ThyroidActive surveillance of low-risk papillary thyroid cancer: A meta-analysis
Section snippets
Background
The increasing incidence of thyroid cancer worldwide is attributed in large to increased utilization of ultrasound and technical advances coupled to formal population screening programs.1, 2, 3, 4 Although the incidence of papillary thyroid cancer (PTC) has been rapidly increasing, the associated mortality has not changed substantially in North America.2 This can be attributed to the fact that the majority of PTC diagnosed incidentally by imaging are papillary thyroid microcarcinoma (PTMC)
Data search and study selection
A systematic search was conducted of EMBASE, MEDLINE, and PubMed (from inception to September 2018) for English language publications using the keywords “active surveillance,” “microcarcinoma”, “cancer,” and “thyroid carcinoma.” The references of relevant literature were also reviewed for applicable publications. All publications were reviewed independently by 2 team members and assessed for inclusion. All discrepancies between reviewers were resolved by consensus. Inclusion criteria included
Study selection
A total of 2,821 articles were identified, and 65 articles selected for full text review as outlined in Fig 1. In full text review, 12 studies met inclusion criteria, with 9 publications included for analysis, and 3 excluded as they contained duplicate populations.
Individual study characteristics
A total of 9 publications were included for final analysis. All publications were cohort studies; 4 were prospective, and 5 were retrospective in design. Across the 9 studies, a total of 4,156 patients were followed with AS after
Discussion
In this meta-analysis, 4.4% (95% CI 3.2–5.8%) demonstrated growth of their tumor with only 1.0% (95% CI 0.7–1.4%) developing cervical lymph node metastasis and 0.04% (95% CI 0.002–0.2%) developing metastatic disease. Most importantly, the pooled mortality related to thyroid cancer was 0.03% (95% CI 0.0005–0.2%). For the 9.9% (95% CI 6.4–14.0%) of patients undergoing DTS during surveillance only 1.1% (95% CI 0.1–3.8%) developed recurrent disease. These results are limited with regards to tumor
Funding/Support
None to declare.
Conflict of interest/Disclosure
Dr. T. McMullen is a paid consultant with Galapagos LLC and has received speaker fees from Novartis. No other competing interests are declared.
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