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Active Surveillance Versus Immediate Surgery: Questionnaire Survey on the Current Treatment Strategy for Adult Patients with Low-Risk Papillary Thyroid Microcarcinoma in Japan
- Source :
- Thyroid
- Publication Year :
- 2019
- Publisher :
- Mary Ann Liebert Inc, 2019.
-
Abstract
- Background: Two Japanese prospective trials of active surveillance (AS) for adult patients with low-risk papillary thyroid carcinoma (PTC) ≤1 cm (cT1aN0M0 PTMC) have verified the safety of AS in oncological control and its superiority over immediate surgery with respect to unfavorable outcomes. Thus, AS has been accepted as an alternative to immediate surgery for asymptomatic papillary thyroid microcarcinomas (PTMCs). However, the real-world clinical approach for PTMC is unknown. Thus, this study aimed to investigate the current state of management of asymptomatic PTMCs in Japan. Methods: We conducted a questionnaire survey on the actual treatment patterns for adult patients with low-risk PTMCs. The subjects were member institutions of the Japan Association of Endocrine Surgery (JAES) or Japanese Society of Thyroid Surgery (JSTS), including the departments of surgery and head and neck surgery (HNS). Results: Responses were obtained from 134 institutes, where 72.4% of Japanese thyroid cancer cases operated by surgeons were treated. For suspicious tumors on ultrasound, 18 responders (13.4%) conducted cytological examination routinely, while 69 (51.5%) and 40 (27.8%) conducted it only for tumors >5 and >10 mm, respectively. After the diagnosis, 42 responders (31.3%) recommend AS, 35 (26.1%) recommend immediate surgery as the management, and 52 (38.8%) allowed patients to decide the treatment course. The present responders tended to recommend surgery for PTMCs that were located adjacent to the dorsal surface of the thyroid, were multiple, or measured almost 10 mm in size. At these institutions, 1176 patients with PTMC underwent surgery in 2017, accounting for 18.1% of surgeries for PTC. During the succeeding three months, 310 of 576 (53.8%) PTMC patients underwent AS. The treatment strategies did not differ between the departments (Surgery or HNS). The institutions that have six or more surgeons, that were located in metropolitan areas, or that were certified by JAES or JSTS performed AS more actively. Conclusion: More than 50% of low-risk PTMCs are on AS in Japan. However, the indication and recommendation for AS vary significantly between institutions. To improve the implementation of this management modality, physicians and patients should be further educated, and the sociomedical environment should be improved.
- Subjects :
- Adult
Male
Risk
Pediatrics
medicine.medical_specialty
endocrine system diseases
Endocrinology, Diabetes and Metabolism
Papillary Thyroid Microcarcinoma
030209 endocrinology & metabolism
Time-to-Treatment
immediate surgery
Thyroid carcinoma
03 medical and health sciences
0302 clinical medicine
Endocrinology
Japan
Surveys and Questionnaires
Humans
Medicine
papillary thyroid microcarcinoma
Prospective Studies
Thyroid Neoplasms
Watchful Waiting
Aged
Ultrasonography
Surgeons
Adult patients
business.industry
active surveillance
Disease Management
Questionnaire
Thyroid Cancer and Nodules
Middle Aged
questionnaire survey
Carcinoma, Papillary
Treatment Outcome
030220 oncology & carcinogenesis
Thyroidectomy
Treatment strategy
Female
business
management
Subjects
Details
- ISSN :
- 15579077 and 10507256
- Volume :
- 29
- Database :
- OpenAIRE
- Journal :
- Thyroid
- Accession number :
- edsair.doi.dedup.....faa8e34441f23b4a25472f945eea3771