[1]黎志超,高 锐,朱章添.基于倾向性评分匹配法分析微波消融和甲状腺切除术治疗老年孤立性T1N0M0期甲状腺乳头状癌临床价值[J].介入放射学杂志,2026,(03):281-288.[doi:10.3969/j.issn.1008-794X.2026.03.008 ]
　LI Zhichao,GAO Rui,ZHU Zhangtian..Microwave ablation and thyroidectomy for elderly patients with solitary T1N0M0 papillary thyroid carcinoma:analysis of its clinical value based on propensity score matching method[J].J Intervent Med,2026,(03):281-288.[doi:10.3969/j.issn.1008-794X.2026.03.008 ]
点击复制

基于倾向性评分匹配法分析微波消融和甲状腺切除术治疗老年孤立性T1N0M0期甲状腺乳头状癌临床价值()

PDF下载中关闭

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2026年03
页码:
281-288
栏目:
非血管介入
出版日期:
2026-03-25

文章信息/Info

Title:
Microwave ablation and thyroidectomy for elderly patients with solitary T1N0M0 papillary thyroid carcinoma:analysis of its clinical value based on propensity score matching method
文章编号:
1008-794X(2026)-003-0281-08
作者:
黎志超;  高 锐;  朱章添
510282 广东广州 南方医科大学珠江医院甲状腺外科(黎志超、朱章添); 广州广钢新城医院外科(高 锐)
Author(s):
LI Zhichao; GAO Rui; ZHU Zhangtian.
Department of Thyroid Surgery,Zhujiang Hospital of Southern Medical University,Guangzhou,Guangdong Province 510282,China
关键词:
倾向性评分匹配;  微波消融;  甲状腺切除术;  老年;  甲状腺乳头状癌
分类号:
R736.1
DOI:
10.3969/j.issn.1008-794X.2026.03.008
文献标志码:
A
摘要:
目的 基于倾向性评分匹配(propensity score matching,PSM)法分析微波消融(MWA)和甲状腺切除术治疗老年孤立性T1N0M0期甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的临床价值。方法 回顾性收集2021年3月至2023年3月南方医科大学珠江医院收治的老年孤立性T1N0M0期PTC患者临床资料。根据手术方式将患者分为研究组(接受MWA术)和对照组(接受甲状腺切除术)。采用R4.4.3软件行PSM(卡钳值=0.2)。PSM后评价两组患者手术相关情况,术后2年内PTC病灶体积变化,手术前后甲状腺球蛋白(Tg)、游离甲状腺素4(FT4)、游离三碘甲状腺原氨酸(FT3)、促甲状腺素(TSH)水平和甲状腺癌特异性生活质量(thyroid cancer-specic quality of life,THYCA-QoL)[6]量表评分,以及并发症、肿瘤进展/复发等情况。结果 300例患者经PSM后成功匹配122对。PSM后两组一般资料比较差异无统计学意义(均P>0.05)。研究组手术时间、术中出血量、住院时间与对照组相比显著减少(均P<0.001)。研究组T1期、T1aN0M0期、T1bN0M0期患者,术后1个月PTC体积分别较术前增加(均P<0.05),术后2、3、6、12、24个月分别逐渐减小(均P<0.05),至随访末PTC体积缩小率分别为89.68%～100.00%、92.55%～100.00%、87.92%～100.00%,肿瘤消失率分别达70.49%(86/122)、74.51%(76/102)、50.00%(10/20); T1aN0M0期中位肿瘤消失时间(12个月,95%CI=11.3～12.6个月)显著短于T1bN0M0期(22个月,95%CI=19.7～24.2个月)(P<0.05),肿瘤消失率显著高于T1bN0M0期(P<0.05)。术后6个月,研究组Tg、FT4、FT3、TSH水平与对照组比较差异无统计学意义(均P>0.05),THYCA-QoL量表评分显著低于对照组(P<0.001)。研究组与对照组随访期间并发症发生率(4.10%比4.92%)、肿瘤进展/复发率(4.10%比3.28%)比较差异无统计学意义(均P>0.05)。结论 与甲状腺切除术相比,MWA治疗老年孤立性T1N0M0期PTC更有效,可减少创伤、保留甲状腺功能、促进肿瘤消退且安全性良好,值得临床推广实践。

