甲状腺乳头状微小癌的积极监测:实施与困惑

Active surveillance of papillary thyroid microcarcinoma: implement and perplexity

当前,积极监测被认为是甲状腺乳头状微小癌(PTMC)的替代治疗方法之一。大多数新诊断的甲状腺癌是惰性微小癌,可能是积极监测而非立即手术的较好适应证。对适合积极监测的PTMC患者制定选择标准时,我们必须考虑到许多因素,包括肿瘤的特征、患者和医疗团队。如果可能,PTMC的积极监测应成为前瞻性临床试验的一部分,以确保长期安全性,并确定与PTMC进展相关的临床和(或)分子标记物。本文讨论了关于PTMC手术干预的经验教训,描述了PTMC积极监测的概念、应用、注意事项及困惑和展望。对于选择适当的PTMC患者来说,积极监测是替代立即手术的一种较好方案。

Active surveillance(AS)is now regarded as an alternative strategy of treatment for papillary thyroid microcarcinoma(PTMC). Most cases of newly diagnosed thyroid cancer are small indolent microcarcinoma and could be good candidates for AS instead of immediate surgery. Many considerations must be taken into account for establishing selection criteria suitable for AS of PTMC, including the characteristics of the tumor, the patient, and the medical team. If possible, AS of PTMC should be a part of a prospective clinical trial to ensure long-term safety and to identify clinical and(or)molecular markers of the progression of PTMC. In this review, we discuss lessons regarding surgical interventions for PTMC, and then describe the concept, application, caveats, unanswered questions, and future perspectives of AS for PTMC. For appropriately selected patients with PTMC, AS can be a good alternative to immediate surgery.