Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Medas Fabio, Dobrinja Chiara, Al-Suhaimi Ebtesam Abdullah, Altmeier Julia, Anajar Said, Arikan Akif Enes, Azaryan Irina, Bains Lovenish, Basili Giancarlo, Bolukbasi Hakan, Bononi Marco, Borumandi Farzad, Bozan Mehmet Buğra, Brenta Gabriela, Brunaud Laurent, Brunner Maximilian, Buemi Antoine, Canu Gian Luigi, Cappellacci Federico, Cartwright Sara Burchfield, Castells Fusté Ignasi, Cavalheiro Beatriz, Cavallaro Giuseppe, Chala Andres, Chan Shun Yan Bryant, Chaplin John, Cheema Mustafa Sajjad, Chiapponi Costanza, Chiofalo Maria Grazia, Chrysos Emmanuel, D'Amore Annamaria, de Cillia Michael, De Crea Carmela, de Manzini Nicolò, de Matos Leandro Luongo, De Pasquale Loredana, Del Rio Paolo, Demarchi Marco Stefano, Dhiwakar Muthuswamy, Donatini Gianluca, Dora Jose Miguel, D'Orazi Valerio, Doulatram Gamgaram Viyey Kishore, Eismontas Vitalijus, Kabiri El Hassane, El Malki Hadj Omar, Elzahaby Islam, Enciu Octavian, Eskander Antoine, Feroci Francesco, Figueroa-Bohorquez David, Filis Dimitrios, François Gorostidi, Frías-Fernández Pedro, Gamboa-Dominguez Armando, Genc Volkan, Giordano Davide, Gómez-Pedraza Antonio, Graceffa Giuseppa, Griffin James, Guerreiro Sofia Cuco, Gupta Karan, Gupta Keshav Kumar, Gurrado Angela, Hajiioannou Jiannis, Hakala Tommi, Harahap Wirsma Arif, Hargitai Lindsay, Hartl Dana, Hellmann Andrzej, Hlozek Jiri, Hoang Van Trung, Iacobone Maurizio, Innaro Nadia, Ioannidis Orestis, Jang J H Isabelle, Xavier-Junior Jose Candido, Jovanovic Milan, Kaderli Reto Martin, Kakamad Fahmi, Kaliszewski Krzysztof, Karamanliev Martin, Katoh Hiroshi, Košec Andro, Kovacevic Bozidar, Kowalski Luiz Paulo, Králik Robert, Yadav Sanjay Kumar, Kumorová Adriána, Lampridis Savvas, Lasithiotakis Konstantinos, Leclere Jean-Christophe, Leong Eugene Kwong Fei, Leow Melvin Khee-Shing, Lim James Y, Lino-Silva Leonardo S, Liu Shirley Yuk Wah, Llorach Núria Perucho, Lombardi Celestino Pio, López-Gómez Javier, Lori Eleonora, Quintanilla-Dieck Lourdes, Lucchini Roberta, Madani Amin, Manatakis Dimitrios, Markovic Ivan, Materazzi Gabriele, Mazeh Haggi, Mercante Giuseppe, Meyer-Rochow Goswin Yason, Mihaljevic Olgica, Miller Julie A, Minuto Michele, Monacelli Massimo, Mulita Francesk, Mullineris Barbara, Muñoz-de-Nova José Luis, Muradás Girardi Fábio, Nader Saki, Napadon Tangjaturonrasme, Nastos Constantinos, Offi Chiara, Ronen Ohad, Oragano Luigi, Orois Aida, Pan Yongqin, Panagiotidis Emmanouil, Panchangam Ramakanth Bhargav, Papavramidis Theodosios, Parida Pradipta Kumar, Paspala Anna, Pérez Òscar Vidal, Petrovic Sabrina, Raffaelli Marco, Ramacciotti Constanza Fernanda, Ratia Gimenez Tomas, Rivo Vázquez Ángel, Roh Jong-Lyel, Rossi Leonardo, Sanabria Alvaro, Santeerapharp Alena, Semenov Arseny, Seneviratne Sanjeewa, Serdar Altinay, Sheahan Patrick, Sheppard Sean C, Slotcavage Rachel L, Smaxwil Constantin, Kim Soo Young, Sorrenti Salvatore, Spartalis Eleftherios, Sriphrapradang Chutintorn, Testini Mario, Turk Yigit, Tzikos George, Vabalayte Kristina, Vargas-Osorio Kelly, Vázquez Rentería Rafael Sebastián, Velázquez-Fernández David, Vithana Sanura Malinda Pallegoda, Yücel Levent, Yulian Erwin Danil, Zahradnikova Petra, Zarogoulidis Paul, Ziablitskaia Evgeniia, Zolotoukho Anna, Calò Pietro Giorgio, THYCOVID Collaboration Group
Аннотация
METHODS: In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186.
FINDINGS: Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039).
INTERPRETATION: Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation.
FUNDING: None.