Purpose

The current management guidelines for low-risk papillary thyroid microcarcinoma (PTMC) do not specify how to screen for growing tumors. We sought to explore the possible risk factors for tumor enlargement in patients with low-risk PTMC under active surveillance (AS).

Methods

We searched the PubMed and Embase databases for high quality studies up to January 10th, 2024. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies, and Review Manager 5.4 was used to analyze possible risk factors and calculate pooled risk ratios (RRs) via the inverse-variance calculation method.

Results

Eleven studies were included in our meta-analysis. Among the 8880 participants, 464 experienced tumor growth, and the incidence of tumor growth varied from 3.4% to 19.4%. The results of the meta-analysis showed that tumor enlargement was associated with younger age (pooled RR = 2.32, 95% CI = 1.85–2.90, p < 0.00001; 8 studies), and higher serum thyroid-stimulating hormone (TSH) levels (pooled RR = 2.28, 95% CI = 1.19–4.37, p = 0.01; 6 studies), and could be related to pregnancy (pooled RR = 2.54, 95% CI = 1.17–5.52, p = 0.02; 2 studies). However, these following factors showed no significant association with tumor growth: sex (pooled RR = 1.07, 95% CI = 0.63–1.84, p = 0.79; 7 studies), tumor size at diagnosis (pooled RR = 1.08, 95% CI = 0.63–1.85, p = 0.77; 5 studies), and Hashimoto’s thyroiditis (HT) (pooled RR = 1.56, 95% CI = 0.93–2.60, p = 0.09; 2 studies).

Conclusion

Our analysis identified that younger age and higher serum TSH levels were higher risk factors for tumor enlargement in low-risk PTMC patients. Pregnancy is a suspected risk factor.

中文翻译：

---

低危甲状腺微小乳头状癌患者肿瘤增大的危险因素：系统评价和荟萃分析

目的

目前的低风险甲状腺微小乳头状癌 (PTMC) 管理指南没有具体说明如何筛查正在生长的肿瘤。我们试图探讨主动监测（AS）下低危 PTMC 患者肿瘤增大的可能危险因素。

方法

我们检索了 PubMed 和 Embase 数据库中截至 2024 年 1 月 10 日的高质量研究。使用纽卡斯尔-渥太华量表（NOS）评估纳入研究的质量，使用 Review Manager 5.4 分析可能的风险因素并计算通过逆方差计算方法汇总风险比（RR）。

结果

我们的荟萃分析中纳入了十一项研究。在8880名参与者中，有464名经历了肿瘤生长，肿瘤生长的发生率从3.4%到19.4%不等。荟萃分析的结果显示，肿瘤增大与年轻年龄相关（汇总 RR = 2.32，95% CI = 1.85–2.90，p  < 0.00001；8 项研究）和较高的血清促甲状腺激素 (TSH) 水平（汇总 RR = 2.28，95% CI = 1.19–4.37，p  = 0.01；6 项研究），并且可能与妊娠有关（汇总 RR = 2.54，95% CI = 1.17–5.52，p  = 0.02；2 项研究）。然而，以下因素与肿瘤生长没有显着相关性：性别（汇总 RR = 1.07，95% CI = 0.63–1.84，p  = 0.79；7 项研究）、诊断时肿瘤大小（汇总 RR = 1.08，95% CI = 0.63–1.85，p  = 0.77；5 项研究）和桥本甲状腺炎 (HT)（汇总 RR = 1.56，95% CI = 0.93–2.60，p  = 0.09；2 项研究）。

结论

我们的分析发现，年龄较小和血清 TSH 水平较高是低风险 PTMC 患者肿瘤增大的较高危险因素。怀孕是一个可疑的危险因素。