Endocrinol Metab.
2025 Apr;40(2):236-246. 10.3803/EnM.2024.2136.
Study Protocol of Expanded Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro-EXP)
- Moon JH
1 - Lee EK2,3
- Cha W4
- Chai YJ5
- Cho SW6
- Choi JY7
- Choi SY3,8
- Chu AJ9
- Chung EJ10
- Hwangbo Y2,3
- Jeong WJ4
- Jung YS3,8
- Kim K11,12
- Kim MJ1
- Kim Sj13
- Kim W13
- Kim YH6
- Lee CY3,14
- Lee JY15
- Lee KE13
- Lee YK2,3
- Lim H16
- Park DJ6
- Park SK11,12
- Ryu CH3,8
- Ryu J3,8
- Seok J10
- Song YS17
- Yi KH17
- Yu HW7
- White E18,19
- Mastrocostas K20
- Clifton-Bligh RJ18,19,21
- Glover A18,22
- Gild ML18,19,21
- Kim Jh15
- Park YJ6,23
- Affiliations
-
- 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- 2Department of Internal Medicine, National Cancer Center, Goyang, Korea
- 3Center for Thyroid Cancer, National Cancer Center, Goyang, Korea
- 4Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- 5Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- 6Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- 7Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- 8Department of Otorhinolaryngology, National Cancer Center, Goyang, Korea
- 9Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- 10Department of Otorhinolaryngology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- 11Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- 12Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, Korea
- 13Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- 14Department of Radiology, National Cancer Center, Goyang, Korea
- 15Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- 16Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- 17Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- 18Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, Australia
- 19Cancer Genetics Laboratory, Kolling Institute of Medical Research, Sydney, Australia
- 20Department of Radiology, Royal North Shore Hospital, Sydney, Australia
- 21Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
- 22Kinghorn Cancer Centre, Garvan Institute of Medical Research, St. Vincent’s Medical School, University of NSW, Darlinghurst, Australia
- 23Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
- KMID: 2567178
- DOI: http://doi.org/10.3803/EnM.2024.2136
Abstract
- Background
Active surveillance (AS) has emerged as a viable management strategy for low-risk papillary thyroid microcarcinoma (PTMC), following pioneering trials at Kuma Hospital and the Cancer Institute Hospital in Japan. Numerous prospective cohort studies have since validated AS as a management option for low-risk PTMC, leading to its inclusion in thyroid cancer guidelines across various countries. From 2016 to 2020, the Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) enrolled 1,177 patients, providing comprehensive data on PTMC progression, sonographic predictors of progression, quality of life, surgical outcomes, and cost-effectiveness when comparing AS to immediate surgery. The second phase of MAeSTro (MAeSTro-EXP) expands AS to low-risk papillary thyroid carcinoma (PTC) tumors larger than 1 cm, driven by the hypothesis that overall risk assessment outweighs absolute tumor size in surgical decision-making.
Methods
This protocol aims to address whether limiting AS to tumors smaller than 1 cm may result in unnecessary surgeries for low-risk PTCs detected during their rapid initial growth phase. By expanding the AS criteria to include tumors up to 1.5 cm, while simultaneously refining and standardizing the criteria for risk assessment and disease progression, we aim to minimize overtreatment and maintain rigorous monitoring to improve patient outcomes.
Conclusion
This study will contribute to optimizing AS guidelines and enhance our understanding of the natural course and appropriate management of low-risk PTCs. Additionally, MAeSTro-EXP involves a multinational collaboration between South Korea and Australia. This cross-country study aims to identify cultural and racial differences in the management of low-risk PTC, thereby enriching the global understanding of AS practices and their applicability across diverse populations.
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