Active surveillance of low-risk papillary thyroid cancer: A meta-analysis.

BACKGROUND: This study evaluates the safety and efficacy of active surveillance for low-risk papillary thyroid carcinoma.

METHODS: MEDLINE, EMBASE, and PubMed were searched from inception for relevant studies of active surveillance for low-risk papillary thyroid carcinoma, defined as T1a or T1b, N0, M0 disease. Main outcomes of interest were growth of primary tumor, metastatic spread, thyroid cancer-related mortality, and disease recurrence after delayed thyroid surgery.

RESULTS: Nine publications with 4,156 patients were included. Primary analysis of the 9 studies revealed pooled proportion of tumor growth during active surveillance to be 4.4% (95% confidence interval 3.2-5.8%). The pooled rate of metastatic spread to cervical nodes was 1.0% (95% confidence interval 0.7-1.4%), and pooled mortality due to thyroid cancer was 0.03% (95% confidence interval 0.0005-0.2%). Eight studies assessed incidence of delayed thyroid surgery with pooled proportion of 9.9% (95% confidence interval 6.4-14.0%). The main indication for surgery was patient preference, not disease progression, at 51.9% (95% confidence interval 44.9-58.9%). The pooled proportion of recurrence after delayed thyroid surgery was 1.1% (95% confidence interval 0.1-3.8%).

CONCLUSION: Active surveillance appears to be a safe alternative to surgery for the management of low-risk papillary thyroid carcinoma, without increased risk of recurrence or death. This strategy allows for avoidance of exposure to surgical risk and need for subsequent thyroid replacement therapy.