Endocrinol Metab.  2018 Jun;33(2):278-286. 10.3803/EnM.2018.33.2.278.

Study Protocol of Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro)

• Moon JH
• Kim JH
• Lee EK
• Lee KE
• Kong SH
• Kim YK
• Jung WJ
• Lee CY
• Yoo RE
• Hwangbo Y
• Song YS
• Kim MJ
• Cho SW
• Kim SJ
• Jung EJ
• Choi JY
• Ryu CH
• Lee YJ
• Hah JH
• Jung YS
• Ryu J
• Hwang Y
• Park SK
• Sung HK
• Yi KH
• Park DJ
• Park YJ

• KMID: 2420498
• DOI: http://doi.org/10.3803/EnM.2018.33.2.278

Abstract

BACKGROUND
The ongoing Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) aims to observe the natural course of papillary thyroid microcarcinoma (PTMC), develop a protocol for active surveillance (AS), and compare the long-term prognosis, quality of life, and medical costs between the AS and immediate surgery groups.
METHODS
This multicenter prospective cohort study of PTMC started in June 2016. The inclusion criteria were suspicious of malignancy or malignancy based on fine needle aspiration or core needle biopsy, age of ≥18 years, and a maximum diameter of ≤1 cm. If there was no major organ involvement, no lymph node/distant metastasis, and no variants with poor prognosis, the patients were explained of the pros and cons of immediate surgery and AS before selecting AS or immediate surgery. Follow-up visits (physical examination, ultrasonography, thyroid function, and questionnaires) are scheduled every 6 months during the first 2 years, and then every 1 year thereafter. Progression was defined as a maximum diameter increase of ≥3, ≥2 mm in two dimensions, suspected organ involvement, or lymph node/distant metastasis.
RESULTS
Among 439 enrolled patients, 290 patients (66.1%) chose AS and 149 patients (33.9%) chose immediate surgery. The median follow-up was 6.7 months (range, 0.2 to 11.9). The immediate surgery group had a larger maximum tumor diameter, compared to the AS group (7.1±1.9 mm vs. 6.6±2.0 mm, respectively; P=0.014).
CONCLUSION
The results will be useful for developing an appropriate PTMC treatment policy based on its natural course and risk factors for progression.

Keyword

Thyroid neoplasms; Active surveillance; Prospective cohort; Papillary thyroid microcarcinoma

MeSH Terms

Biopsy, Fine-Needle
Biopsy, Large-Core Needle
Cohort Studies*
Follow-Up Studies
Humans
Neoplasm Metastasis
Prognosis
Prospective Studies*
Quality of Life
Risk Factors
Thyroid Gland*
Thyroid Neoplasms
Ultrasonography

Figure

• 

  Fig. 1 Conduct of the study. PTMC, papillary thyroid microcarcinoma; US, ultrasonography; CT, computed tomography; AS, active surveillance; TSH, thyroid-stimulating hormone; T4, thyroxine; Tg Ab, thyroglobulin antibody.

• 

  Fig. 2 Age and gender distribution of participants.

• 

  Fig. 3 Distribution of (A) age and (B) tumor diameter at diagnosis according to active surveillance and immediate surgery group.

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