Endocrinology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Oral Oncol. 2013 Jul;49(7):695-701. doi: 10.1016/j.oraloncology.2013.03.443. Epub 2013 Apr 16.
Much progress has been made over the last 10 years with regard to risk estimation in non-medullary differentiated thyroid cancer with risk of recurrence systems and response to therapy re-evaluation approaches being used to augment initial risk estimates obtained using standard anatomic staging systems. Furthermore, risk stratification is being increasingly viewed as an active, evolving, dynamic process that requires re-evaluation during follow-up rather than a single static risk estimate predicted by initial staging. As with differentiated thyroid cancer, multiple clinico-pathologic factors have been demonstrated to correlate with the risk of disease specific mortality, risk of death, likelihood of disease progression, likelihood of cure with initial therapy, and likelihood of cure with additional therapy in medullary thyroid cancer.
In this review, we re-examine the clinically important initial risk factors in medullary thyroid cancer and then re-evaluate how some of these risk factors can be used to alter risk estimates over time as they reflect the response to therapy and the clinical course of the disease.
We demonstrate that the same response to therapy nomenclature that we have proposed and validated in differentiated thyroid cancer (excellent response, biochemical incomplete response, structural incomplete response, indeterminant response) can be easily applied to medullary cancer and used to guide on-going clinical management.
在过去的 10 年中，非髓样分化型甲状腺癌的风险评估取得了很大进展，使用复发风险系统和治疗反应评估方法来增强使用标准解剖分期系统获得的初始风险估计。此外，风险分层越来越被视为一个积极的、不断发展的动态过程，需要在随访期间重新评估，而不是通过初始分期预测的单一静态风险估计。与分化型甲状腺癌一样，多项临床病理因素已被证明与疾病特异性死亡率、死亡风险、疾病进展可能性、初始治疗治愈可能性以及额外治疗治愈可能性相关。
在这篇综述中，我们重新检查了髓样甲状腺癌中临床重要的初始风险因素，然后重新评估了随着时间的推移，这些风险因素中的一些如何被用来改变风险估计，因为它们反映了治疗反应和疾病的临床过程。
我们证明，我们在分化型甲状腺癌中提出并验证的相同的治疗反应命名法（完全缓解、生化不完全缓解、结构不完全缓解、不确定反应）可以很容易地应用于髓样癌，并用于指导正在进行的临床管理。
