Clinical trial NCT06725576: Ultrasound-Guided Microwave Ablation Vs. Surgery for Low-Risk PapilaryThyroid Carcinoma
Official title: Ultrasound and Gene-Guided Microwave Ablation Versus Surgery for Low-Risk Papillary Thyroid Carcinoma: a Prospective Observational Cohort Study.
Study type: OBSERVATIONAL
Overall status: RECRUITING
Conditions: Thyroid Cancer, Papillary
Keywords: Papillary Thyroid Carcinoma
Ablation Therapy
Personalized treatment
Thyroid cancer gene mutations
Lead sponsor: Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
Sponsor class: OTHER
Collaborators: name: National Natural Science Foundation of China
name: Guangzhou Science and Technology Innovation Commission,China
First posted: 2024-12-10
Enrollment: 201
Sex: ALL
Minimum age (years): 18
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: OTHER
Sampling method: NON_PROBABILITY_SAMPLE
Study population: The study population includes patients diagnosed with papillary thyroid carcinoma (PTC) at Sun Yat-Sen Memorial Hospital from January 2022 to November 2024. A total of 201 patients were prospectively enrolled in this study.

Brief summary: This study aims to investigate the efficacy and prognosis of ultrasound-guided and gene-based microwave ablation (MWA) versus surgical treatment in patients with low-risk papillary thyroid carcinoma (PTC). By analyzing genetic testing results, the study explores the impact of genetic mutations on treatment selection for low-risk patients, providing more precise molecular biological evidence for treatment choices and prognosis evaluation of thyroid cancer. This prospective study collects clinical data from patients diagnosed with PTC at Sun Yat-sen Memorial Hospital of Sun Yat-sen University between January 2022 and November 2024, who underwent genetic testing prior to treatment, and assesses efficacy and complications through long-term follow-up.

Detailed description: Objective: This study evaluates and compares the efficacy and prognosis of ultrasound and gene-based microwave ablation (MWA) and surgical treatment in patients with low-risk papillary thyroid carcinoma (PTC), emphasizing the influence of genetic mutations on low-risk patients' selection.

Background: MWA, a minimally invasive technique, is increasingly recognized in the management of PTC. While traditional criteria for ablation focus on tumor size, number, and location, the impact of genetic mutations on treatment efficacy remains underexplored.

Methods: A total of 201 patients with low-risk PTC without metastasis were prospectively enrolled. All patients underwent ultrasound and next-generation sequencing to confirm low-risk status. Patients chose either ablation or surgery and were monitored until November 2024. Efficacy and complications were assessed using thyroid ultrasound and contrast-enhanced ultrasound.

Eligibility criteria: The inclusion criteria of this study were as followed:

1. PTC confirmed by fine-needle aspiration (FNA);
2. Confirmed low-risk mutation types by next-generation sequencing (NGS) before surgery;
3. No severe functional diseases, such as heart failure, severe respiratory diseases, or renal failure;
4. Availability of complete follow-up data.

The exclusion criteria were as followed:

1. No local or distant metastasis assessed by imaging evaluations, including ultrasound or computed tomography (CT);
2. Lacking of preoperative genetic testing or inability to assess genetic test results;
3. Inability to complete follow-up or lost to follow-up during the study.

Low-risk PTC is defined as:

1. Maximum tumor diameter ≤1 cm;
2. Solitary lesion;
3. No local or distant metastasis;
4. No tumor invasion into extrathyroidal tissues;
5. No vascular invasion;
6. Non-invasive pathological subtype for the primary lesion (invasive subtypes include tall cell, columnar cell, diffuse sclerosing, solid/trabecular, and oncocytic vari ants);
7. No history of head and neck radiotherapy during adolescence;
8. No family history of thyroid cancer;
9. Genetic testing showing BRAF V600E mutation (without concurrent TERT mutation), RAS family gene mutations, (HRAS, NRAS, KRAS), or other low-risk mutations, such as isolated RET/PTC) rearrangements.

Intermediate-high risk PTC is defined as:

1. Maximum tumor diameter \>1 cm;
2. Multifocal thyroid cancer;
3. Local or distant metastasis;
4. Primary lesion with extrathyroidal extension;
5. Vascular invasion;
6. Primary lesion with an invasive pathological subtype;
7. History of head and neck radiotherapy during adolescence;
8. Family history of thyroid cancer;
9. Genetic testing revealing high-risk mutation combinations, such as BRAF V600E or RAS mutations with concurrent TERT or TP53 mutations, or RAS mutations combined with EIF1AX mutations.

Primary outcomes:
measure: Disease progression
timeFrame: through study completion, an average of 1 year
Secondary outcomes:
measure: Complications
timeFrame: through study completion, an average of 1 year
measure: Treatment costs
timeFrame: through study completion, an average of 1 year
measure: Time of hospital stay
timeFrame: from admission to discharge, up to 1 week.
measure: Operative time
timeFrame: immediately after the intervention
measure: Ablation efficacy
timeFrame: Follow-up examination one month after treatment.
measure: Changes in ablation zone volume
timeFrame: through study completion, an average of 1 year
measure: Thyroid function
timeFrame: through study completion, an average of 1 year
Other outcomes:
Locations:
city: Guangzhou
country: China
facility: Sun Yat-sen Memorial Hospital, Sun Yat-sen University
state: Guangdong
Study officials:
affiliation: Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
name: Miaoyun Long, MD
role: STUDY_DIRECTOR
References: