Follow-up strategy of radiofrequency ablation for papillary thyroid microcarcinoma: defining a response-to-ablation system.
Eur Radiol
; 34(2): 761-769, 2024 Feb.
Article
em En
| MEDLINE
| ID: mdl-37597031
ABSTRACT
OBJECTIVE:
To define a response-to-ablation system based on dynamic risk stratification proposed by the 2015 American Thyroid Association guidelines for predicting clinical outcomes and guiding follow-up strategies for patients with low-risk papillary thyroid microcarcinoma (PTMC) who underwent radiofrequency ablation (RFA).METHODS:
This retrospective study reviewed patients with low-risk PTMC who underwent RFA between 2014 and 2018. We classified patients into three groups based on their response to therapy at the 1-year follow-up complete, indeterminate, and incomplete. The primary endpoints were local tumor progression (LTP) and disease-free survival (DFS).RESULTS:
Among the 748 patients (mean age, 43.7 years ± 9.8; 586 women), 4.0% (30/748) had LTP during a median follow-up of 5 years. The response was complete in 80.2% (600/748) of the patients, indeterminate in 18.1% (135/748), and incomplete in 1.7% (13/748). The LTP rate in the final follow-up was 1% (6/600), 8.1% (11/135), and 100% (13/13), respectively. The risk of LTP was significantly different in the incomplete response group (HR, 1825.82; 95% CI 458.27, 7274.36; p < 0.001) and indeterminate response group (HR, 8.12; 95% CI 2.99, 22.09; p < 0.001) than in the complete response group. There were significant differences in DFS among groups (p < 0.001). The proportion of variation explained and C-index of the system was high (27.66% and 0.79, respectively).CONCLUSIONS:
We defined a response-to-ablation system that provides a new paradigm for the management of patients with PTMC who underwent RFA. Our data confirm that the system can effectively predict the risk of LTP and guide ongoing follow-up recommendations. KEY POINTS ⢠The response-to-ablation system can classify patients with low-risk PTMC who underwent RFA into complete, indeterminate, or incomplete response categories. ⢠Results suggest that, in this population, this system can identify three separate cohorts of patients who have significantly different clinical outcomes. ⢠The response-to-ablation system will help better tailor the ongoing follow-up recommendations.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Neoplasias da Glândula Tireoide
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Carcinoma Papilar
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Ablação por Radiofrequência
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article