甲状腺癌远处转移的临床病理特征及危险因素

Clinicopathological characteristics and risk factors of distant metastasis in thyroid cancer

甲状腺癌远处转移(TCDM)病人往往预后较差,是甲状腺癌癌症相关死亡的主要原因,影响TCDM的临床病理因素很多,包括儿童和青少年、老年病人、男性、肿瘤直径越大(肿瘤最大直径≥4 cm)、甲状腺包膜侵犯、淋巴结转移(数量越多、直径越大)以及分化差的病理学类型如甲状腺髓样癌、低分化型甲状腺癌、甲状腺未分化癌等。BRAFV600E和TERT启动子突变是甲状腺乳头状癌和甲状腺未分化癌远处转移的危险因素,RET融合基因及NTRK融合基因突变是儿童及青少年分化型甲状腺癌远处转移的危险因素,RAS基因突变是甲状腺髓样癌远处转的风险因素。在甲状腺癌诊治中,综合考虑TCDM的高危因素并制定更加严格的诊疗方案,提高TCDM病人的生存时间。

Objective Patients with distant metastasis of thyroid cancer(TCDM)often have a poor prognosis,which is the main cause of cancer-related death of thyroid cancer.Many factors affect TCDM.Including children and adolescents,elderly patients,male patients,larger tumor diameter(maximum tumor diameter≥4 cm),thyroid capsule invasion,lymph node metastasis(more number,larger diameter),and poorly differentiated pathological types such as medullary thyroid cancer,poorly differentiated thyroid carcinoma,anaplastic thyroid carcinoma,etc.BRAFV600E and TERT promoter mutations are risk factors for distant metastasis of papillary thyroid carcinoma and anaplastic thyroid carcinoma,RET fusion gene and NTRK fusion gene mutations are risk factors for distant metastasis of differentiated thyroid cancer in children and adolescents,and RAS gene mutations are risk factors for distant metastasis of MTC.In the diagnosis and treatment of thyroid cancer,the high-risk factors of distant metastasis of thyroid cancer should be comprehensively considered,and more strict diagnosis and treatment plans should be formulated to improve the survival time of patients with distant metastasis of thyroid cancer.