
浏览全部资源
扫码关注微信
1.贵州医科大学临床医学院,贵州 贵阳 550000
2.贵州医科大学甲状腺外科教研室,贵州 贵阳 550000
3.贵州省第二人民医院甲状腺外科,贵州 贵阳 550001
4.贵州医科大学附属医院甲状腺外科,贵州 贵阳 550004
5.汉中市中心医院老年医学科,陕西 汉中 723000
张翊伦,E-mail:438831017@qq.com
收稿:2024-12-18,
纸质出版:2026-01-25
移动端阅览
张其超,张翊伦,高庆军等.甲状腺微小乳头状癌治疗研究进展[J].局解手术学杂志,2026,35(01):80-84.
ZHANG Qi-chao,ZHANG Yi-lun,GAO Qing-jun,et al.Research progress in the treatment of papillary thyroid microcarcinoma[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(01):80-84.
张其超,张翊伦,高庆军等.甲状腺微小乳头状癌治疗研究进展[J].局解手术学杂志,2026,35(01):80-84. DOI: 10.11659/jjssx.12E024098.
ZHANG Qi-chao,ZHANG Yi-lun,GAO Qing-jun,et al.Research progress in the treatment of papillary thyroid microcarcinoma[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(01):80-84. DOI: 10.11659/jjssx.12E024098.
甲状腺癌发病率在全球范围内呈逐年上升趋势,严重威胁患者健康。甲状腺微小乳头状癌(PTMC)是最为常见的甲状腺癌。尽管绝大多数PTMC患者预后良好,但其潜在的恶化风险也不容忽视,如何平衡治疗风险与获益并制定适当的治疗策略成为了临床一线关注的重点,更是PTMC治疗的疑难点。目前PTMC的治疗策略主要分为主动监测、外科手术以及热消融。随着医学界对PTMC的再认识、循证医学证据的补充和治疗技术的更新,国内外针对PTMC的治疗理念和策略越来越丰富,但关于PTMC治疗的争议也与日俱增。本文就近年来PTMC主要的治疗策略和研究进展进行综述,以期为PTMC的治疗提供一定的理论依据。
The global incidence of thyroid cancer continues to rise, posing a significant threat to public health.Papillary thyroid microcarcinoma (PTMC) is the most common type of thyroid cancer.Although the most PTMC patients have a good prognosis, the potential risk of deterioration should not be ignored.Balancing treatment risks against benefits to formulate optimal strategies remains a central challenge and a point of debate in PTMC managemen.At present,the treatment strategies for PTMC mainly include active surveillance,surgical operation,and thermal ablation.The treatment concepts and strategies for PTMC have become increasingly diverse at home and abroad,with the medical community's evolving understanding of PTMC,the supplement of evidence-based medical evidence and the update of treatment techniques.However,this expansion of options has been accompanied by growing controversy regarding PTMC treatment.This article reviews the main treatment strategies and research progress of PTMC in recent years,aiming to provide a evidence-based perspective for the treatment of PTMC.
Sung H , Ferlay J , Siegel RL , et al . Global Cancer Statistics 2022:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin , 2024 , 74 ( 3 ): 229 - 263 . doi: 10.3322/caac.21834 http://dx.doi.org/10.3322/caac.21834 .
郑荣寿 , 陈茹 , 韩冰峰 , 等 . 2022年中国恶性肿瘤流行情况分析 [J]. 中华肿瘤杂志 , 2024 , 46 ( 3 ): 221 - 231 . doi: 10.3760/cma.j.cn112152-20240119-00035 http://dx.doi.org/10.3760/cma.j.cn112152-20240119-00035 .
Walgama E , Sacks WL , Ho AS . Papillary thyroid microcarcinoma:optimal management versus overtreatment [J]. Curr Opin Oncol , 2020 , 32 ( 1 ): 1 - 6 . doi: 10.1097/CCO.0000000000000595 http://dx.doi.org/10.1097/CCO.0000000000000595 .
Miyauchi A , Ito Y , Fujishima M , et al . Long-term outcomes of active surveillance and immediate surgery for adult patients with low-risk papillary thyroid microcarcinoma:30-year experience [J]. Thyroid , 2023 , 33 ( 7 ): 817 - 825 . doi: 10.1089/thy.2023.0076 http://dx.doi.org/10.1089/thy.2023.0076 .
