Fewer adults with low-risk papillary microcarcinoma undergoing conversion surgery
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Adults in Japan with low-risk papillary microcarcinoma were less likely to undergo conversion surgery if active surveillance began after December 2011 than from February 2005 to November 2011, according to study data.
“Patients with papillary microcarcinoma in the latter part of our experience were significantly less likely to undergo conversion surgery than those in the earlier experience with active surveillance,” Akira Miyauchi, MD, PhD, president and chief operating officer of Kuma Hospital in Kobe, Japan, and colleagues wrote in a study published in Thyroid. “This is probably because the accumulation of favorable outcomes with this management strategy significantly contributed to physicians’ confidence and patients’ trust and understanding of the disease.”
Researchers enrolled 2,288 adults with low-risk papillary microcarcinoma who had electronic records at Kuma Hospital from February 2005 to June 2017 and chose to have active surveillance. Active surveillance consisted of regular follow-up with ultrasonography and thyroid function tests either once or twice a year. Of the study cohort, 162 participants had conversion surgery (87.65% women; median age, 52 years). Researchers asked those who had conversion surgery for their reason behind the decision. The size of the tumor in each participant and the time they began active surveillance were also analyzed.
Of the 162 participants who had conversion surgery, 57 underwent surgery due to disease progression, 43 had surgery based on their own preference, 31 said the surgery was based on physician preference, 21 had coexisting enlargement of benign nodules, three had hyperparathyroidism, two began immunosuppressive therapy for autoimmune diseases such as rheumatoid arthritis, and the reasons for five were unknown. Of the disease progression group, 42 participants had tumor enlargement and 15 had new lymph node metastasis.
“For physician preference, multiple endocrine surgeons, endocrinologists, and head and neck surgeons saw the patients for a long period of time at the Kuma Hospital,” the researchers wrote. “Some physicians tended to recommend surgery for minor findings, such as a slight increase in tumor size, tumor location near the trachea or dorsal portion of the thyroid lobe, or possible presence of multiple foci.”
Those who had surgery due to disease progression had a larger tumor size than the patient preference or physician preference cohorts. Additionally, 27.9% in the patient preference group and 16.1% in the physician preference group had a tumor volume doubling rate of less than –0.1 per year. Of those groups, 11.6% in patient preference and 6.5% in physician preference had at least a 50% reduction in tumor volume before surgery. In the disease progression group, 5.3% had a tumor volume doubling rate of less than –0.1 per year, and all those individuals had surgery due to new appearances of lymph node metastasis.
When the study cohort was divided into a first-half group that commenced surveillance between February 2005 and November 2011 (n = 561) and a second-half group in which surveillance began between December 2011 and June 2017 (n = 1,727), those in the second-half cohort were less likely to have conversion surgery than the first-half group (4.2% vs. 12.3%; P < .001). The percentage of individuals having conversion surgery remained lower in the second-half group in analysis of the disease progression, patient preference and physician preference subgroups.
“It was previously demonstrated that the proportion of patients with low-risk papillary microcarcinoma who chose active surveillance has gradually increased from 42% between 2003 and 2006, to 64% between 2007 and 2013, and 88% since 2014,” the researchers wrote. “This may be because the accumulation of favorable outcomes for active surveillance made attending physicians explain its merits to their patients based on more convincing data. Also, this may have resulted in patients’ trust in their physicians and active surveillance management of their disease. This can explain the significantly lower cumulative conversion rates during the second-half period in the patient preference and physician preference groups.”
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