Controversies in primary treatment of low-risk papillary thyroid cancer
Controversies in primary treatment of low-risk papillary thyroid cancer
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DOI：
10.1016/s0140-6736(12)62205-3
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发表时间：
2013-03-23
期刊：
影响因子：
168.9
通讯作者：
Cooper, David S.
中科院分区：
文献类型：
--
作者：
McLeod, Donald S. A.;Sawka, Anna M.;Cooper, David S.
在世界上许多地方，甲状腺乳头状癌的发病率比任何其他恶性肿瘤的发病率增长都要快。大多数被诊断出的乳头状甲状腺癌都很小，通常被认为风险较低，对死亡率影响很小或没有影响。甲状腺乳头状癌是一个临床挑战，因为很难证明这种疾病的传统治疗三联疗法（即甲状腺全切除术伴或不伴预防性中央颈淋巴结清扫术，放射性碘残留消融术，以及用左旋甲状腺素抑制血清促甲状腺激素）的益处。然而，这些治疗可能会降低疾病复发的风险，在一个子集的患者更具侵略性的疾病。在过去的十年中，专业协会和其他团体已经建立了基于证据的临床实践指南，用于管理乳头状甲状腺癌，但这些努力由于缺乏随机对照试验而变得困难。在这篇综述中，我们总结了疾病发病率的流行病学数据，讨论了疾病管理中的一些争议，并概述了基于最佳医学证据和临床实践指南的现有建议的治疗框架。
In many parts of the world, incidence of papillary thyroid cancer is increasing faster than any other malignancy. Most papillary thyroid cancers that are diagnosed are small and are generally regarded as being low risk, with little or no effect on mortality. Papillary thyroid cancer is a clinical challenge because it is difficult to prove benefit from the traditional therapeutic triad for this disorder (ie, total thyroidectomy with or without prophylactic central neck dissection, radioiodine remnant ablation, and suppression of serum thyroid-stimulating hormone with levothyroxine). However, risk of disease recurrence might be reduced by these therapies in a subset of patients with more aggressive disease. In the past decade, professional societies and other groups have established evidence-based clinical practice guidelines for management of papillary thyroid cancer, but these efforts have been made difficult by a paucity of randomised controlled trials. In this review, we summarise epidemiological data for disease incidence, discuss some controversies in disease management, and outline a therapeutic framework founded in the best available medical evidence and existing recommendations from clinical practice guidelines.