Liu Q , Song M , Zhang H . Choice of management strategy for papillary thyroid microcarcinoma:active surveillance or immediate surgery? [J]. J Cancer , 2024 , 15 ( 4 ): 1009 - 1020 . doi: 10.7150/jca.91612 http://dx.doi.org/10.7150/jca.91612 .
Ito Y , Miyauchi A , Fujishima M , et al . Active surveillance for adult low-risk papillary thyroid microcarcinoma-a review focused on the 30-year experience of Kuma Hospital [J]. Endocr J , 2024 , 71 ( 1 ): 7 - 21 . doi: 10.1507/endocrj.EJ23-0395 http://dx.doi.org/10.1507/endocrj.EJ23-0395 .
Chou R , Dana T , Haymart M , et al . Active surveillance versus thyroid surgery for differentiated thyroid cancer:a systematic review [J]. Thyroid , 2022 , 32 ( 4 ): 351 - 367 . doi: 10.1089/thy.2021.0539 http://dx.doi.org/10.1089/thy.2021.0539 .
Haugen BR , Alexander EK , Bible KC , et al . 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer:the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer [J]. Thyroid , 2016 , 26 ( 1 ): 1 - 133 . doi: 10.1089/thy. 2015.0020 http://dx.doi.org/10.1089/thy.2015.0020 .
Pacini F , Basolo F , Bellantone R , et al . Italian consensus on diagnosis and treatment of differentiated thyroid cancer:joint statements of six Italian societies [J]. J Endocrinol Invest , 2018 , 41 ( 7 ): 849 - 876 . doi: 10.1007/s40618-018-0884-2 http://dx.doi.org/10.1007/s40618-018-0884-2 .
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 . doi: 10.1089/thy.2020.0330 http://dx.doi.org/10.1089/thy.2020.0330 .
Walter LB , Scheffel RS , Zanella AB , et al . Active surveillance of differentiated thyroid cancer metastatic cervical lymph nodes:a retrospective single-center cohort study [J]. Thyroid , 2023 , 33 ( 3 ): 312 - 320 . doi: 10.1089/thy.2022.0542 http://dx.doi.org/10.1089/thy.2022.0542 .
Benmiloud F , Godiris-Petit G , Gras R , et al . Association of autofluorescence-based detection of the parathyroid glands during total thyroidectomy with postoperative hypocalcemia risk:results of the PARAFLUO multicenter randomized clinical trial [J]. JAMA Surg , 2020 , 155 ( 2 ): 106 - 112 . doi: 10.1001/jamasurg.2019.4613 http://dx.doi.org/10.1001/jamasurg.2019.4613 .
Sasaki T , Miyauchi A , Fujishima M , et al . Comparison of postoperative unfavorable events in patients with low-risk papillary thyroid carcinoma:immediate surgery versus conversion surgery following active surveillance [J]. Thyroid , 2023 , 33 ( 2 ): 186 - 191 . doi: 10.1089/thy.2022.0444 http://dx.doi.org/10.1089/thy.2022.0444 .
Gluvic ZM , Zafirovic SS , Obradovic MM , et al . Hypothyroidism and risk of cardiovascular disease [J]. Curr Pharm Des , 2022 , 28 ( 25 ): 2065 - 2072 . doi: 10.2174/1381612828666220620160516 http://dx.doi.org/10.2174/1381612828666220620160516 .
Ho AS , Kim S , Zalt C , et al . Expanded parameters in active surveillance for low-risk papillary thyroid carcinoma:a nonrandomized controlled trial [J]. JAMA Oncol , 2022 , 8 ( 11 ): 1588 - 1596 . doi: 10.1001/jamaoncol.2022.3875 http://dx.doi.org/10.1001/jamaoncol.2022.3875 .
Durante C , Hegedus L , Czarniecka A , et al . 2023 European thyroid association clinical practice guidelines for thyroid nodule management [J]. Eur Thyroid J , 2023 , 12 ( 5 ): e230067 . doi: 10.1530/ETJ-23-0067 http://dx.doi.org/10.1530/ETJ-23-0067 .
Jarzab B , Dedecjus M , Lewinski A , et al . Diagnosis and treatment of thyroid cancer in adult patients - recommendations of Polish Scientific Societies and the National Oncological Strategy.2022 update [J]. Endokrynol Pol , 2022 , 73 ( 2 ): 173 - 300 . doi: 10.5603/EP.a2022. 0028 http://dx.doi.org/10.5603/EP.a2022.0028 .
