Long-Term Durability of Active Surveillance of Small, Low-Risk Papillary Thyroid Cancer

作者：Anna M. Sawka, Sangeet Ghai, Lorne Rotstein, Jonathan C. Irish, Jesse D. Pasternak, Eric Monteiro, Janet Chung, Jie Su, Wei Xu, Alex O. Esemezie, Jennifer M. Jones, Amiram Gafni, Nancy N. Baxter, David P. Goldstein, Canadian Thyroid Cancer Active Surveillance Study Group (Greater Toronto Area), Avik Banerjee, Vinita Bindlish, Maky Hafidh, Jose Prudencio, Vinod Bharadwaj, Denny Lin, Laura Whiteacre, Eric Arruda, Artur Gevorgyan, Marshall Hay, Philip Solomon, Karen Hernandez, Allan Vescan, Ian Witterick, Everton Gooden, Manish D. Shah, Michael Chang, Andres Gantous, Jennifer Anderson, Vinay T. Fernandes, Sumeet Anand, Danny Enepekides, Antoine Eskander, Ilana Halperin, Kevin Higgins, Karim Nazarali, Lorne Segall, John R. de Almeida, Shereen Ezzat, Ralph Gilbert, Patrick Gullane, Amin Madani, Richard Tsang, Mark Korman, Karen Devon, Afshan Zahedi · 发表于：JAMA Surgery · 年份：2025 · DOI：10.1001/jamasurg.2025.2957 · 被引用次数：8 · 研究领域：Thyroid Cancer Diagnosis and Treatment、Thyroid and Parathyroid Surgery、Multiple and Secondary Primary Cancers

Importance: In managing early-stage cancers, active surveillance (AS) may be preferentially favored by older individuals. In counseling patients, it is important to understand the durability of AS in the context of age. Objective: To evaluate the durability of AS in patients with small, low-risk papillary thyroid cancer (PTC) according to age at the time of choosing AS. Design, Setting, and Participants: This single-center, prospective, long-term follow-up cohort study was conducted at a tertiary care hospital in Toronto, Ontario, Canada. Adult patients with small, localized, low-risk PTC less than 2 cm in maximal diameter were enrolled between May 2016 and February 2021. The clinical outcome data were analyzed up to the time point of May 25, 2025, and final data analysis was performed in June 2025. Exposure: All patients were offered the choice of AS or thyroid surgery. Main Outcomes and Measures: The primary outcome was the overall rate of AS crossover to definitive treatment (treatment completed or recommended by an investigator) and the indications. Cumulative crossover incidence function curves were examined according to age, with death from other causes as the competing risk. Results: A total of 200 patients (155 patients under AS and 45 who had immediate surgery) were followed up for a median (IQR) duration of 71 (59-84) months. Overall mean (SD) age was 52.0 (14.9) years, and 153 patients (76.5%) were female. There were no observed thyroid cancer-related deaths or any...