放射性碘治疗在儿童分化型甲状腺癌中应用

Radioactive iodine therapy for children differentiated thyroid cancer

儿童分化型甲状腺癌(cDTC)的临床病理特征及远期预后与成人分化型甲状腺癌(aDTC)存在较大差异,针对成人的诊疗策略并不能完全适用于儿童。目前cDTC的;I治疗推荐主要基于复发风险分层,相对于aDTC,现有指南中c DTC的复发风险分层体系证据有限且更多侧重淋巴结转移。新近的研究证据揭示了基因特征与c DTC的侵袭性及分化程度的关系,这将为cDTC的复发风险分层体系增加新的证据,并将有助于指导;I治疗前评估、治疗决策及预测疗效;针对融合基因的靶向治疗诱导分化联合;I治疗为儿童碘难治性(RAIR)晚期DTC的治疗提供了新的思路;动态风险度评估(DRS)体系及刺激性甲状腺球蛋白(sTg)水平或可用于cDTC的疗效评价及实时预测最终疾病状态。上述进展将有望为cDTC;I个体化精准诊疗决策提供依据。

The clinicopathological features and long-term prognosis of children differentiated thyroid cancer(cDTC)are significantly different from that of adult DTC(aDTC),thus the diagnosis and management strategies for adults cannot be completely applicable to cDTC. Currently,;I therapy recommendations for cDTC are based primarily on recurrence risk stratification. Compared with a DTC,the international guidelines for cDTC recurrence risk stratification have limited evidence and focus more on lymph node metastasis. Recent studies have revealed the relationship between gene characteristics and invasion and differentiation of cDTC,which add new evidence for the recurrence risk of cDTC,and will help guide the evaluation and efficacy predicting before;I therapy. Gene expression was associated with aggressive clinical behavior and may afford evidence in the future;I management in cDTC, as well as provide opportunities to incorporate oncogene-specific inhibitory therapy for re-differentiation in those;I-refractory cDTC.DRS system and sTg levels may be used for pre-;I evaluation and disease status follow-up in the decision making for cDTC.The above advancements are expected to provide basis for individualized assessment and decision making of;I management in cDTC.