Active surveillance vs. surgery in low‐risk papillary thyroid microcarcinoma patients and the risk of loss to follow‐up

Abstract

AbstractBackgroundPapillary thyroid microcarcinoma (PTMC) management has evolved, with active surveillance (AS) gaining prominence as a management option. However, a key concern for both clinicians and patients is the potential for patient loss to follow‐up during AS.AimsThis study aimed to determine adherence and loss‐to‐follow‐up rates in low‐risk PTMC patients undergoing AS versus surgical intervention, in order to gain insights into clinical pathways and safety profiles.Materials and MethodsThis cohort study analyzed the 2016 data from a single registered institution of Japan's public National Cancer Registry.ResultsWe identified and retrospectively analyzed the cases of 327 patients diagnosed with low‐risk PTMC; 227 patients chose to undergo AS while the other 100 underwent PTMC surgery. Main outcomes were the adherence rate and loss‐to‐follow‐up rate of each group, factors influencing discontinuation, and safety considerations. The rate of AS adoption was substantial in the complete series of 327 low‐risk PTMC patients (69.4%). There was a significantly higher loss‐to‐follow‐up rate at 5 years in the AS group (28.6%) compared to the Surgery group (17.8%) (HR 1.62, 95% CI: 1.01–2.61; p = 0.046). Both univariate and multivariate analyses confirmed the significantly higher loss‐to‐follow‐up rate in the AS group as well as in older patients. No deaths due to PTMC progression were observed in the cases lost to follow‐up.ConclusionDespite concerns about loss to follow‐up, active surveillance remains a safe option for low‐risk PTMCs. Consistent follow‐up strategies are crucial, and further research is needed to enhance patient counseling and care for the management of patients with PTMC.