甲状腺微小乳头状癌复发危险因素的网状Meta分析

doi:10.13481/j.1671-587X.20230613

Abstract

Abstract:

Objective To discuss the risk factors of recurrence of papillary thyroid microcarcinoma （PTMC），and to provide the reference for the individualized diagnosis and treatment of PTMC. Methods The retrieval time was limited from the establishment to April 2022， and the case-control studies related to PTMC recurrence searched in PubMed， EMBase， Elsevier Science Direct and Web of Science Databases were collected.Review Manager 5.4 software was used to perform the Meta-analysis and ADDIS 1.16.8 software was used to make the Bayesian network Meta-analysis，and the risk factors of PTMC recurrence were screened out and ranked. Results Fourteen studies were included， involving 7 834 PTMC patients who underwent surgical treatment，302 patients experienced lymphnode recurrence， local thyroid bed recurrence， or distant metastasis recurrence. Age， multifocality， tumor size， extrathyroidal invasion， lymphnode metastasis， and vascular invasion of the patients were related to the PTMC recurrence （P<0.05）. Lymphnode metastasis was the most significant risk factor for the PTMC recurrence， followed by vascular invasion， and multifocality was the least significant risk factor. There were no significant correlations between gender， lesion histopathological background， gland histopathological background， radioactive iodine treatment， surgical margin， and the extent of thyroidectomy with PTMC recurrence （P>0.05）. Conclusion Lymphnode metastasis， vascular invasion， tumor size>5 mm，age，extrathyroidal invasion， and multifocality are the risk factors for the PTMC recurrence.The clinician may consider to treat the PTMC patients with routine central lymphnode dissection to prevent disease recurrence，and develop the individualized treatment plans based on the risk factor stratification.

Key words: Papillary thyroid microcarcinoma, Recurrence, Risk factor, Reticulated Meta-analysis, Lymphnode metastasis

CLC Number:

R736.1

Peng QI,Xianying MENG,Meihua PIAO,Qiang ZHANG. Network Meta-analysis on risk factors of recurrence of papillary thyroid microcarcinoma[J].Journal of Jilin University(Medicine Edition), 2023, 49(6): 1504-1512.

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Study	Country	Year	Follow-up duration（year）	Recorded /Total patients (η/%)	Risk factors	NOS score
ROSS et al ^[16]	American	2009	3.0－4.0	38/611 (6.2)	3, 6, 10,13	8
LEE et al ^[13]	Korea	2013	3.0	41/2018 (2.0)	1, 2, 3, 5, 4, 8, 10, 13	9
SUGITANI et al ^[8]	Japan	1999	12.0	13/178 (7.3)	1, 3, 5, 4, 6, 8	7
GIORDANO et al ^[17]	Italy	2010	3.6	9/97 (9.3)	1, 2, 3, 5, 4, 6, 9, 10, 7	8
CELESTINO et al ^[18]	Italy	2010	3.0±1.7	9/287 (3.1)	1, 2, 6, 9, 11	9
MERCANTE et al ^[19]	Italy	2008	5.3	17/389 (4.4)	1, 2, 3, 5, 4, 6, 11	8
KIM et al ^[20]	Korea	2015	5.6	36/1661 (2.2)	1, 2, 3, 5, 4, 6, 13	9
CALISKAN et al ^[21]	Korea	2012	5.4±1.8	19/842 (2.3)	1, 2, 3, 5, 4, 6, 13	9
CHOW et al ^[22]	China	2003	8.5	12/203 (5.9)	1, 2, 3, 5, 4, 6, 10, 11, 13	8
CREACH et al ^[23]	American	2011	5.3	40/407 (9.8)	1, 2， 3, 5, 6, 10, 7, 12	9
BESIC et al ^[24]	Slovenia	2008	7.0	7/228 (3.1)	1, 2, 3, 5, 4, 6, 8, 7, 12	8
LEE et al ^[25]	Korea	2013	12.7	21/281 (7.5)	1, 2, 3, 5, 4	9
GAO et al ^[26]	China	2019	1.5	23/158 (14.6)	1, 3, 5, 4, 9, 7	9
CHO et al ^[27]	Korea	2012	4.0±2.0	17/474 (3.6)	1, 2, 3, 5, 9, 6, 10, 13	7

Risk factor	Rank 1	Rank 2	Rank 3	Rank 4	Rank 5	Rank 6
Extrathyroidal extension	<0.01	0.07	0.19	0.24	0.27	0.23
Multifocality	<0.01	0.03	0.12	0.18	0.28	0.38
Vascular invasion	0.22	0.42	0.10	0.07	0.06	0.13
Age	<0.01	0.11	0.25	0.25	0.22	0.17
Lymphnode metastasis	0.77	0.22	<0.01	<0.01	<0.01	<0.01
Tumor size	<0.01	0.14	0.34	0.26	0.17	0.09

Parameter	OR (95% CI)
Random effects standard deviation (consistency model)	0.57 (0.37—0.83)
Random effects standard deviation (inconsistency model)	0.58 (0.38—0.84)
Inconsistency standard deviation	0.19 (0—0.85)

Risk factor	Direct effect OR (95%CI)	Indirect effect OR (95%CI)	Overall OR (95%CI)	P
Age vs lymphnode metastasis	0.62 (0.10—1.16)	1.06 (0.17—1.97)	0.68 (0.21—1.18)	0.38
Age vs tumor size	0.03 (－0.43—0.49)	0.26 (－0.57—1.06)	0.06 (－0.39—0.51)	0.61
Age vs vascular invasion	0.43 (－0.79—1.55)	－0.22 (－2.11—1.40)	0.33 (－0.64—1.21)	0.52
Extrathyroidal extension vs lymphnode metastasis	0.72 (0.22—1.23)	0.41 (－0.64—1.47)	0.72 (0.24—1.21)	0.58
Extrathyroidal extension vs tumor size	0.06 (－0.39—0.51)	0.85 (－0.73—2.45)	0.10 (－0.36—0.54)	0.32
Lymphnode metastasis vs multifocality	－0.75 (－1.23—－0.30)	－0.90 (－1.80—－0.05)	－0.79 (－1.26—－0.33)	0.75
Lymphnode metastasis vs tumor size	－0.74 (－1.25—－0.26)	－0.38 (－1.15—0.38)	－0.63 (－1.10—－0.17)	0.39
Lymphnode metastasis vs vascular invasion	－0.12 (－1.41—1.05)	－0.88 (－2.71—0.73)	－0.36 (－1.35—0.54)	0.45
Multifocality vs tumor size	0.12 (－0.34—0.55)	0.92 (－0.67—2.49)	0.16 (－0.27—0.62)	0.32
Tumor size vs vascular invasion	0.19 (－0.99—1.31)	0.67 (－1.19—2.27)	0.27 (－0.69—1.14)	0.64

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Network Meta-analysis on risk factors of recurrence of papillary thyroid microcarcinoma

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