甲状腺微小乳头状癌预后影响因素与治疗进展

Prognostic Factors and Treatment Progress of Papillary Thyroid Microcarcinoma

甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)是甲状腺乳头状癌的一个特殊亚型,通常呈惰性进展,而少部分PTMC患者早期即出现颈部淋巴结转移和远处转移,预后不良。临床实践中,外科手术、主动监测(active surveillance,AS)、超声引导下热消融是目前PTMC治疗的主要策略。特别是对于低风险PTMC,AS、超声引导下热消融已逐渐成为替代手术的一线管理策略。然而对于PTMC患者临床上如何进行有效风险分层、完善预后风险评估以及确立精准个体化治疗方案,目前国内外尚未形成统一认识。鉴于此,本研究梳理了近5年有关PTMC的文献,基于PTMC患者临床病理学、分子生物学、影像学等特征总结其预后影响因素,包括患者年龄、性别、病灶直径、病灶位置、病灶数量、腺外侵犯、颈部淋巴结转移、远处转移、病理亚型、分子标记物、促甲状腺素水平、甲状腺钙化、妊娠等,针对PTMC预后影响因素及治疗决策的最新进展做一综述,以期为临床PTMC患者的风险评估及治疗决策选择提供有意义的参考。

Papillary thyroid microcarcinoma(PTMC)is a special subtype of thyroidpapillary carcinomathat usually progresses inertly.However,a small proportion of PTMC patients showed cervical lymph node metastasis and distant metastasis in the early stage,and the prognosis is poor.In clinical practice,surgery,active surveillance(AS)and ultrasound-guided thermal ablation are the main treatment strategies for PTMC.For low-risk PTMC,AS and ultrasound-guided thermal ablation have gradually become the first-line management strategies to replace surgery.However,for PTMC patients,how to carry out effective risk stratification in clinical practice,improve prognostic risk assessment and establish precise and individualized treatment plans,there is no unified understanding at home and abroad at present.Therefore,in this paper,the factors influencing the prognosis of PTMC were summarized from the aspects of clinicopathological characteristics,molecular biological characteristics and imaging characteristics by referring to the recent 5 year literatures related to PTMC,which mainly include Lymph node metastasis(LNM),distant metastasis,pathological subtypes,molecular markers,TSH level,calcification,pregnancy and so on.The prognostic factors of PTMC and the latest progress of treatment decision-making was reviewed,in order to provide a meaningful reference for the clinical risk assessment and treatment decision-making of PTMC.