Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
Semin Oncol. 2010 Dec;37(6):557-66. doi: 10.1053/j.seminoncol.2010.10.008.
Differentiated thyroid cancer, which includes papillary and follicular histologies, is a common malignancy and is increasing in incidence. It carries a favorable prognosis compared to other cancers. However, optimal outcomes are achieved only via coordinated multimodal therapy. Of these treatments, surgery is the cornerstone of initial management. Most patients should undergo thyroidectomy with concomitant central neck (level VI) lymph node dissection. On the other hand, thyroidectomy alone may be appropriate for patients with smaller tumors (T1 or T2) and no evidence of suspicious lymphadenopathy. Surgery is also indicated in cases of cervical lymph node metastases and locoregional recurrence. The principal adjuvant therapy is radioactive iodine, which should be considered in patients with a high risk of locoregional recurrence or with metastatic disease. Similarly, suppression of endogenous thyroid-stimulating hormone is recommended in patients with an elevated risk of recurrence. External-beam radiotherapy is indicated in patients with gross extrathyroidal extension or residual disease not amenable to surgery. Finally, molecular therapies, especially those targeting key tyrosine kinases and/or inhibiting angiogenesis, are emerging treatment modalities that could replace the limited efficacy of conventional chemotherapy.
分化型甲状腺癌包括乳头状和滤泡状组织学类型，是一种常见的恶性肿瘤，其发病率正在增加。与其他癌症相比，它的预后较好。然而，只有通过协调的多模式治疗才能实现最佳效果。在这些治疗方法中，手术是初始治疗的基石。大多数患者应接受甲状腺切除术，同时进行中央颈部（VI 水平）淋巴结清扫术。另一方面，对于肿瘤较小（T1 或 T2）且无可疑淋巴结病证据的患者，单独进行甲状腺切除术可能是合适的。对于颈部淋巴结转移和局部区域复发的患者，也需要进行手术。主要的辅助治疗是放射性碘，对于局部区域复发或转移性疾病风险较高的患者应考虑使用。同样，对于复发风险较高的患者，建议抑制内源性甲状腺刺激激素。对于有明显甲状腺外延伸或无法手术的残留疾病的患者，需要进行外照射放疗。最后，分子治疗方法，特别是针对关键酪氨酸激酶和/或抑制血管生成的治疗方法，正在成为新兴的治疗方式，可能会取代传统化疗的有限疗效。
