Active surveillance of highly suspicious thyroid nodules cohort in China shows a worse psychological status in younger patients

Abstract

BackgroundActive surveillance has been considered a safe alternative to surgery for low-risk papillary thyroid microcarcinoma. This study aimed to assess the oncological outcomes and psychological status of active surveillance of highly suspicious thyroid nodules ≤10 mm in China.MethodsThis prospective single-center cohort study enrolled 336 patients with highly suspicious thyroid nodules for active surveillance to assess oncological outcomes and psychological status. The psychological status of patients was assessed by two different questionnaires and compared among different patient groups.ResultsDuring a median follow-up period of 28.5 months, eight patients underwent delayed surgery for tumor enlargement and one for lymph node metastases. The cumulative incidence of disease progression at 5 and 10 years was 6.0% and 12.8%, respectively. Patients who underwent delayed surgery had no permanent complications, and no patient had distant metastasis or death. Patients ≤30 years old had a higher baseline anxiety score (4.9 vs. 3.8, p=0.024), a higher proportion of baseline anxiety score, i.e., ≥8 points (24.0% vs. 12.6%, p=0.033), and a worse baseline emotional function (62.7 vs. 70.7, p=0.013) than patients >30. During AS, patients ≤30 years of age had higher overall anxiety levels (p=0.005) and a worse overall emotional function (p=0.001).ConclusionsActive surveillance in Chinese patients with highly suspicious subcentimetre thyroid nodules has good oncological outcomes and can be used as a safe alternative to surgery. Younger patients (≤30) show a worse psychological status; therefore, more attention should be paid to younger patients.

Active Surveillance for Low-Risk Thyroid Cancers: A Review of Current Practice Guidelines

“…In a cross-sectional study, Jeon et al [79] found that the AS group reported better QOL in areas such as neuromuscular, throat/mouth, and scar problems compared to the surgery group. Longitudinal studies have initially shown better physical QOL in AS groups compared to surgery groups, but after 1 to 2 years, the QOL scores between the two groups tend to be comparable [28,80]. Yoshida et al [81] reported higher anxiety in the AS group than in the surgery group.…”