| 陆一丹,时开元,欧 笛.甲状腺微小癌预后风险评估与治疗决策的研究进展[J].中国肿瘤,2020,29(12):962-969. |
| 甲状腺微小癌预后风险评估与治疗决策的研究进展 |
| Progress on Prognostic Risk Assessment and Treatment Strategy for Thyroid Microcarcinoma |
| 中文关键词 修订日期：2020-09-18 |
| DOI：10.11735/j.issn.1004-0242.2020.12.A013 |
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| 中文关键词: 甲状腺微小癌 预后评估 消融 |
| 英文关键词:thyroid microcarcinoma prognostic risk assessment ablation |
| 基金项目:国家自然科学基金面上项目(81871370、82071946)； |
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| 中文摘要: |
| 摘 要：随着诊疗技术的发展和健康意识的提升，甲状腺微小癌(thyroid microcarcinoma，TMC)发病率逐年上升，占新发甲状腺癌的近半数。其中绝大部分是甲状腺微小乳头状癌(papillary thyroid microcarcinoma，PTMC)，相对惰性，预后较好，治疗方案不断精准化，对低危PTMC可选择手术或积极监测（active surveillance，AS)。目前TMC的预后风险评估尚待完善，本文总结了其危险因素，淋巴结转移风险危险因素包括年轻、男性、微小髓样癌、肿瘤直径≥7mm、多灶性、腺外侵犯。复发风险危险因素包括BRAF突变、淋巴结转移、腺外侵犯。远处转移风险危险因素包括微小滤泡癌、微小髓样癌。超声引导下消融治疗技术的发展为低危PTMC患者提供了新选择，疗效已得到认可，并可减少对脏器的损伤，减小心理负担和经济负担，有望成为手术和AS的替代疗法，尤其是不耐受或拒绝手术、顾虑过重或要求微创介入治疗，经术前充分专业评估，临床分期cT1aN0M0甲状腺乳头状癌患者。 |
| 英文摘要: |
| Abstract：With the development of diagnosis technology and the improvement of health awareness，the incidence of thyroid microcarcinoma(TMC) has increased，accounting for nearly half of the new cases of thyroid cancer. The majority of TMC are papillary thyroid microcarcinoma (PTMC)，which is relatively inert and has a good prognosis. The treatment strategy is continuously refined. For low-risk PTMC，surgery or active surveillance(AS) can be selected. The current prognostic risk assessment of TMC has yet to be perfected. This article summarizes the following risk factors，the risk of lymph node metastasis：young，male，medullary microcarcinoma，tumor diameter ≥7mm，multifocal，extraglandular invasion. Risk of recurrence：BRAF mutation，lymph node metastasis，extraglandular invasion. Risk of distant metastasis：follicular microcarcinoma，medullary microcarcinoma. The development of ultrasound-guided ablation treatment technology provides new options for low-risk PTMC patients. The curative effect has been recognized，and it can reduce organ damage，reduce psychological and economic burdens. It is expected to become an alternative therapy for surgery and AS，especially for clinically staged cT1aN0M0 papillary cancer patients who with intolerance or refusal of surgery，excessive concerns or request for minimally invasive interventional treatment，have been fully professionally evaluated before ablation. |
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