Sturgeon Cord, Angelos Peter
Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
Oncology (Williston Park). 2006 Mar;20(3):253-60.
Most thyroid cancers are slow-growing, easily treatable tumors with an excellent prognosis after surgical resection and targeted medical therapy. Unfortunately, 10% to 15% of thyroid cancers exhibit aggressive behavior and do not follow an indolent course. Approximately one-third of patients with differentiated thyroid cancers will have tumor recurrences. Distant metastases are present in about 20% of patients with recurrent cancer. Approximately half of patients with distant metastases die within 5 years. The loss of the ability to concentrate radioiodine and produce thyroglobulin is a sign of dedifferentiation, which occurs in about 30% of patients with persistent or recurrent thyroid cancer. Dedifferentiation is associated with poorer responses to conventional therapy and difficulty monitoring tumor burden. Clinicians must identify tumors with more aggressive biology and treat them accordingly with more aggressive regimens. Part 1 of this two-part article describes in detail the distinct types of thyroid cancer, as well as risk factors, outcomes, and prognostic factors, with a focus on thyroid cancers of follicular cell origin. Part 2, which will appear in next month's issue, covers risk assessment and staging, findings that suggest the presence of aggressive tumors, recurrent/metastatic disease, and the value of treatment with chemotherapy and external-beam radiotherapy. Experimental treatments utilizing molecular targets, redifferentiation agents, and gene therapy are covered briefly as well.
大多数甲状腺癌生长缓慢，是易于治疗的肿瘤，手术切除和靶向药物治疗后预后良好。不幸的是，10%至15%的甲状腺癌表现出侵袭性，病程并非惰性。大约三分之一的分化型甲状腺癌患者会出现肿瘤复发。约20%的复发癌患者存在远处转移。出现远处转移的患者中约一半会在5年内死亡。丧失摄取放射性碘和产生甲状腺球蛋白的能力是去分化的标志，约30%的持续性或复发性甲状腺癌患者会出现这种情况。去分化与对传统治疗反应较差以及监测肿瘤负荷困难有关。临床医生必须识别具有更具侵袭性生物学行为的肿瘤，并相应地采用更积极的治疗方案进行治疗。这篇分两部分的文章的第1部分详细描述了甲状腺癌的不同类型、危险因素、治疗结果和预后因素，重点是滤泡细胞来源的甲状腺癌。第2部分将在下个月的期刊中刊出，内容包括风险评估和分期、提示存在侵袭性肿瘤的发现、复发/转移性疾病以及化疗和外照射放疗的治疗价值。还简要介绍了利用分子靶点、再分化剂和基因治疗的实验性治疗方法。
