical lymph nodes. Finally, no subject had a documented mortality due to thyroid cancer during AS. Currently, the American Thyroid Association guidelines do not support AS as the first-line treatment in patients with PMC; however, they consider AS to be an effective alternative, particularly in patients with high surgical risk or poor life expectancy due to comorbid conditions. Thus, AS could be an alternative to immediate surgery for patients with very-low-risk tumors showing no cytologic evidence of aggressive disease, for high-risk surgical candidates, for those with concurrent comorbidities requiring urgent intervention, and for patients with a relatively short life expectancy. MDPI 2021-08-13 /pmc/articles/PMC8397017/ /pubmed/34441866 http://dx.doi.org/10.3390/jcm10163569 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Patrone, Renato
Velotti, Nunzio
Masone, Stefania
Conzo, Alessandra
Flagiello, Luigi
Cacciatore, Chiara
Filardo, Marco
Granata, Vincenza
Izzo, Francesco
Testa, Domenico
Avenia, Stefano
Sanguinetti, Alessandro
Polistena, Andrea
Conzo, Giovanni
Management of Low-Risk Thyroid Cancers: Is Active Surveillance a Valid Option? A Systematic Review of the Literature
title Management of Low-Risk Thyroid Cancers: Is Active Surveillance a Valid Option? A Systematic Review of the Literature
title_full Management of Low-Risk Thyroid Cancers: Is Active Surveillance a Valid Option? A Systematic Review of the Literature
title_fullStr Management of Low-Risk Thyroid Cancers: Is Active Surveillance a Valid Option? A Systematic Review of the Literature
title_full_unstemmed Management of Low-Risk Thyroid Cancers: Is Active Surveillance a Valid Option? A Systematic Review of the Literature
title_short Management of Low-Risk Thyroid Cancers: Is Active Surveillance a Valid Option? A Systematic Review of the Literature
title_sort management of low-risk thyroid cancers: is active surveillance a valid option? a systematic review of the literature
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397017/
https://www.ncbi.nlm.nih.gov/pubmed/34441866
http://dx.doi.org/10.3390/jcm10163569
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