cN_(0)峡部甲状腺乳头状癌的临床病理特征及治疗研究进展

Progress in clinicopathological features and treatment of cN_(0) isthmus papillary thyroid carcinoma

甲状腺乳头状癌(papillary thyroid carcinoma,PTC)是甲状腺癌中最常见的病理类型,绝大多数位于两侧腺叶,但仍有小部分起源于峡部。相比腺叶癌,峡部PTC表现出更具侵袭性的临床病理特征。基于峡部PTC解剖学和生物学行为的特殊性,目前国内外指南针对临床淋巴结阴性(cN_(0))峡部PTC缺乏明确的治疗细则,临床医生最常用的治疗方案为甲状腺全部切除术+预防性中央区淋巴结清扫(preventive central region lymph node dissection,pCLND)。但在倡导对肿瘤风险分层、实施个性化精准治疗的背景下,学者们对于cN_(0)峡部PTC的手术切除及预防性中央区淋巴结清扫的范围存在很大争议。同时,热消融技术在甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)治疗中的不断推进,也可能为cN_(0)峡部PTMC的治疗带来了新思路。本文就cN_(0)峡部PTC的临床病理特征及治疗进展进行系统的综述,为外科医生选择最佳治疗方案提供参考。

Papillary thyroid carcinoma(PTC),the most common pathologic type of thyroid cancer,is mostly bilateral in the glandular lobes,but a small percentage of them originate in the isthmus.Compared with adenocarcinoma,isthmic PTC presents more aggressive clinicopathological features.Due to the particularity of anatomy and biological behavior of isthmic PTC,there is a lack of clear treatment rules for clinically negative(cN_(0))isthmic PTC in current guidelines at home and abroad.The most commonly used treatment plan for clinicians is total thyroidectomy+preventive central region lymph node dissection(pCLND).However,under the background of advocating tumor risk stratification and personalized precision therapy,scholars have great controversies over the scope of surgical resection of PTC in the isthmus of cN_(0) and preventive lymph node dissection in the central region.At the same time,the continuous advancement of thermal ablation in the treatment of papillary thyroid microcarcinoma(PTMC)may also bring new ideas for the treatment of PTMC in the isthmus of cN_(0).In this paper,the clinicopathological features and treatment progress of PTC in cN_(0) isthmus were systematically reviewed to provide a reference for surgeons to choose the best treatment.