参考文献/References:

[1] Li Y,Teng D,Ba J,et al.Efficacy and safety of long-term universal salt iodization on thyroid disorders:epidemiological evidence from 31 provinces of Mainland China[J].Thyroid,2020,30:568-579.
[2]Haddad RI,Bischoff L,Ball D,et al.Thyroid carcinoma,version 2.2022,NCCN clinical practice guidelines in oncology[J].J Natl Compr Canc Netw,2022,20:925-951.
[3]中华医学会内分泌学分会,中华医学会外科学分会甲状腺及代谢外科学组,中国抗癌协会头颈肿瘤专业委员会,等.甲状腺结节和分化型甲状腺癌诊治指南(第二版)[J].中华内分泌代谢杂志,2023,39:181-226.
Chinese Society of Endocrinology,Chinese Society of Thyroid and Metabolism Surgery,Chinese Society of Surgery,Chinese Medical Association,China Anti-Cancer Association Head and Neck Oncology Committee,et al.Guidelines for Diagnosis and Treatment of Thyroid Nodules and Differentiated Thyroid Carcinoma(Second Edition)[J].Chin J Endocrinol Metab,2023,39:181-226.
[4]Chen Y,Li J,Zhao S,et al.Ultrasound-guided thermal ablation vs surgery in T1N0M0 papillary thyroid carcinoma:a systematic review and meta-analysis[J].Acad Radiol,2025,32:3291-3303.
[5]Luo X,Kandil E.Microwave ablation:a technical and clinical comparison to other thermal ablation modalities to treat benign and malignant thyroid nodules[J].Gland Surg,2024,13:1805-1813.
[6]Husson O,Haak HR,Mols F,et al.Development of a disease-specific health-related quality of life questionnaire(THYCA-QoL)for thyroid cancer survivors[J].Acta Oncol,2013,52:447-454.
[7]Upadhyaya A,Upadhyaya SA,Chang L,et al.Ultrasound-guided percutaneous radiofrequency and microwave ablation for cervical lymph node metastasis from papillary thyroid carcinoma:a systematic review and meta-analysis of clinical efficacy and safety[J].Acad Radiol,2025,32:2533-2544.
[8]Chen J,Shi X.Ultrasound-guided percutaneous radiofrequency and microwave ablation for lymph node recurrence of PTC[J].Acad Radiol,2025,32:3136.
[9]Fei YL,Wei Y,Zhao ZL,et al.Efficacy and safety of thermal ablation for solitary low-risk T2N0M0 papillary thyroid carcinoma[J].Korean J Radiol,2024,25:756-766.
[10]魏 莹,杨 猛,赵朕龙,等.微波消融与手术切除治疗孤立性T1N0M0期甲状腺乳头状癌[J].中国介入影像与治疗学,2023,20:65-69.
Wei Y,Yang M,Zhao ZL,et al.Microwave ablation and surgical resection in treatment of solitary T1N0M0 papillary thyroid carcinoma[J].Chin J Interv Imag Ther,2023,20:65-69.
[11]李昌金,胡 薇.微波消融与传统开放手术治疗甲状腺微小乳头状癌的安全性及近期疗效Meta分析[J].中华介入放射学电子杂志,2020,8:339-345.
Li CJ,Hu W.Meta-analysis of the safety and short-term efficacy of microwave ablation and traditional open surgeryin the treatment of papillary thyroid microcarcinomas[J].Chin J Interv Radiol:electronic edition,2020,8:339-345.
[12]顾美琴,奚 静,李 尊,等.超声引导下微波消融治疗多灶性T1N0M0甲状腺乳头状癌的可行性研究[J].介入放射学杂志,2024,33:495-499.
Gu MQ,Xi J,Li Z,et al.Ultrasound-guided microwave ablation for multifocal T1N0M0 papillary thyroid carcinoma:a feasibility study[J].J Interv Radiol,2024,33:495-499.
[13]中国抗癌协会肿瘤消融治疗专业委员会,中国临床肿瘤学会(CSCO)肿瘤消融专家委员会,中国医师协会介入医师分会肿瘤消融专业委员会,等.甲状腺乳头状癌热消融治疗专家共识(2024版)[J].中华内科杂志,2024,63:355-364.
