Active Surveillance for Locoregional Recurrent Differentiated Thyroid Cancer: A Systematic Review and Meta-Analysis
Authors' conclusion
Reported progression rates of AS for locoregional recurrent DTC may be underestimated due to heterogeneity and follow-up loss. Consequently, AS should be considered with caution. Higher progression rates were observed in patients with elevated baseline serum thyroglobulin levels and advanced tumor stage, suggesting that these factors may help identify patients who require closer monitoring or earlier intervention.
Study context
- Population
- Patients with locoregional recurrent differentiated thyroid cancer (DTC) (thyroid bed nodules or lymph node metastases) managed with active surveillance after complete resection of the primary tumor
- Participants
- 841 patients10 retrospective studies
- Outcome
- Pooled progression rate during active surveillance
Methodological detailsrandom-effects model, subgroup, sensitivity and meta-regression analyses, modeling adjustment for follow-up loss, PRISMA
- Random-effects model
- Subgroup, sensitivity and meta-regression analyses
- Modeling adjustment for follow-up loss
- PRISMA
Pooled result
As reported in the abstract
Overall pooled progression rate
23%
95% CI 12–34%
Further pooled results
<40 months mean follow-up vs ≥40 months mean follow-up
Progression by mean follow-up duration · higher with <40 months
P < 0.05
Progression vs Stable
| Outcome | Progression | Stable | P value |
|---|---|---|---|
| Log-transformed baseline serum TgHigher with progression | 1.02 | −0.07 | P < 0.05 |
<75% Stage I vs ≥75% Stage I
Progression by proportion of Stage I patients (subgroup) · higher with <75% Stage I
P < 0.05
≥5% Stage IV vs <5% Stage IV
Progression by proportion of Stage IV patients (subgroup) · higher with ≥5% Stage IV
P < 0.05
Progression rate in biopsy-confirmed cases
- Pooled progression rate, biopsy-confirmed cases
- 32% (95% CI 15-55%)
Pooled progression rate adjusted for follow-up loss
- Adjusted pooled progression rate, up to
- 35-70%
Original publication
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