Active Surveillance for Low-Risk Papillary Thyroid Microcarcinoma in China: A Prospective Study on Progression, Influencing Factors, and Cost-Effectiveness.

BACKGROUND

The rising detection rate of papillary thyroid microcarcinoma (PTMC) necessitates effective management strategies to prevent overtreatment. Active surveillance (AS) has emerged as a potential solution; however, its applicability and cost-effectiveness within China's healthcare system need further investigation. This study aims to evaluate the feasibility and economic benefits of AS for Chinese patients with PTMC.

METHODS

This prospective study enrolled 145 PTMC patients at Ruijin Hospital, Shanghai. We analyzed progression risk factors and compared 5-year medical costs between AS and immediate surgery (IS), employing SPSS 26 and R for Kaplan-Meier and COX survival analyses.

RESULTS

Among the 145 participants, 105 completed the study. According to the Kaplan-Meier analysis, the cumulative progression rate in our study was 13% (95% CI: 0.05-0.20) over 35 months. Among these patients, 26 underwent surgery, and a higher lymph node metastasis rate was observed in patients with disease progression (61.5%) compared to those without progression (7.7%). Risk factors for PTMC progression included calcification, age, and tumor size. Economically, AS was theoretically more cost-effective than IS. The medical expense of IS with subsequent 5 years follow-up was approximately 6 times higher than that of a 5-year regimen of AS.

CONCLUSIONS

AS is a cost-effective option for managing low-risk PTMC in China. High resolution ultrasonography allowed to detect disease progression. Patients younger than 40 years, the presence of initial tumor microcalcifications, and tumor size exceeding 7 mm were significantly associated with disease progression. Further validation of these findings is needed with larger sample sizes.