甲状腺微小乳头状癌预后影响因素与治疗进展

摘要/Abstract

摘要： 甲状腺微小乳头状癌（papillary thyroid microcarcinoma, PTMC）是甲状腺乳头状癌的一个特殊亚型，通常呈惰性进展，而少部分PTMC患者早期即出现颈部淋巴结转移和远处转移，预后不良。临床实践中，外科手术、主动监测（active surveillance, AS）、超声引导下热消融是目前PTMC治疗的主要策略。特别是对于低风险PTMC，AS、超声引导下热消融已逐渐成为替代手术的一线管理策略。然而对于PTMC患者临床上如何进行有效风险分层、完善预后风险评估以及确立精准个体化治疗方案，目前国内外尚未形成统一认识。鉴于此，本研究梳理了近5年有关PTMC的文献，基于PTMC患者临床病理学、分子生物学、影像学等特征总结其预后影响因素，包括患者年龄、性别、病灶直径、病灶位置、病灶数量、腺外侵犯、颈部淋巴结转移、远处转移、病理亚型、分子标记物、促甲状腺素水平、甲状腺钙化、妊娠等，针对PTMC预后影响因素及治疗决策的最新进展做一综述，以期为临床PTMC患者的风险评估及治疗决策选择提供有意义的参考。

关键词: font-size:medium, ">甲状腺微小乳头状癌；预后影响因素；主动监测；消融

Abstract: Papillary thyroid microcarcinoma(PTMC) is a special subtype of thyroidpapillary carcinomathat usually progresses inertly.However, a small proportion of PTMC patients showed cervical lymph node metastasis and distant metastasis in the early stage,and the prognosis is poor.In clinical practice，surgery, active surveillance(AS) and ultrasound-guided thermal ablation are the main treatment strategies for PTMC.For low-risk PTMC, AS and ultrasound-guided thermal ablation have gradually become the first-line management strategies to replace surgery. However, for PTMC patients, how to carry out effective risk stratification in clinical practice,improve prognostic risk assessment and establish precise and individualized treatment plans，there is no unified understanding at home and abroad at present.Therefore,in this paper, the factors influencing the prognosis of PTMC were summarized from the aspects of clinicopathological characteristics, molecular biological characteristics and imaging characteristics by referring to the recent 5 year literatures related to PTMC, which mainly include Lymph node metastasis(LNM), distant metastasis, pathological subtypes, molecular markers, TSH level, calcification, pregnancy and so on.The prognostic factors of PTMC and the latest progress of treatment decision-making was reviewed, in order to provide a meaningful reference for the clinical risk assessment and treatment decision-making of PTMC.

Key words: Papillary thyroid microcarcinoma, Prognostic factors, Active sueveillance, Ablation

中图分类号:

祝嘉, 秦晓茹, 郝玲玲, 李鹏飞, 朱春悦, 王跃欣. 甲状腺微小乳头状癌预后影响因素与治疗进展[J]. 中国医药导刊, 2021, 23(12): 907-911.

ZHU Jia, QIN Xiaoru, HAO Lingling, LI Pengfei, ZHU Chunyue, WANG Yuexin. Prognostic Factors and Treatment Progress of Papillary Thyroid Microcarcinoma[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2021, 23(12): 907-911.

