Endocrinol Metab.  2018 Jun;33(2):278-286. 10.3803/EnM.2018.33.2.278.

Study Protocol of Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro)

Affiliations
  • 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
  • 2Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
  • 3Department of Internal Medicine, National Cancer Center, Goyang, Korea.
  • 4Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
  • 5Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. yjparkmd@snu.ac.kr
  • 6Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
  • 7Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
  • 8Department of Radiology, National Cancer Center, Goyang, Korea.
  • 9Department of Otorhinolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
  • 10Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
  • 11Department of Otorhinolaryngology, National Cancer Center, Goyang, Korea.
  • 12Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 13Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea.
  • 14Cancer Research Institute, Seoul National University, Seoul, Korea.
  • 15Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
  • 16Director General, Korea National Institute of Health, Cheongju, Korea.

Abstract

BACKGROUND
The ongoing Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) aims to observe the natural course of papillary thyroid microcarcinoma (PTMC), develop a protocol for active surveillance (AS), and compare the long-term prognosis, quality of life, and medical costs between the AS and immediate surgery groups.
METHODS
This multicenter prospective cohort study of PTMC started in June 2016. The inclusion criteria were suspicious of malignancy or malignancy based on fine needle aspiration or core needle biopsy, age of ≥18 years, and a maximum diameter of ≤1 cm. If there was no major organ involvement, no lymph node/distant metastasis, and no variants with poor prognosis, the patients were explained of the pros and cons of immediate surgery and AS before selecting AS or immediate surgery. Follow-up visits (physical examination, ultrasonography, thyroid function, and questionnaires) are scheduled every 6 months during the first 2 years, and then every 1 year thereafter. Progression was defined as a maximum diameter increase of ≥3, ≥2 mm in two dimensions, suspected organ involvement, or lymph node/distant metastasis.
RESULTS
Among 439 enrolled patients, 290 patients (66.1%) chose AS and 149 patients (33.9%) chose immediate surgery. The median follow-up was 6.7 months (range, 0.2 to 11.9). The immediate surgery group had a larger maximum tumor diameter, compared to the AS group (7.1±1.9 mm vs. 6.6±2.0 mm, respectively; P=0.014).
CONCLUSION
The results will be useful for developing an appropriate PTMC treatment policy based on its natural course and risk factors for progression.

Keyword

Thyroid neoplasms; Active surveillance; Prospective cohort; Papillary thyroid microcarcinoma

MeSH Terms

Biopsy, Fine-Needle
Biopsy, Large-Core Needle
Cohort Studies*
Follow-Up Studies
Humans
Neoplasm Metastasis
Prognosis
Prospective Studies*
Quality of Life
Risk Factors
Thyroid Gland*
Thyroid Neoplasms
Ultrasonography

Figure

  • Fig. 1 Conduct of the study. PTMC, papillary thyroid microcarcinoma; US, ultrasonography; CT, computed tomography; AS, active surveillance; TSH, thyroid-stimulating hormone; T4, thyroxine; Tg Ab, thyroglobulin antibody.

  • Fig. 2 Age and gender distribution of participants.

  • Fig. 3 Distribution of (A) age and (B) tumor diameter at diagnosis according to active surveillance and immediate surgery group.


Cited by  5 articles

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Endocrinol Metab. 2021;36(2):359-364.    doi: 10.3803/EnM.2020.890.

Active Surveillance as an Effective Management Option for Low-Risk Papillary Thyroid Microcarcinoma
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Endocrinol Metab. 2021;36(4):717-724.    doi: 10.3803/EnM.2021.1042.

The Concept of Economic Evaluation and Its Application in Thyroid Cancer Research
Kyungsik Kim, Mijin Kim, Woojin Lim, Bo Hyun Kim, Sue K. Park
Endocrinol Metab. 2021;36(4):725-736.    doi: 10.3803/EnM.2021.1164.

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Do Joon Park
Endocrinol Metab. 2023;38(1):69-71.    doi: 10.3803/EnM.2023.104.

Lower Thyroid Cancer Mortality in Patients Detected by Screening: A Meta-Analysis
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Endocrinol Metab. 2023;38(1):93-103.    doi: 10.3803/EnM.2023.1667.


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