Chinese Anti-Cancer Association,Committee of Ablation Therapy in Oncology,the Ablation Expert Committee of the Chinese Society of Clinical Oncology,the Society of Tumor Ablation Therapy of Chinese College of Interventionalists,et al.Expert Consensus on Thermal Ablation Therapy of Papillary Thyroid Cancer(2024 Edition)[J].Chin J Intern Med,2024,63:355-364.
[14]Zhao HX,Wei Y,Zhao ZL,et al.Clinical outcomes of microwave ablation for solitary T1N0M0 papillary thyroid carcinoma:a more than 5-year follow-up study[J].Eur Radiol,2025,35:1714-1722.
[15]王双龙,吕绍闻,王贝贝,等.超声引导下微波消融与射频消融治疗甲状腺微小乳头状癌疗效及安全性的对比研究[J].现代肿瘤医学,2025,33:975-981.
Wang SL,Lyu SW,Wang BB,et al.Comparison of the efficacy and safety of ultrasound-guided microwave and radiofrequency ablation for the treatment of papillary thyroid microcarcinoma[J].J Mod Oncol,2025,33:975-981.
[16]伍 洁,魏 莹,赵朕龙,等.超声引导下微波消融治疗侵犯被膜的甲状腺乳头状癌[J].中国介入影像与治疗学,2023,20:70-73.
Wu J,Wei Y,Zhao ZL,et al.Ultrasound-guided microwave ablation in treatment of papillary thyroid carcinoma with capsular invasion[J].Chin J Interv Imag Ther,2023,20:70-73.
[17]Zhou HD,Wei Y,Zhao ZL,et al.A clinical study on microwave ablation of T1N0M0 papillary thyroid carcinoma locating in dangerous region[J].BMC Cancer,2025,25:240.
[18]崔姗姗,叶新华,姚志勇,等.超声引导下微波消融治疗甲状腺微小乳头状癌的疗效和安全性[J].中国超声医学杂志,2025,41:502-504.
Cui SS,Ye XH,Yao ZY,et al.Efficacy and safety of ultrasound-guided microwave ablation in the treatment of papillary thyroid microcarcinomas[J].Chin J Ultras Med,2025,41:502-504.
[19]Zhou HD,Yu XY,Wei Y,et al.A clinical study on microwave ablation of multifocal(≤3)T1N0M0 papillary thyroid carcinoma[J].Eur Rad iol,2023,33:4034-4041.
[20]Zhao ZL,Wang SR,Dong G,et al.Microwave ablation versus surgical resection for US-detected multifocal T1N0M0 papillary thyroid carcinoma:a 10-center study[J].Radiology,2024,311:e230459.
[21]Guo MH,Dou JP,Zheng L,et al.Ultrasound-guided microwave ablation versus surgery for solitary T1bN0M0 papillary thyroid carcinoma:a prospective multicenter study[J].Eur Radiol,2024,34:569-578.
[22]Yan L,Yang Z,Jing H,et al.Comparative outcomes of ultrasound-guided radiofrequency ablation vs.microwave ablation for patients with T1N0M0 papillary thyroid carcinoma:a retrospective cohort study[J].Eur Radiol,2025,35:3697-3706.
[23]Zhao ZL,Dong G,Wang SR,et al.Efficacy and safety of microwave ablation for the treatment of multifocal versus unifocal T1N0M0 papillary thyroid carcinoma:a propensity-matched multicentre retrospective study[J].Eur Radiol,2023,33:8727-8735.
[24]Gao X,Yang Y,Wang Y,et al.Efficacy and safety of ultrasound-guided radiofrequency,microwave and laser ablation for the treatment of T1N0M0 papillary thyroid carcinoma on a large scale:a systematic review and meta-analysis[J].Int J Hyperthermia,2023,40:2244713.
(收稿日期:2025-08-05)
(本文编辑:谷 珂)

