Ahmadieh Hala, Azar Sami T
Division of Endocrinology, Department of Internal Medicine, American University of Beirut Medical Center, 3 Dag Hammarskjold Plaza, New York, NY 10017, USA.
J Thyroid Res. 2012;2012:512401. doi: 10.1155/2012/512401. Epub 2012 Dec 30.
Thyroid cancer is among the most common endocrine malignancies. Genetic and environmental factors play an important role in the pathogenesis of differentiated thyroid cancer. Both have good prognosis but with frequent recurrences. Cancer staging is an essential prognostic part of cancer management. There are multiple controversies in the management and followup of differentiated thyroid cancer. Debate still exists with regard to the optimal surgical approach but trends toward a more conservative approach, such as lobectomy, are being more favored, especially in papillary thyroid cancer, of tumor sizes less than 4 cm, in the absence of other high-risk suggestive features. Survival of patients with well-differentiated thyroid cancer was adversely affected by lymph node metastases. Prophylactic central LN dissection did improve accuracy in staging and decrease postop TG level, but it had no effect on small-sized tumors. Conservative approach was more applied with regard to the need and dose of radioiodine given postoperatively. There have been several advancements in the management of radioiodine resistant advanced differentiated thyroid cancers. Appropriate followup is required based on risk stratification of patients postoperatively. Many studies are still ongoing in order to reach the optimal management and followup of differentiated thyroid cancer.
甲状腺癌是最常见的内分泌恶性肿瘤之一。遗传和环境因素在分化型甲状腺癌的发病机制中起着重要作用。两者预后均良好，但复发频繁。癌症分期是癌症管理中至关重要的预后部分。在分化型甲状腺癌的管理和随访方面存在诸多争议。关于最佳手术方式仍存在争论，但更保守的方法，如甲状腺叶切除术，正越来越受到青睐，尤其是对于肿瘤大小小于4厘米、且无其他高风险提示特征的乳头状甲状腺癌。分化型甲状腺癌患者的生存会受到淋巴结转移的不利影响。预防性中央淋巴结清扫确实提高了分期的准确性并降低了术后甲状腺球蛋白水平，但对小肿瘤无效。在术后放射性碘的使用需求和剂量方面，更倾向于采用保守方法。在放射性碘难治性晚期分化型甲状腺癌的管理方面已经取得了一些进展。术后需要根据患者的风险分层进行适当的随访。为了实现分化型甲状腺癌的最佳管理和随访，许多研究仍在进行中。
