27 april 2020: Bron: JAMA Otolaryngol Head Neck Surg. Published online April 16, 2020.

Mensen in leeftijd tussen 40 en 50 jaar met een primaire papillaire schildklierkanker in een actief wait-and-see programma hebben minder kans op tumorgroei en ziekteprogressie / recidief dan jongere mensen met dezelfde aandoening. Dat blijkt uit een review studie - meta analyse van 5 studies.

Bealngrijkste punt uit de studie:

Doel van de studie:
Wordt leeftijd geassocieerd met het risico van tumorprogressie (dat wil zeggen tumorvergroting of incidentele uitzaaiende ziekte) bij personen met een klein, laag risico papillair schildkliercarcinoom onder een actief observatieprogramma?

Resultaat van de studie:
In deze systematische review en meta-analyse, inclusief gegevens uit 5 onderzoeken, werd de risicoverhouding voor tumorgroei van 3 mm of meer in maximale diameter met ongeveer de helft verminderd bij personen van 40 tot 50 jaar in vergelijking met jongere personen. Het risico op gemetastaseerde ziekte was op alle leeftijden laag.

Conclusie:

Hogere leeftijd kan onder actieve observatie (wait-and-see programma) in verband worden gebracht met een verminderd risico op vergroting van de papillaire schildkliertumor.

Het volledige studieverslag: Association of Patient Age With Progression of Low-Risk Papillary Thyroid Carcinoma Under Active Surveillance is tegen betaling in te zien.

Hier het abstract van de studie: 

Original Investigation
April 16, 2020

Association of Patient Age With Progression of Low-Risk Papillary Thyroid Carcinoma Under Active SurveillanceA Systematic Review and Meta-analysis

JAMA Otolaryngol Head Neck Surg. Published online April 16, 2020. doi:10.1001/jamaoto.2020.0368

Key Points

Question  Is age associated with the risk of tumor progression (ie, tumor enlargement or incident metastatic disease) in individuals with small, low-risk papillary thyroid carcinoma under active surveillance?

Findings  In this systematic review and meta-analysis including data from 5 studies, the risk ratio for tumor growth of 3 mm or more in maximal diameter was reduced by about half in individuals aged 40 to 50 years compared with younger individuals. The risk of incident metastatic disease was low at all ages.

Meaning  Advancing age may be associated with reduced risk of papillary thyroid tumor enlargement under active surveillance.

Abstract

Importance  Active surveillance is sometimes considered as a disease management option for individuals with small, low-risk papillary thyroid carcinoma.

Objective  To assess whether patient age is associated with progression of low-risk papillary thyroid carcinoma (tumor growth or incident metastatic disease) in adults under active surveillance.

Evidence Review  Eight electronic databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Emcare, PsycINFO, Web of Science, and ClincalTrials.gov) were searched from inception to March 2019, supplemented with a hand search. Two investigators independently screened citations, reviewed full-text articles, and abstracted data. Additional data were sought from authors. Random-effects meta-analyses were performed using incidence data (statistically adjusted for confounders and crude rates).

Findings  A total of 1658 unique citations were screened, and 62 full-text articles were reviewed, including 5 studies. Three studies included exclusively microcarcinomas and 2 included tumors up to 2 cm in maximal diameter. The mean age of participants was 51.0 to 55.2 years in 4 studies reporting this value. The mean or median follow-up was 5 years or more in 3 studies and approximately 2 years in 2 studies. The pooled risk ratio for tumor growth of 3 mm or more in maximal diameter in individuals aged 40 to 50 years compared with younger individuals was 0.51 when adjusted for confounders (95% CI, 0.29-0.89; 1619 patients, 2 studies), and the unadjusted risk ratio of this outcome for individuals 40 years or older was 0.55 (95% CI, 0.36-0.82; 2097 patients, 4 studies). In adults aged 40 to 45 years, the unadjusted risk ratio for any tumor volume increase compared with younger individuals was 0.65 (95% CI, 0.51-0.83; 1232 patients, 4 studies). The pooled risk ratio for incident nodal metastases in individuals 40 years or older was 0.22 (95% CI, 0.10-0.47; 1806 patients, 3 studies); however, in a secondary analysis, the risk difference was not significantly different. There was no statistically significant heterogeneity in any of the meta-analyses. There were no thyroid cancer–related deaths nor incident distant metastases.

Conclusions and Relevance  This study suggests that older age may be associated with a reduced risk of primary papillary thyroid carcinoma tumor growth under active surveillance. Incident metastatic disease is uncommon during active surveillance.


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