碘难治性分化型甲状腺癌诱导再分化治疗研究进展

Progress in Re-differentiating Therapy of Radioiodine-refractory Differentiated Thyroid Cancer

分化型甲状腺癌(DTC)大多进展缓慢,经手术、促甲状腺素抑制治疗和(或)放射性碘(RAI)等规范化治疗后总体预后好,但仍有部分患者治疗后出现复发或远处转移,并可能在自然病程或治疗过程中丧失摄碘能力,不能从后续RAI治疗中获益,成为碘难治性分化型甲状腺癌(RAIR-DTC)。RAIR-DTC患者可选择的治疗方法有限,且效果欠佳。近年来,随着对RAIR-DTC分子机制研究的不断深入,诱导再分化联合RAI治疗在RAIR-DTC中展现出一定的应用前景。本文综述了信号通路抑制剂、组蛋白去乙酰化酶抑制剂(HDACi)、DNA甲基化酶抑制剂、维甲酸类药物及过氧化物酶体增殖物激活受体(PPAR)激动剂在RAIR-DTC诱导再分化治疗中的进展。

The majority patients of differentiated thyroid carcinoma(DTC)with indolent progression have general good prognosis after standard primary treatments including surgery,thyroid stimulating hormone(TSH)suppression and radioactive iodine(RAI)therapy.However,there are still some patients suffered from recurrence or distant metastasis after initial treatment.They may lose the ability of uptaking iodine during their natural course of disease or treatment and could not benefit from subsequent RAI treatment,which will result in radioiodine-refractory differentiated thyroid cancer(RAIR-DTC).Options are very limited for RAIR-DTC patients,which is associated with a poor prognosis.Recently,with the research advances on the molecular mechanism of RAIR-DTC,redifferentiation combined with RAI therapy have been increasingly used to treat RAIR-DTC,and some outcomes are quite encouraging.This paper reviews the progress of signaling pathway inhibitors,histone deacetylase inhibitors,DNA methyltransferase inhibitors,retinoids and peroxisome proliferator-activated receptor agonists in redifferentiating therapy of RAIR-DTC.