相似文献/References:

[1]李晓峰,钱国军,张 磊,等. 微波高功率条件下消融原发性肝癌的初步研究[J].介入放射学杂志,2011,(12):974.
　LI Xiao-feng,QIAN Guo-jun,ZHANG Lei,et al.Microwave ablation with high output power for the treatment of hepatocellular carcinoma: a preliminary study[J].J Intervent Med,2011,(03):974.
[2]陈奇峰,贾振宇,杨正强,等.肝动脉化疗栓塞联合微波消融与单独肝动脉化疗栓塞治疗大肝癌疗效meta分析[J].介入放射学杂志,2017,(03):225.
　CHEN Qifeng,JIA Zhenyu,YANG Zhengqiang,et al.TACE combined with MWA versus simple TACE for the treatment of large hepatic cancers： a meta- analysis of curative effect[J].J Intervent Med,2017,(03):225.
[3]杨国威,张 巍,钱 晟,等.热损伤对肝细胞肝癌细胞增殖及侵袭转移特性影响的实验研究 [J].介入放射学杂志,2017,(05):436.
　YANG Guowei,ZHANG Wei,QIAN Sheng,et al.The effect of thermal damage on the cell proliferation and invasive metastasis of HCC： an experimental study in vitro[J].J Intervent Med,2017,(03):436.
[4]李 鑫,梁 萍,于晓玲,等.经皮微波消融肾细胞癌疗效的超声造影评价[J].介入放射学杂志,2014,(08):688.
　LI Xin,LIANG Ping,YU Xiao ling,et al.Percutaneous microwave ablation for renal cell carcinoma： evaluation of therapeutic effect with contrast enhanced ultrasound[J].J Intervent Med,2014,(03):688.
[5]王 会,胡继红,赵 卫. 骨肿瘤的消融治疗[J].介入放射学杂志,2012,(10):879.
　WANG Hui,HU Ji- hong,ZHAO Wei.. Recent advances in ablation therapy of bone neoplasm[J].J Intervent Med,2012,(03):879.
[6]经 翔,丁建民,王彦冬,等. 射频消融和微波消融治疗肝癌的比较[J].介入放射学杂志,2014,(04):306.
　JING Xiang,DING Jian? min,WANG Yan? dong,et al. Ultrasound-guided percutaneous radiofrequency ablation and microwave ablation for the treatment of hepatocellular carcinoma： a comparison study[J].J Intervent Med,2014,(03):306.
[7]万豪光,许 伟,徐 浩,等. 经导管化疗栓塞联合经皮微波消融治疗中晚期肝癌64例的预后分析[J].介入放射学杂志,2014,(06):477.
　WAN Hao- guang,XU Wei,XU Hao,et al. Transcatheter arterial chemoembolization combined with percutaneous microwave ablation for the treatment of intermediate- advanced hepatocellular carcinoma： analysis of prognostic factors in 64 cases[J].J Intervent Med,2014,(03):477.
[8]张春淼,何 晶,张艳霞,等.CT引导经皮穿刺微波消融治疗原发性肝癌的护理[J].介入放射学杂志,2015,(03):265.
　ZHANG Chun miao,HE Jing,ZHANG Yan xia,et al.Nursing care for patients with primary liver cancer receiving CT guided percutaneous microwave ablation treatment[J].J Intervent Med,2015,(03):265.
[9]唐 田,古善智,李国文,等.经皮肝穿刺胆道引流联合CT引导下微波消融治疗肝门区胆管癌的疗效分析[J].介入放射学杂志,2015,(09):811.
　TANG Tian,GU Shan- zhi,LI Guo- wen,et al.PTCD combined with CT- guided microwave ablation for hepatic hilar cholangiocarcinoma： analysis of therapeutic efficacy[J].J Intervent Med,2015,(03):811.
[10]李 征,米登海,杨克虎,等.经动脉化疗栓塞联合微波消融治疗肝癌有效性和安全性的系统评价[J].介入放射学杂志,2015,(11):957.
　LI Zheng,MI Deng- hai,YANG Ke- hu,et al.Effectiveness and safety of TACE combined with MWA for primary hepatic cancer： a systematic review[J].J Intervent Med,2015,(03):957.

备注/Memo

备注/Memo:
基金项目: 广东省医学科研基金(A2023117)
通信作者: 黎志超 E-mail:397450208@qq.com
更新日期/Last Update: 2026-03-25