Abstract:

Objective

To investigate the quality of life， depression status， and the influencing factors of non-remission of depression in patients with T1N0M0 papillary thyroid carcinoma （PTC） before and after microwave ablation （MWA）.

Methods

A prospective longitudinal study design was adopted.A total of 302 T1N0M0 PTC patients who underwent MWA in the Department of Interventional Ultrasound of Chinese PLA General Hospital from November 2023 to October 2024 were prospectively selected.The Patient Health Questionnaire （PHQ-9）， European Organization for Research and Treatment of Cancer Quality of Life Questionnaire （EORTC QLQ-C30）， and Thyroid Cancer-specific Quality of Life Questionnaire （THYCA-QoL）were used to evaluate quality of life （QOL） and depressive status of the patients before and one month after surgery.The scores before and after treatment were compared， and multivariate Logistic regression was used to analyze the independent influencing factors related to unrelieved depression in PTC patients after ablation.

Results

After excluding 93 patients who did not complete the postoperative questionnaire， 209 patients with PTC were included in this study.Compared with the scores before MWA， depression scores were significantly decreased one month after MWA （3.74±2.69 vs 2.64±2.15， P＜0.001）.The incidence of depression （PHQ-9 score ≥5 points） decreased from 30.6% （64/209） before MWA to 17.2% （36/209） after MWA， with a statistically significant difference （P=0.001）.Compared with those before MWA treatment， the total QOL score of EORTC QLQ-C30 had no significant change （P=0.947）， but the scores of emotional and cognitive function were improved （P=0.048 and 0.035， respectively）， and that of role function was decreased （P=0.002）.THYCA-QoL total score decreased significantly after treatment （17.60±3.41 vs 16.80±2.80， P=0.009）， and neuromuscular， attention， sympathetic nerve， psychological， sensory， and feeling cold scores were significantly improved （P=0.013， 0.010， 0.031， 0.001， 0.031， and 0.010， respectively）.Multivariate logistic regression analysis showed that female gender （odds ratio ［OR］=5.598， 95% confidence interval ［CI］： 1.127-27.813， P=0.035） and nodules adjacent to the danger triangle of the face （OR=10.230， 95%CI： 2.542-41.168， P=0.001） were independent risk factors for unrelieved depression in PTC patients after MWA.

Conclusion

MWA can improve depression，thyroid cancer-specific symptoms， and quality of life related to emotional and cognitive function in early PTC patients.However， female patients or patients with nodules adjacent to the death triangle have poor relief in depression after MWA， and they should receive additional psychological support to better relieve depression and improve the QOL.

Key words: Papillary thyroid cancer, Depression, Quality of life, Microwave ablation