Thyroid Cancer: Risk-Stratified Management and Individualized Therapy
Thyroid Cancer: Risk-Stratified Management and Individualized Therapy
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DOI：
10.1158/1078-0432.ccr-16-0484
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发表时间：
2016-10-15
影响因子：
11.5
通讯作者：
Frank-Raue, Karin
中科院分区：
文献类型：
--
作者：
Raue, Friedhelm;Frank-Raue, Karin
甲状腺癌是最常见的内分泌恶性肿瘤。分化型甲状腺癌（DTC）有两种亚型，乳头状甲状腺癌（PTC）和滤泡状甲状腺癌（FTC），是甲状腺癌中最常见的亚型;更罕见的亚型是甲状腺髓样癌（MTC）和甲状腺未分化癌（ATC）。近年来，由于颈部超声和甲状腺结节细针穿刺（FNA）等成像方法的使用越来越频繁，DTC的发病率迅速增加。在甲状腺全切除术和放射性碘治疗后，DTC在大多数患者中仍然是一种无痛和可治愈的疾病，而MTC的治愈率较低，并依赖于早期诊断。大多数ATC是无法治愈的。近年来，在识别甲状腺癌的遗传变化方面取得了很大进展，FNA样本或血液样本的基因检测为临床决策提供了有用的信息。肿瘤分期，无论是术后或通过成像，并测量肿瘤标志物甲状腺球蛋白的DTC和降钙素的MTC，允许动态风险适应分层的后续程序。在晚期转移性甲状腺癌中，使用酪氨酸激酶受体抑制剂（包括索拉非尼、乐凡替尼、凡德他尼和卡博替尼）的分子靶向治疗有助于控制肿瘤进展和延长无进展生存期。使用动态风险分层方法管理甲状腺癌，与其他癌症相比，大多数甲状腺癌患者的结局都很好。未来的主要挑战是识别高风险患者，并对他们进行适当的治疗和监测。(C)2016年AACR。
Thyroid cancer is the most common endocrine malignancy. Differentiated thyroid cancer (DTC) with the two subtypes, papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC), is the most frequent subtype of thyroid cancer; more rare subtypes are medullary thyroid cancer (MTC) and anaplastic thyroid cancer (ATC). The incidence of DTC has increased rapidly in recent years due to the more frequent use of imaging methods such as ultrasound of the neck and fine-needle aspiration (FNA) of thyroid nodules. After total thyroidectomy and radioiodine treatment, DTC remains an indolent and curable disease in most patients, whereas the cure rate in MTC is lower and depends on early diagnosis. Most ATCs are incurable. In recent years, there has been great progress in identifying genetic changes in thyroid cancer, and genetic testing of FNA samples or blood samples provides useful information for clinical decision making. Tumor staging, either postoperatively or by imaging, and measuring the tumor markers thyroglobulin for DTC and calcitonin for MTC, allow for dynamic risk-adapted stratification for follow-up procedures. In advanced metastatic thyroid cancer, molecular targeted therapy using tyrosine kinase receptor inhibitors, including sorafenib, lenvantinib, vandetanib, and cabozantinib, helps control tumor progression and prolongs progression-free survival. Using a dynamic risk-stratified approach to manage thyroid cancer, the outcomes for most thyroid cancer patients are excellent compared with those for other cancers. The major challenge in the future is to identify high-risk patients and to treat and monitor them appropriately. (C) 2016 AACR.