| Autor: |
Kim MJ; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea., Won H; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea., Kim WB; Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Lee EK; Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea., Lee CY; Department of Radiology, National Cancer Center, Goyang, Republic of Korea., Cho SW; Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea., Baek HS; Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea., Lee YS; Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Republic of Korea., Kang YE; Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea., Kim SW; Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., Kang HC; Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea., Lee J; Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea., Kim M; Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.; Biomedical Research Institute, Pusan National University Hospital, Yangsan, Republic of Korea., Jeon MJ; Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Moon JH; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. |
| Abstrakt: |
Background: Patients diagnosed with low-risk papillary thyroid microcarcinoma (PTMC) face the decision between thyroid lobectomy and active surveillance (AS). This study aimed to investigate the factors influencing treatment decisions in low-risk PTMC and to compare the quality of life (QoL) according to the treatment plan. Methods: The multicenter prospective cohort study comparing AS and thyroid lobectomy was conducted. Clinical characteristics were compared between the AS and Lobectomy groups. QoL questionnaires were administered every 6 months in the initial year and annually thereafter. Results: A total of 927 patients (453 in the AS group and 474 in the Lobectomy group) with low-risk PTMC were included in this study. The mean age was 47.4 ± 12.2 years, and 72.2% of the patients were women. Older age (odd ratio [OR] 1.04, confidence interval [CI] 1.02-1.05, p < 0.001), smaller tumor size (OR 0.78, CI 0.69-0.87, p < 0.001), family history of thyroid cancer (OR 1.48, CI 1.03-2.12, p = 0.035), prior awareness of AS (OR 1.53, CI 1.16-2.02, p = 0.003), and higher income (OR 1.79, CI 1.13-2.83, p = 0.013) were significantly associated with a higher likelihood of choosing AS. The median follow-up was 27.3 months (23.9-43.9) in the AS group and 28.7 months (20.4-44.5) in the Lobectomy group. During the follow-up period, the AS group showed significantly better QoL scores compared with the Lobectomy group ( β 0.17, CI 0.02-0.33, p = 0.029). Although baseline QoL scores favored the AS group significantly (7.1 ± 1.2 vs. 6.7 ± 1.2, p < 0.001), no significant difference was observed after 12 months (7.2 ± 1.2 vs. 7.1 ± 1.2, p = 0.592). Conclusions: This study demonstrated that age, tumor size, family history of thyroid cancer, awareness of AS, and income were associated with patients' treatment choices. Although the overall QoL scores were significantly higher in the AS group, the QoL became similar between the two groups after 12 months. Clinical Trial Registration: KCT0004935. |
