甲状腺癌骨转移诊断及治疗

Surgical diagnosis and treatment of bone metastasis in thyroid cancer

甲状腺癌约4%并发骨转移,预后变差,70%病人在确诊后4年内死亡。甲状腺癌骨转移的发生与年龄、性别、种族、特别是病理类型、颈部病灶严重程度等因素相关。骨转移常引起骨痛、高钙血症等,增加了骨骼相关事件(SRE)的发生,如病理性骨折和脊髓压迫,严重影响病人生活质量。甲状腺癌骨转移的诊断主要依靠影像学检查,包括颈部超声、增强CT、MRI、骨扫描和正电子发射计算机断层扫描(PET-CT)等,可用于明确甲状腺病灶、侵犯范围和骨转移情况。甲状腺癌骨转移的治疗需要多学科联合诊治,制定个体化治疗方案。治疗方式包括手术治疗、同位素治疗、局部姑息治疗和小分子靶向治疗。手术治疗主要针对甲状腺原发病灶和骨寡转移灶,可进行病灶切除和骨缺损重建。分化型甲状腺癌骨转移病人在甲状腺全切术后可进行同位素^(131)I治疗,治疗前需停服甲状腺素并进行低碘饮食。局部姑息治疗方式包括骨水泥固定、姑息性刮除固定术、射频或冷冻、局部外放射和血管栓塞治疗等,可用于缓解局部症状、延缓肿瘤生长和减少术中出血。近年来,小分子靶向治疗发展迅速,索拉菲尼、仑伐替尼、凡德他尼、卡博替尼、安罗替尼等药物广泛用于晚期甲状腺癌的治疗,可有效抑制肿瘤血管生成和肿瘤生长。甲状腺癌骨转移,通过积极的综合治疗常仍能获得较好预后。

The prognosis for bone metastasis in thyroid cancer is relatively poor,with an incidence rate of about 4%,and 70%of patients die within four years of diagnosis.Bone metastasis often causes bone pain,pathological fractures,spinal cord compression syndrome,and hypercalcemia,severely affecting patients'quality of life.Diagnosing bone metastasis in thyroid cancer mainly relies on imaging examinations,including neck ultrasound,enhanced CT,MRI,PET-CT,and bone scanning,which can identify thyroid lesions,the extent of invasion,and bone metastasis.The treatment of bone metastasis in thyroid cancer requires a multidisciplinary approach to develop individualized treatment plans.Treatment methods include surgical treatment,isotope therapy,other treatments,and small molecule targeted therapy.Surgical treatment mainly targets the primary thyroid lesion and bone oligometastatic foci and can involve lesion resection and bone defect reconstruction.Patients with differentiated thyroid cancer bone metastasis can undergo isotope therapy after total thyroidectomy,which requires discontinuation of thyroxine and a low-iodine diet before treatment.Other treatments include bone cement fixation,palliative curettage fixation,radiofrequency or cryoablation,local external radiation,and vascular embolization therapy,which can be used to relieve local symptoms,delay tumor growth,and reduce intraoperative bleeding.In recent years,the development of small-molecule targeted therapy has been rapid,with drugs such as sorafenib,lenvatinib,vandetanib,cabozantinib,and nilotinib widely used for the treatment of advanced thyroid cancer,effectively inhibiting tumor angiogenesis and growth.Studies have shown that factors such as age,gender,race,and marital status are related to the occurrence of bone metastasis in thyroid cancer.Bone metastasis in thyroid cancer increases the occurrence of skeletal-related events(SREs),such as pathological fractures and spinal cord compression,affecting patients'quality of life.Patients with differentiated thyroid cancer bone metastasis often achieve better prognoses through active comprehensive treatment.