Natural history and tumor volume kinetics of papillary thyroid cancers during active surveillance Journal Article


Authors: Tuttle, R. M.; Fagin, J. A.; Minkowitz, G.; Wong, R. J.; Roman, B.; Patel, S.; Untch, B.; Ganly, I.; Shaha, A. R.; Shah, J. P.; Pace, M.; Li, D.; Bach, A.; Lin, O.; Whiting, A.; Ghossein, R.; Landa, I.; Sabra, M.; Boucai, L.; Fish, S.; Morris, L. G. T.
Article Title: Natural history and tumor volume kinetics of papillary thyroid cancers during active surveillance
Abstract: IMPORTANCE: Active surveillance of low-risk papillary thyroid cancer (PTC) is now an accepted alternative to immediate surgery, but experience with this approach outside of Japan is limited. The kinetics (probability, rate, and magnitude) of PTC tumor growth under active surveillance have not been well defined. OBJECTIVE: To describe the kinetics of PTC tumor growth during active surveillance. DESIGN, SETTING, AND PARTICIPANTS: Cohort study of 291 patients undergoing active surveillance for low-risk PTC (intrathyroidal tumors ≤1.5 cm) with serial tumor measurements via ultrasonography at a tertiary referral center in the United States. INTERVENTION: Active surveillance. MAIN OUTCOMES AND MEASURES: The cumulative incidence, rate, and magnitude of the change in tumor diameter or volume, as well as associations with patient and tumor characteristics. RESULTS: Of the 291 patients, 219 (75.3%) were women; mean (SD) age was 52 (15) years. During a median (range) active surveillance of 25 (6-166) months, growth in tumor diameter of 3 mm or more was observed in 11 of 291 (3.8%) patients, with a cumulative incidence of 2.5% (2 years) and 12.1% (5 years). No regional or distant metastases developed during active surveillance. In all cases, 3-dimensional measurements of tumor volume allowed for earlier identification of growth (median, 8.2 months; range, 3-46 months before increase in tumor diameter). In multivariable analysis, both younger age at diagnosis (hazard ratio per year, 0.92; 95% CI, 0.87-0.98; P = .006) and risk category at presentation (hazard ratio for inappropriate, 55.17; 95% CI, 9.4-323.19; P < .001) were independently associated with the likelihood of tumor growth. Of the tumors experiencing volume growth, kinetics demonstrated a classic exponential growth pattern, with a median doubling time of 2.2 years (range, 0.5-4.8 years; median r2 = 0.75; range, 0.42-0.99). CONCLUSIONS AND RELEVANCE: The rates of tumor growth during active surveillance in a US cohort with PTCs measuring 1.5 cm or less were low. Serial measurement of tumor volumes may facilitate early identification of tumors that will continue to grow and thereby inform the timing of surveillance imaging and therapeutic interventions. © 2017 American Medical Association. All rights reserved.
Keywords: adult; aged; aged, 80 and over; middle aged; young adult; cohort studies; tumor volume; proportional hazards models; carcinoma, papillary; cohort analysis; health survey; pathology; proportional hazards model; tumor burden; watchful waiting; thyroid neoplasms; population surveillance; very elderly; humans; human; male; female
Journal Title: JAMA Otolaryngology - Head and Neck Surgery
Volume: 143
Issue: 10
ISSN: 2168-6181
Publisher: American Medical Association  
Date Published: 2017-10-01
Start Page: 1015
End Page: 1020
Language: English
DOI: 10.1001/jamaoto.2017.1442
PUBMED: 28859191
PROVIDER: scopus
PMCID: PMC5710258
DOI/URL:
Notes: Article -- Export Date: 4 December 2017 -- Source: Scopus
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MSK Authors
  1. James A Fagin
    107 Fagin
  2. Ronald A Ghossein
    296 Ghossein
  3. Ashok R Shaha
    535 Shaha
  4. Ariadne Bach
    56 Bach
  5. Snehal G Patel
    286 Patel
  6. Robert M Tuttle
    350 Tuttle
  7. Oscar Lin
    231 Lin
  8. Duan Li
    11 Li
  9. Richard J Wong
    228 Wong
  10. Luc Morris
    123 Morris
  11. Ian Ganly
    229 Ganly
  12. Mona M Sabra
    28 Sabra
  13. Stephanie Anne Fish
    16 Fish
  14. Jatin P Shah
    538 Shah
  15. Brian Untch
    23 Untch
  16. Benjamin Raphael Roman
    44 Roman
  17. Laura   Boucai
    12 Boucai
  18. Mark David Pace
    1 Pace