甲状腺乳头状癌术后复发靶向治疗进展

Progress of targeted therapies for postoperative recurrence of papillary thyroid carcinoma

甲状腺乳头状癌术后复发仍是临床中的常见问题。一些肿瘤信号通路的激活与基因突变会促使甲状腺癌发生发展,导致肿瘤易复发、碘难治甚至去分化。复发性甲状腺乳头状癌一旦发生去分化或远处转移,病人预后不容乐观,包括手术、促甲状腺激素抑制治疗及放射性碘治疗在内的常规治疗对这些病人帮助甚微,靶向治疗成为目前难治性复发甲状腺乳头状癌的新型治疗手段。目前靶向治疗主要包括多靶点酪氨酸激酶抑制剂治疗、放射性再敏疗法、免疫疗法等,但临床证据尚显不足,同时带来的不良反应也不容忽视。更具针对性地为各种基因类型甲状腺癌病人提供个性化治疗是未来发展的方向。

Postoperative recurrence of papillary thyroid carcinoma(PTC) is still a common problem.The activation of some tumor signaling pathways and gene mutations will promote the occurrence and development of thyroid carcinoma,resulting in the relapse,iodine refractory to treatment,and even dedifferentiation.Once the dedifferentiation or distant metastasis occurs in recurrent papillary thyroid carcinoma,the prognosis is poor,with limited benefits from conventional treatments including surgery,thyroid stimulating hormone(TSH) suppression and radioactive iodine therapy.Therefore,targeted therapy has undoubtedly become a new powerful therapeutic strategy for refractory relapsed PTC.At present,targeted therapy mainly includes multi-target tyrosine kinase inhibitor therapy,radiation re-sensitization therapy,immunotherapy,etc,but the clinical evidence is still insufficient,and the side effects cannot be ignored.To precisely characterize subtypes of thyroid carcinoma patients and to provide personalized targeted therapy are promising and awaited to be further investigated.