参考文献

[1]Sung H,Ferlay J,Siegel RL, et al.Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA Cancer J Clin,2021,71(3):209-249.
     [2]Leboulleux S,Tuttle RM,Pacini F, et al.Papillary thyroid microcarcinoma: time to shift from surgery to active surveillance? [J]Lancet Diabetes Endocrinol,2016,4(11):933-942.
     [3]Zheng X,Peng C,Gao M, et al.Risk factors for cervical lymph node metastasis in papillary thyroid microcarcinoma: a study of 1 587 patients[J].Cancer Biol Med,2019,16(1):121-130.
     [4]Liang JA, Luo YB, Liang KB, et al.Clinicopathologic factors and preoperative ultrasonographic characteristics for predicting central lymph node metastasis in papillary thyroid microcarcinoma: a single center retrospective study[J].Braz J Otorhinolaryngol,2020,DOI:10.1016/j.bjorl.2020.05.004.
     [5]Zhang Q,Wang Z,Meng X, et al.Predictors for central lymph node metastases in CN0 papillary thyroid microcarcinoma(mPTC): A retrospective analysis of 1304 cases[J].Asian J Surg,2019,42(4):571-576.
     [6]Kim M,Kim YN,Kim WG, et al.Optimal cut-off age in the TNM Staging system of differentiated thyroid cancer: is 55 years better than 45 years? [J].Clin Endocrinol(Oxf),2017,86(3):438-443.
     [7]Chen Z,Ruan J,Yao Y, et al.A comparison of the seventh and eighth editions of the AJCC staging systems to predict recurrence in papillary thyroid microcarcinoma[J].Ann Surg Oncol,2021,28:6564-6571.
     [8]Oh HS,Park S,Kim M, et al.Young age and male sex are predictors of large-volume central neck lymph node metastasis in clinical N0 papillary thyroid microcarcinomas[J].Thyroid,2017,27(10):1285-1290.
     [9]Yu XM,Wan Y,Sippel RS, et al.Should all papillary thyroid microcarcinomas be aggressively treated? An analysis of 18 445 cases[J].Ann Surg,2011,254(4):653-660.
     [10]Liu C,Chen T,Zeng W, et al.Reevaluating the prognostic significance of male gender for papillary thyroid carcinoma and microcarcinoma: a SEER database analysis[J].Sci Rep,2017,7(1):11412.
     [11]Song J,Yan T,Qiu W, et al.Clinical analysis of risk factors for cervical lymph node metastasis in papillary thyroid microcarcinoma: aretrospective study of 3686 patients[J].Cancer Manag Res,2020,12:2523-2530.
     [12]Huang K,Gao N,Zhai Q, et al.The anteroposterior diameter of nodules in the risk assessment of papillary thyroid microcarcinoma[J].Medicine(Baltimore),2018,97(10):e9712.
     [13]Lee WK,Lee J,Kim H, et al.Peripheral location and infiltrative margin predict invasive features of papillary thyroid microcarcinoma[J].Eur J Endocrinol,2019,181(2):139-149.
     [14]Back K,Kim JS,Kim JH, et al.Superior located papillary thyroid microcarcinoma is a risk factor for lateral lymph node metastasis[J].Ann Surg Oncol,2019,26(12):3992-4001.
     [15]Cai J,Fang F,Chen J, et al.Unilateral multifocality and bilaterality could be two different multifocal entities in patients with papillary thyroid microcarcinoma[J].BioMed Res Int,2020,(7):1-7.
     [16]Choi WR,Roh JL,Gong G, et al.Multifocality of papillary thyroid carcinoma as a risk factor for disease recurrence[J].Oral Oncol,2019,94:106-110.
     [17]Park JS,Chang JW,Liu L, et al.Clinical implications of microscopic extrathyroidal extension in patients with papillary thyroid carcinoma[J].Oral Oncol,2017,72:183-187.
     [18]Feng JW,Ye J,Wu WX, et al.Management of cN0 papillary thyroid microcarcinoma patients according to risk-scoring model for central lymph node metastasis and predictors of recurrence[J].J Endocrinol Invest,2020,43(12).1807-1817.
     [19]武元元,刘锐锋,范向达, 等.cN0期甲状腺乳头状微小癌中央区淋巴结转移危险因素的Meta分析[J].中国医学文摘(耳鼻咽喉科学),2020,35(1):4-9,2.
     [20]Jeon MJ,Kim WG,Choi YM, et al.Features predictive of distant metastasis in papillary thyroid microcarcinomas[J].Thyroid,2016,26(1):161-168.
