Abstract:

Objective

To comprehensively compare the efficacy, postoperative quality of life, and psychological status in patients undergoing radiofrequency ablation (RFA) versus surgical treatment for papillary thyroid microcarcinoma (PTMC), with the aim of providing clinicians with evidence for treatment decision-making and improving patients’ postoperative quality of life and psychological health.

Methods

A total of 107 patients who were diagnosed with PTMC and underwent radiofrequency ablation at the First Affiliated Hospital of Zhejiang University School of Medicine between January 2020 and March 2023 were selected and subjected to propensity score matching (PSM) with 536 PTMC patients who underwent surgical operation.Matching variables included age, nodule location, and maximum nodule volume.In the radiofrequency ablation group, the changes in nodule volume were measured by ultrasound at 1, 3, and 6 months after the operation.The χ² test or t-test was used to compare the differences in postoperative complications, recurrence, operation and hospitalization time, changes in thyroid hormone levels, quality of life, psychological anxiety, and depression between the two groups.Additionally,multiple linear regression analysis was performed to identify the influencing factors of postoperative quality of life and psychological status.

Results

After PSM, there were 107 patients in each group.Compared with the surgical operation group, the radiofrequency ablation group had significantly shorter operation time [(30.05±5.95)min vs (57.15±7.01) min, t=-30.48, P＜0.001] and hospitalization time [(3.08±1.06) d vs (6.56±1.27) d, t=-21.79, P＜0.001], and lower hospitalization costs [(10274.92±984.88) yuan vs (14802.46±2409.91) yuan, t=-17.99, P＜0.001].There were no serious complications in either group.Three cases (2.8%) in the radiofrequency ablation group and eight cases (7.5%) in the surgical operation group had minor complications, with no statistically significant difference in the rate of complications between the two groups (P＞0.05).In terms of postoperative recurrence rate, it was 2.8% in the radiofrequency ablation group and 0.9% in the surgical operation group, with no statistically significant difference (P＞0.05).There were no significant changes in thyroid function after the operation in the radiofrequency ablation group, while in the surgical operation group, there was a significant increase in thyroid-stimulating hormone (TSH) and significant decrease in free triiodothyronine (FT3) and free thyroxine (FT4) (P＜0.05).There were significant differences in the nodule volume changes at 1, 3, and 6 months after the operation in the radiofrequency ablation group.The scores of physical health (PCS), mental health (MCS),and overall quality of life in the radiofrequency ablation group were significantly higher than those of the surgical operation group [(83.89±9.25) points vs (78.15±10.93) points, t=4.32, P＜0.001; (79.10±8.39) points vs(74.07±9.28) points, t=3.89, P＜0.001; (81.49±6.46) points vs (76.11±6.82) points, t=5.67, P＜0.001], and the standard scores of the Zung self-rating anxiety scale (SAS) and the Zung self-rating depression scale (SDS) in the radiofrequency ablation group were significantly lower than those of the surgical operation group [(46.75±6.57)points vs (50.34±7.66) points, t=2.22, P=0.027; (54.30±7.18) points vs (56.58±7.77) points, t=2.18, P=0.0.030].Surgical approach and SAS standard score were main factors influencing the patients’ overall postoperative quality of life (β=-7.49 and 0.84, respectively; both P＜0.001).Surgical approach, surgical costs, and PCS and MCS scores were main factors influencing the patients’ postoperative anxiety and depression levels (β=6.17, 0.00, 0.39,and 0.36; P＜0.001, =0.025, ＜0.001, and ＜0.001, respectively).

Conclusion

Ultrasound-guided radiofrequency ablation is an effective treatment for papillary thyroid microcarcinoma with less surgical trauma, reduced costs,and improved postoperative quality of life.Compared to surgical treatment, radiofrequency ablation is a safe and effective alternative, improving patients’ quality of life and psychological well-being.

Key words: Papillary thyroid microcarcinoma, Radiofrequency ablation, Surgery, Quality of life, Psychology