Pooled analysis of patients-reported outcomes across treatment strategies in papillary thyroid microcarcinoma

Given the favorable prognosis of papillary thyroid microcarcinoma (PTMC), treatment decisions increasingly rely on patient-reported outcomes (PROs). Comparative PRO data between active surveillance, thermal ablation, and surgery are limited. Pooled analysis of 13 studies comprising 5793 adult PTMC patients investigated PRO data across treatment strategies: 2356 patients underwent active surveillance, 242 received thermal ablation (211 radiofrequency, 31 laser), and 3195 underwent surgery (2350 lobectomy, 833 total thyroidectomy, 12 unspecified). Active surveillance was consistently associated with better PROs compared with surgery across thyroid-specific domains, including neuromuscular symptoms, voice problems, concentration issues, psychological distress, sympathetic complaints, feelings of being chilly, and scar-related concerns. Generic instruments (eg, 36-item Short Form Health Survey, version 2) supported these findings. Across studies, heterogeneity arose from differences in treatment strategies and comparators, outcome instruments, and duration of follow-up. The authors conclude that this pooled analysis found that patients whose PTMC was managed with active surveillance reported equal or better health-related quality of life than those undergoing surgery. These findings support the importance of incorporating PROs into shared decision-making for low-risk thyroid cancer.