浅议如何优化我国低危甲状腺微小乳头状癌的动态监测

Discussion on how to optimize active surveillance for low-risk papillary thyroid microcarcinoma in China

作为低危甲状腺微小乳头状癌的管理策略,动态监测得到国内外多数指南的推荐,然而在国内却未获得中国患者和医师的广泛接纳。医师应提高对甲状腺微小乳头状癌"低危"的认识,熟练鉴别中高危病例,熟悉诊断疾病进展的标准及方法,及时为疾病进展患者选择更积极的治疗策略。通过分析动态监测的长期成本效益,重视患者因诊疗行为付出的健康成本和术后疾病状态对患者社会功能的削弱,推动诊疗行为向有利于患者长期生活质量,有利于提高社会整体健康水平、降低整体成本的方向调整。同时,激发患者的主观能动性,帮助患者全面了解各种治疗方式对心理、身体状态的影响,从心理上积极支持患者,坚定其执行动态监测的信心。通过加强多学科诊疗团队与制度建设,实现微小甲状腺乳头状癌的危险分层、疾病进展的准确判断、心理波动的及时疏导、动态随访的长期坚持。应找准提高我国甲状腺癌患者生存率的着力点,提高中晚期甲状腺癌患者的治疗水平,促进低危甲状腺微小乳头状癌动态监测的良性发展。未来,中国针对动态监测应积极开展多中心的前瞻性研究,积累高质量的文献证据,推动标准化进程,规范的动态监测一定会使低危甲状腺微小乳头状癌患者受益。

Active surveillance,as a first-line treatment strategy for low-risk papillary thyroid microcarcinoma,has been recommended by guidelines worldwide.However,active surveillance has not been widely accepted by doctors and patients in China.In view of the huge challenges faced by active surveillance,doctors should improve their understanding of the“low risk”of papillary thyroid micropapillary cancer,identify some intermediate or high-risk cases,be familiar with the criteria and methods of diagnosis for disease progression,and timely turn patients with disease progression into more active treatment strategies.By analyzing the long-term cost-effectiveness of active surveillance,it is clear that medical expense is only one cost form of medical activities,and the health cost(thyroid removal and surgical complications)paid by patients due to“over-diagnosis and over-treatment”is the most important.Moreover,the weakening of the patients′social function caused by surgical procedures is a more hidden and far-reaching cost.The formulation of health economic policies(including medical insurance)should promote the adjustment of diagnosis and treatment behavior to the direction which is conducive to the long-term life and treatment of patients,improving the overall health level of society and reducing the overall cost.At the same time,doctors should stimulate the subjective initiative of patients,help them fully understand the impact of various treatment methods on their psychological and physical status,support patients psychologically,and strengthen their confidence in implementing active surveillance.By strengthening multi-disciplinary treatment team and system support,doctors can achieve risk stratification of papillary thyroid microcarcinoma,accurate judgment of disease progress,timely counseling for psychological problems,and long-term adherence to active surveillance.Improving the treatment level of advanced thyroid cancer is the key point of improve the prognosis.It is important to promote the development of active surveillance for low-risk papillary thyroid microcarcinoma.In the future,it is necessary to carry out multi-center prospective research and accumulate research evidence for promoting the standardization process of active surveillance.Standardized active surveillance will certainly benefit specific papillary thyroid microcarcinoma patients.