Điều trị ung thư tuyến giáp thể biệt hóa nguy cơ thấp: Các vấn đề đang tranh luận?

Tóm tắt

Hiện nay UTTG đứng hàng thứ 5 trong số các ung thư phổ biến nhất ở nữ giới. UTTG thể biệt hoá bao gồm thể nhú và thể nang chiếm phần lớn (> 90%) các loại UTTG¹. Ở Mỹ, tỉ lệ phát sinh UTTG thể biệt hóa đã tăng lên gấp 3 lần trong 30 năm. Sự gia tăng tỉ lệ phát sinh này chủ yếu ở nhóm có kích thước u ≤ 2 cm và đại đa số NB nhóm này được phân loại là nhóm “nguy cơ thấp”². Xu hướng thay đổi về kích thước u này dẫn tới việc thay đổi trong chiến lược điều trị ban đầu cũng như theo dõi lâu dài cho người bệnh UTTG thể biệt hóa. Các khuyến cáo điều trị hiện nay chủ yếu dựa trên dữ liệu quan sát hồi cứu thường không đầy đủ, ảnh hưởng bởi sai số lựa chọn. Do đó, các vấn đề liên quan đến quản lý và điều trị ung thư tuyến giáp thể biệt hóa nguy cơ thấp vẫn còn gây tranh cãi.Tổng quan này sẽ xem xét những tranh cãi xung quanh các chủ đề quan trọng trong điều trị bước đầu ung thư tuyến giáp thể biệt hóa nguy cơ thấp: lựa chọn theo dõi chủ động? Lựa chọn phẫu thuật với các mức độ phẫu thuật khác nhau? Lựa chọn đốt sóng cao tần? Vai trò của chẩn đoán hình ảnh trước mổ?

Từ khóa: Ung thư tuyến giáp thể biệt hóa, điều trị ban đầu, nguy cơ thấp.

Management of low-risk differentiated thyroid cancer: Current controversial issues?

Phan Hoang Hiep, Do Thanh Cong, Dinh Ngoc Trieu

National Hospital of Endocrinology

Abstract

Currently, thyroid cancer ranks 5th among the most common cancers in women. Differentiated thyroid cancer, including papillary and follicular thyroid cancer, accounts for most of all thyroid cancers (>90%). In the United States, the incidence of differentiated thyroid cancer has increased three-fold in the last 30 years. The rise in incidence has been the most rapid for tumors ≤ 2 cm, and the vast majority of patients in this group were classified as “low-risk”. This tendency to change in tumor size leads to a change in the initial treatment strategy as well as the long-term follow-up for patients with differentiated thyroid cancer. Current recommended treatments are based primarily on retrospective observational data that is often incomplete, influenced by selection bias. Therefore, issues related to treating low-risk differentiated thyroid cancer remain controversial. This overreview will examine the controversies surrounding essential topics in the initial treatment of low-risk differentiated thyroid cancer: active surveillance, surgical options with different extents of surgery, or radiofrequency ablation. What is the role of preoperative diagnostic imaging?

Keywords: Differentiated thyroid cancer, initial treatment, low-risk.