     [21]伊丹丹,布尔兰,伊米努尔·伊力哈木, 等.甲状腺乳头状癌临床病理亚型的研究进展[J].东南大学学报(医学版),2019,38(4):747-752.
     [22]Kim KJ,Kim SG,Tan J, et al.BRAF V600E status may facilitate decision-making on active surveillance of low-risk papillary thyroid microcarcinoma[J].Eur J Cancer,2020,124:161-169.
     [23]Chen B,Shi Y,Xu Y, et al.The predictive value of coexisting BRAFV600E and TERT promoter mutations on poor outcomes and high tumour aggressiveness in papillary thyroid carcinoma: A systematic review and meta-analysis[J].Clin Endocrinol(Oxf),2021,94(5):731-742.
     [24]Lin P,Yao Z,Sun Y, et al.Deciphering novel biomarkers of lymph node metastasis of thyroid papillary microcarcinoma using proteomic analysis of ultrasound-guided fine-needle aspiration biopsy samples[J].J Proteomics,2019,204:103414.
     [25]Kim HI,Jang HW,Ahn HS, et al.High serum TSH level is associated with progression of papillary thyroid microcarcinoma during active surveillance[J].J Clin Endocrinol Metab,2018,103(2):446-451.
     [26]Oh HS,Kwon H,Song E, et al.Tumor volume doubling time in active surveillance of papillary thyroid carcinoma[J].Thyroid,2019,29(5):642-649.
     [27]Fukuoka O,Sugitani I,Ebina A, et al.Natural history of asymptomatic papillary thyroid microcarcinoma: time-dependent changes in calcification and vascularity during active surveillance[J].World J Surg,2016,40(3):529-537.
     [28]Shindo H,Amino N,Ito Y, et al.Papillary thyroid microcarcinoma might progress during pregnancy[J].Thyroid,2014,24(5):840-844.
     [29]Ito Y,Miyauchi A,Kudo T, et al.Effects of pregnancy on papillary microcarcinomas of the thyroid re-evaluated in the entire patient series at kuma hospital[J].Thyroid,2016,26(1):156-160.
     [30]房居高,杨帆.甲状腺微小乳头状癌规范化诊疗的进展与争议[J].中国耳鼻咽喉颅底外科杂志,2021,27(1):1-5.
     [31]Zhang L,Liu Z,Liu Y, et al.The clinical prognosis of patients with cN0 papillary thyroid microcarcinoma by central neck dissection[J].World J Surg Oncol,2015,13:138.
     [32]Kim BY,Choi N,Kim SW, et al.Randomized trial of prophylactic ipsilateral central lymph node dissection in patients with clinically node negative papillary thyroid microcarcinoma[J].Eur Arch Otorhinolaryngol,2020,277(2):569-576.
     [33]Miyauchi A,Ito Y,Oda H.Insights into the management of papillary microcarcinoma of the thyroid[J].Thyroid,2018,28(1):23-31.
     [34]Sugitani I,Ito Y,Takeuchi D, et al.Indications and strategy for active surveillance of adult low-risk papillary thyroid microcarcinoma: consensus statements from the Japan Association of Endocrine Surgery Task Force on management for papillary thyroid microcarcinoma[J].Thyroid,2021,31(2):183-192.
     [35]Brito JP,Ito Y,Miyauchi A, et al.A Clinical framework to facilitate risk stratification when considering an active surveillance alternative to immediate biopsy and surgery in papillary microcarcinoma[J].Thyroid,2016,26(1):144-149.
     [36]Moon JH,Ryu CH,Cho SW, et al.Effect of initial treatment choice on 2-year quality of life in patients with low-risk papillary thyroid microcarcinoma[J].J Clin Endocrinol Metab,2021,106(3):724-735.
     [37]Cho SJ,Baek SM,Lim HK, et al.Long-term follow-up results of ultrasound-guided radiofrequency ablation for low-risk papillary thyroid microcarcinoma: more than 5-year follow-up for 84 tumors[J].Thyroid,2020,30(12):1745-1751.
     [38]Choi Y,Jung SL.Efficacy and safety of thermal ablation techniques for the treatment of primary papillary thyroid microcarcinoma: asystematic review and meta-analysis[J].Thyroid,2020,30(5):720-731.
     [39]Chu KF,Dupuy DE.Thermal ablation of tumours: biological mechanisms and advances in therapy[J].Nat Rev Cancer,2014,14(3):199-208.

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