Clinical Topics & News

Is It Safe to Manage Thyroid Cancer by Surveillance?

Researchers examined the necessity of surveillance for small papillary carcinomas based on age after surgical treatment.


 

Research groups have suggested that small papillary thyroid cancers (PTCs) (< 2 cm) have been overdiagnosed and overtreated. But then the question is how to manage patients with small PTCs and the even smaller (< 1 cm) papillary microcarcinomas (PMCs).

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In 1993, physicians from Kuma Hospital, Kobe, Japan, initiated an active surveillance trial for patients with low-risk PMCs without worrisome features. They observed that only a minority of patients showed disease progression, and those patients were successfully treated with rescue surgery. The Cancer Institute Hospital in Tokyo reported similar promising data from a trial 2 years later. The 2015 American Thyroid Association guidelines now acknowledge that active surveillance can be an alternative to immediate surgery in patients with low-risk PMCs.

At Kuma Hospital, the researchers noted that over time disease progression differed according to patient age. Using data on 1,211 patients in their surveillance program from 1993 to 2011, they estimated the lifetime probabilities of disease progression during active surveillance.

The estimated trend curves of disease progression “varied markedly,” the researchers found, depending on the patient’s age at presentation. Patients in their 20s and 30s had a steep increase for the first 10 to 20 years, with a gradual increase thereafter. Patients in their 40s or older showed a milder increase. The estimated lifetime probability of disease progression fell with each decade of age at presentation.

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The researchers propose that surveillance be continued for the patient’s lifetime because tumors progress in a “small but noteworthy” percentage of patients. When patients with low-risk PMCs are treated surgically at presentation, they should still be followed after the surgery. Two- thirds of the patients who underwent immediate surgery still needed l-thyroxine and most likely will for their lifetime, the researchers note. However, PMCs that may progress after the 10-year point of active surveillance could be expected to have a very mild progressive nature, the researchers conclude, and the outcome of surgery should be excellent.

Source:

Miyauchi A, Kudo T, Ito Y, et al. Surgery. 2017. http://dx.doi.org/10.1016/j.surg.2017.03.028. In press.

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