中华人民共和国国家卫生健康委员会医政医管局 . 甲状腺癌诊疗指南(2022年版) [J]. 中国实用外科杂志 , 2022 , 42 ( 12 ): 1343 - 1357 . doi: 10.19538/j.cjps.issn1005-2208.2022.12.02 http://dx.doi.org/10.19538/j.cjps.issn1005-2208.2022.12.02 .
Kim MJ , Moon JH , Lee EK , et al . Active surveillance for low-risk thyroid cancers:a review of current practice guidelines [J]. Endocrinol Metab (Seoul) , 2024 , 39 ( 1 ): 47 - 60 . doi: 10.3803/EnM.2024.1937 http://dx.doi.org/10.3803/EnM.2024.1937 .
Patel KN , Yip L , Lubitz CC , et al . Executive summary of the American association of endocrine surgeons guidelines for the definitive surgical management of thyroid disease in adults [J]. Ann Surg , 2020 , 271 ( 3 ): 399 - 410 . doi: 10.1097/SLA.0000000000003735 http://dx.doi.org/10.1097/SLA.0000000000003735 .
中华医学会内分泌学分会 , 中华医学会外科学分会甲状腺及代谢外科学组 , 中国抗癌协会头颈肿瘤专业委员会 , 等 . 甲状腺结节和分化型甲状腺癌诊治指南(第二版) [J]. 中华内分泌代谢杂志 , 2023 , 39 ( 3 ): 181 - 226 . doi: 10.3760/cma.j.cn311282-20221023-00589-1 http://dx.doi.org/10.3760/cma.j.cn311282-20221023-00589-1 .
程若川 , 杨婷婷 . 2016版 中国甲状腺微小乳头状癌诊断与治疗专家共识解读 [J]. 中国实用内科杂志 , 2019 , 39 ( 4 ): 351 - 357 . doi: 10.19538/j.nk2019040109 http://dx.doi.org/10.19538/j.nk2019040109 .
Yu J , Deng Y , Liu T , et al . Lymph node metastasis prediction of papillary thyroid carcinoma based on transfer learning radiomics [J]. Nat Commun , 2020 , 11 ( 1 ): 4807 . doi: 10.1038/s41467-020-18497-3 http://dx.doi.org/10.1038/s41467-020-18497-3 .
李思佳 , 张亚坤 , 罗倩文 , 等 . 经胸乳入路腔镜甲状腺微小乳头状癌切除术与传统开放手术的对比研究 [J]. 腹腔镜外科杂志 , 2021 , 26 ( 4 ): 241 - 245 . doi: 10.13499/j.cnki.fqjwkzz.2021.04.241 http://dx.doi.org/10.13499/j.cnki.fqjwkzz.2021.04.241 .
刘晓楠 , 邸旭 , 张强 , 等 . 低风险甲状腺微小乳头状癌的诊治进展 [J]. 中国实用外科杂志 , 2023 , 43 ( 2 ): 231 - 234 . doi: 10.19538/j.cjps.issn1005-2208.2023.02.21 http://dx.doi.org/10.19538/j.cjps.issn1005-2208.2023.02.21 .
Xu D , Ge M , Yang A , et al . Expert consensus workshop report:guidelines for thermal ablation of thyroid tumors (2019 edition) [J]. J Cancer Res Ther , 2020 , 16 ( 5 ): 960 - 966 . doi: 10.4103/jcrt.JCRT_558_19 http://dx.doi.org/10.4103/jcrt.JCRT_558_19 .
Orloff LA , Noel JE , Jr Stack BC , et al . Radiofrequency ablation and related ultrasound-guided ablation technologies for treatment of benign and malignant thyroid disease: an international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with the Asia Pacific Society of Thyroid Surgery,Associazione Medici Endocrinologi,British Association of Endocrine and Thyroid Surgeons,European Thyroid Association,Italian Society of Endocrine Surgery Units,Korean Society of Thyroid Radiology,Latin American Thyroid Society,and Thyroid Nodules Therapies Association [J]. Head Neck , 2022 , 44 ( 3 ): 633 - 660 . doi: 10.1002/hed.26960 http://dx.doi.org/10.1002/hed.26960 .