Tài liệu tham khảo

1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. Nov 2018;68(6):394-424.
2. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 2006;295(18):2164-2167.
3. Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a populationbased to a more “personalized” approach to cancer staging. CA: a cancer journal for clinicians. 2017;67(2):93-99.
4. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1-133.
5. Ito Y, Uruno T, Nakano K, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid. 2003;13(4):381-387.
6. Ito Y, Miyauchi A, Kihara M, Higashiyama T, Kobayashi K, Miya A. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid. 2014;24(1):27-34.
7. Brito JP, Ito Y, Miyauchi A, Tuttle RM. A clinical framework to facilitate risk stratification when considering an active surveillance alternative to immediate biopsy and surgery in papillary microcarcinoma. Thyroid. 2016;26(1):144-149.
8. Haddad RI, Bischoff L, Ball D, et al. Thyroid Carcinoma, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network. 2022;20(8):925-951.
9. Bilimoria KY, Bentrem DJ, Ko CY, et al. Extent of surgery affects survival for papillary thyroid cancer. Annals of surgery. 2007;246(3):375.
10. Hauch A, Al-Qurayshi Z, Randolph G, Kandil E. Total thyroidectomy is associated with increased risk of complications for low-and high-volume surgeons. Annals of surgical oncology. 2014;21(12):3844-3852.
11. Haigh PI, Urbach DR, Rotstein LE. Extent of thyroidectomy is not a major determinant of survival in low- or high-risk papillary thyroid cancer. Ann Surg Oncol. Jan 2005;12(1):81-9.
12. Barney BM, Hitchcock YJ, Sharma P, Shrieve DC, Tward JD. Overall and cause-specific survival for patients undergoing lobectomy, near-total, or total thyroidectomy for differentiated thyroid cancer. Head Neck. May 2011;33(5):645-9.
13. Nixon IJ, Ganly I, Patel SG, et al. Thyroid lobectomy for treatment of well differentiated intrathyroid malignancy. Surgery. Apr 2012;151(4):571-9.
14. Barczyński M, Konturek A, Stopa M, Nowak W. Prophylactic central neck dissection for papillary thyroid cancer. British Journal of Surgery. 2013;100(3):410-418.
15. Nixon I, Wang L, Ganly I, et al. Outcomes for patients with papillary thyroid cancer who do not undergo prophylactic central neck dissection. British Journal of Surgery. 2016;103(3):218-225.
16. Lang BH-H, Ng S-H, Lau LL, Cowling BJ, Wong KP, Wan KY. A systematic review and meta-analysis of prophylactic central neck dissection on short-term locoregional recurrence in papillary thyroid carcinoma after total thyroidectomy. Thyroid. 2013;23(9):1087-1098.
17. Wang TS, Cheung K, Farrokhyar F, Roman SA, Sosa JA. A meta-analysis of the effect of prophylactic central compartment neck dissection on locoregional recurrence rates in patients with papillary thyroid cancer. Annals of surgical oncology. 2013;20(11):3477-3483.
18. Zetoune T, Keutgen X, Buitrago D, et al. Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a meta-analysis. Annals of surgical oncology. 2010;17(12):3287-3293.
19. Mazzaferri EL. Approach to the pregnant patient with thyroid cancer. The Journal of Clinical Endocrinology & Metabolism. 2011;96(2):265-272.
20. Shindo H, Amino N, Ito Y, et al. Papillary thyroid microcarcinoma might progress during pregnancy. Thyroid. 2014;24(5):840-844.
21. Uruno T, Shibuya H, Kitagawa W, Nagahama M, Sugino K, Ito K. Optimal timing of surgery for differentiated thyroid cancer in pregnant women. World journal of surgery. 2014;38:704-708.
22. AlexanderErik K, PearceElizabeth N, BrentGregory A, et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017;
23. Zhou Y, Zhou Z, Qian M, Gong T, Wang J. Association of thyroid carcinoma with pregnancy: a meta-analysis. Molecular and Clinical Oncology. 2015;3(2):341-346.
24. Alves GV, Santin AP, Furlanetto TW. Prognosis of thyroid cancer related to pregnancy: a systematic review. Journal of Thyroid Research. 2011;2011
25. Gharib H, Papini E, Valcavi R, et al. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocrine Practice. 2006;12(1):63-102.
26. Gupta A, Ly S, Castroneves LA, et al. A standardized assessment of thyroid nodules in children confirms higher cancer prevalence than in adults. The Journal of Clinical Endocrinology & Metabolism. 2013;98(8):3238-3245.
27. Francis GL, Waguespack SG, Bauer AJ, et al. Management guidelines for children with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on pediatric thyroid cancer. Thyroid. 2015;25(7):716-759.
28. Wang Y, Zhou S, Liu X, et al. Transoral endoscopic thyroidectomy vestibular approach vs conventional open thyroidectomy: meta Head & neck. 2021;43(1):345-353.
29. Đinh Ngọc Triều, Trần Ngọc Lương, Đoàn Quốc Hưng. Kết quả phẫu thuật nội soi cắt một thùy tuyến giáp điều trị ung thư tuyến giáp thể biệt hóa nguy cơ thấp tại Bệnh viện Nội tiết trung ương. Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam. 01/26 2021;29:51-58. doi:10.47972/vjcts.v29i.463
30. Trần Ngọc Lương,Phan Hoàng Hiệp. Kết quả phẫu thuật nội soi điều trị ung thư tuyến giáp thể biệt hóa giai đoạn sớm. Y dược học quân sự. 2014;2:134-139.
31. Muhammad H, Santhanam P, Russell JO. Radiofrequency ablation and thyroid nodules: updated systematic review. Endocrine. 2021;72:619-632.
32. Cho SJ, Baek SM, Na DG, Lee KD, Shong YK, Baek JH. Five-year follow-up results of thermal ablation for low-risk papillary thyroid microcarcinomas: systematic review and meta-analysis. European Radiology. 2021;31(9):6446-6456.