低风险T1N0M0甲状腺乳头状癌的射频消融治疗：系统综述与荟萃分析。
完整摘要 · 中文译文
目的：评估超声（US）引导下射频消融（RFA）治疗低风险T1N0M0甲状腺乳头状癌（PTC）的有效性和安全性，重点关注T1a与T1b的结局差异及纵向体积缩小情况。 材料与方法：检索MEDLINE、EMBASE、Cochrane Library和KoreaMed数据库中2000年1月至2025年3月间发表的研究。当RFA结局数据可独立提取时，单臂研究和比较研究均符合纳入条件。共纳入35项研究（9,787个肿瘤）进行分析。采用随机效应模型计算完全消失、肿瘤持续存在、疾病进展及并发症率的汇总估计值。体积缩小率（VRR）在连续随访时间点进行评估。采用亚组分析比较T1a与T1b PTC的结局。 结果：在9,787个接受RFA治疗的肿瘤中，汇总完全消失率为87.2%（I² = 97.9%）。汇总肿瘤持续存在率为0.1%（I² = 57.6%），汇总疾病进展率（反映新发肿瘤[0.8%；I² = 63.9%]和淋巴结转移[0.2%；I² = 19.8%]）为1.3%（I² = 70.0%）。VRR从6个月时的63.4%增加至12个月时的88.7%，并在24个月时达到97.9%。汇总并发症率为2.7%（I² = 93.0%），主要并发症率为0.02%（I² = 0%）。亚组分析显示，T1b肿瘤的完全消失率低于T1a肿瘤（89.2% vs. 58.8%；P < 0.001），而肿瘤持续存在率高于T1a肿瘤（0.02% vs. 2.2%；P < 0.001）；疾病进展率在T1a与T1b之间差异无统计学意义（0.9% vs. 1.1%；P = 0.710）。 ogression (P = 0.234) 与总并发症发生率 (P = 0.794) 具有可比性。结论：超声（US）引导下射频消融（RFA）可能在低危 T1N0M0 甲状腺乳头状癌（PTC）中提供有效的肿瘤控制并具有良好的安全性。然而，若干疗效结局的异质性限制了这些估计值的可解释性。与 T1a PTC 相比，T1b PTC 的完全消失率较低、持续肿瘤率较高，支持需要对 T1b 疾病加强监测。
完整摘要 · 英文原文
OBJECTIVE: To evaluate the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) for low-risk T1N0M0 papillary thyroid carcinoma (PTC), with emphasis on T1a versus T1b outcomes and longitudinal volume regression. MATERIALS AND METHODS: MEDLINE, EMBASE, Cochrane Library, and KoreaMed databases were searched for studies published between January 2000 and March 2025. Both single-arm and comparative studies were eligible when RFA outcome data could be extracted independently. Thirty-five studies (9,787 tumors) were included in the analysis. Pooled estimates for complete disappearance, persistent tumors, disease progression, and complication rates were calculated using random-effects models. The volume-reduction ratio (VRR) was assessed at sequential follow-up intervals. Subgroup analyses were used to compare the outcomes for T1a and T1b PTCs. RESULTS: Among the 9,787 RFA-treated tumors, the pooled complete disappearance rate was 87.2% (I² = 97.9%). The pooled persistent-tumor rate was 0.1% (I² = 57.6%), and the pooled disease-progression rate, which reflected newly developed tumors (0.8%; I² = 63.9%) and lymph node metastasis (0.2%; I² = 19.8%), was 1.3% (I² = 70.0%). The VRR increased from 63.4% at 6 months to 88.7% at 12 months and reached 97.9% at 24 months. The pooled complication rate was 2.7% (I² = 93.0%), and the major complication rate was 0.02% (I² = 0%). Subgroup analyses showed lower complete disappearance rates (89.2% vs. 58.8%; P < 0.001) and higher persistent-tumor rates (0.02% vs. 2.2%; P < 0.001) in T1b tumors than in T1a tumors; disease progression (P = 0.234) and total complication rates (P = 0.794) were comparable. CONCLUSION: US-guided RFA may provide effective tumor control with favorable safety in low-risk T1N0M0 PTC. However, heterogeneity across several efficacy outcomes limits the interpretability of these estimates. T1b PTCs showed lower complete disappearance and higher persistent-tumor rates than T1a PTCs, supporting the need for heightened surveillance of T1b disease.