Cho SJ , Baek SM , Na DG , et al . Five-year follow-up results of thermal ablation for low-risk papillary thyroid microcarcinomas:systematic review and meta-analysis [J]. Eur Radiol , 2021 , 31 ( 9 ): 6446 - 6456 . doi: 10.1007/s00330-021-07808-x http://dx.doi.org/10.1007/s00330-021-07808-x .
Zhang M , Tufano RP , Russell JO , et al . Ultrasound-guided radiofrequency ablation versus surgery for low-risk papillary thyroid microcarcinoma:results of over 5 years' follow-up [J]. Thyroid , 2020 , 30 ( 3 ): 408 - 417 . doi: 10.1089/thy.2019.0147 http://dx.doi.org/10.1089/thy.2019.0147 .
Teng DK , Li WH , Du JR , et al . Effects of microwave ablation on papillary thyroid microcarcinoma:a five-year follow-up report [J]. Thyroid , 2020 , 30 ( 12 ): 1752 - 1758 . doi: 10.1089/thy.2020.0049 http://dx.doi.org/10.1089/thy.2020.0049 .
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 . doi: 10.1089/thy.2020.0106 http://dx.doi.org/10.1089/thy.2020.0106 .
Shen K , Xue S , Xie Y , et al . Comparison of thermal ablation and routine surgery for the treatment of papillary thyroid microcarcinoma:a systematic review and meta-analysis [J]. Int J Hyperthermia , 2020 , 37 ( 1 ): 913 - 924 . doi: 10.1080/02656736.2020.1777331 http://dx.doi.org/10.1080/02656736.2020.1777331 .
Guan SH , Wang H , Teng DK . Comparison of ultrasound-guided thermal ablation and conventional thyroidectomy for benign thyroid nodules:a systematic review and meta-analysis [J]. Int J Hyperthermia , 2020 , 37 ( 1 ): 442 - 449 . doi: 10.1080/02656736.2020.1758802 http://dx.doi.org/10.1080/02656736.2020.1758802 .
Mauri G , Hegedus L , Bandula S , et al . European Thyroid Association and Cardiovascular and Interventional Radiological Society of Europe 2021 Clinical Practice Guideline for the Use of Minimally Invasive Treatments in Malignant Thyroid Lesions [J]. Eur Thyroid J , 2021 , 10 ( 3 ): 185 - 197 . doi: 10.1159/000516469 http://dx.doi.org/10.1159/000516469 .
全英兰 , 李宁 . 甲状腺微小乳头状癌的诊断及热消融治疗 [J]. 基础医学与临床 , 2024 , 44 ( 12 ): 1722 - 1726 . doi: 10.16352/j.issn. 1001-6325.2024.12.1722 http://dx.doi.org/10.16352/j.issn.1001-6325.2024.12.1722 .
Yan L , Lan Y , Xiao J , et al . Long-term outcomes of radiofrequency ablation for unifocal low-risk papillary thyroid microcarcinoma:a large cohort study of 414 patients [J]. Eur Radiol , 2021 , 31 ( 2 ): 685 - 694 . doi: 10.1007/s00330-020-07128-6 http://dx.doi.org/10.1007/s00330-020-07128-6 .
Yan L , Luo Y , Zhang Y , et al . The clinical application of core-needle biopsy after radiofrequency ablation for low-risk papillary thyroid microcarcinoma:a large cohort of 202 patients study [J]. J Cancer , 2020 , 11 ( 18 ): 5257 - 5263 . doi: 10.7150/jca.42673 http://dx.doi.org/10.7150/jca.42673 .
Sun W , Zhang H , He L , et al . Surgery after ultrasound-guided radiofrequency ablation for papillary thyroid carcinoma in 21 patients:a retrospective study from a single center in China [J]. Med Sci Monit , 2020 , 26 : e928391 . doi: 10.12659/MSM.928391 http://dx.doi.org/10.12659/MSM.928391 .
Kim K , Shim SR , Lee SW , et al . Diagnostic values of F-18 FDG PET or PET/CT,CT,and US for preoperative lymph node staging in thyroid cancer:a network meta-analysis [J]. Br J Radiol , 2021 , 94 ( 1120 ): 20201076 . doi: 10.1259/bjr.20201076 http://dx.doi.org/10.1259/bjr.20201076 .
0
浏览量
0
下载量
0
CSCD
关联资源
相关文章
相关作者
相关机构
京公网安备11010802024621