分化型甲状腺癌治疗管理和动态风险评估现状

Management and dynamic risk stratification of differentiated thyroid cancer

分化型甲状腺癌(differentiated thyroid carcinoma,DTC)是甲状腺最常见的恶性肿瘤。随着影像技术和细针穿刺技术的发展,DTC的早期诊断率增高。由于DTC具有侵袭性较低的特征,大多数患者的生存预后良好,死亡风险低,因此对于DTC的管理应该更多关注减少复发和转移的同时减少并发症,提高生存质量。美国癌症联合委员会(American Joint Committee on Cancer,AJCC)制定的TNM分期被广泛用于预测死亡率,但在预测复发风险的能力较差。自2008年起Tuttle等提出了以动态检测"治疗反应"分层监测DTC患者术后复发风险。随着动态风险评估的作用被不同国家的临床研究证实,2015美国甲状腺学会(American Thyroid Association,ATA)指南正式推荐动态危险度分层用于术后长期随访。动态风险评估在中国大陆患者中还缺乏研究数据。甲状腺癌患者的动态风险评估是个体化管理的基础。

Differentiated thyroid cancer (DTC) is the most frequently diagnosed thyroid cancer. With the development of the imaging technology and fine needle aspiration, early diagnosis rate of DTC is increasing. Most patients have favorable prognosis for DTC′s low-invasion. TNM staging is more widely used for predicting mortality than predicting recurrence. In 2008, it was suggested that recurrence risks for DTC should be assessed based on the results of dynamic monitoring treatment response. The validity of dynamic risk stratification (DRS) has been supported by different researches in various countries and DRS is recommended in 2015 American Thyroid Association Management Guidelines. Long-term DRS in patients with DTC make individual management possible.