Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA.
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA.
BMJ. 2014 Jun 16;348:g3045. doi: 10.1136/bmj.g3045.
Thyroid cancer is one of the fastest growing diagnoses; more cases of thyroid cancer are found every year than all leukemias and cancers of the liver, pancreas, and stomach. Most of these incident cases are papillary in origin and are both small and localized. Patients with these small localized papillary thyroid cancers have a 99% survival rate at 20 years. In view of the excellent prognosis of these tumors, they have been denoted as low risk. The incidence of these low risk thyroid cancers is growing, probably because of the use of imaging technologies capable of exposing a large reservoir of subclinical disease. Despite their excellent prognosis, these subclinical low risk cancers are often treated aggressively. Although surgery is traditionally viewed as the cornerstone treatment for these tumors, there is less agreement about the extent of surgery (lobectomy v near total thyroidectomy) and whether prophylactic central neck dissection for removal of lymph nodes is needed. Many of these tumors are treated with radioactive iodine ablation and thyrotropin suppressive therapy, which-although effective for more aggressive forms of thyroid cancer-have not been shown to be of benefit in the management of these lesions. This review offers an evidence based approach to managing low risk papillary thyroid cancer. It also looks at the future of promising alternative surgical techniques, non-surgical minimally localized invasive therapies (ethanol ablation and laser ablation), and active surveillance, all of which form part of a more individualized treatment approach for low risk papillary thyroid tumors.
甲状腺癌是增长最快的诊断之一；每年发现的甲状腺癌病例比所有白血病以及肝、胰和胃的癌症都要多。这些新发病例大多起源于乳头状癌，而且体积小且局限。这些小的局限性乳头状甲状腺癌患者在 20 年内的存活率为 99%。鉴于这些肿瘤的良好预后，它们被定义为低风险。这些低风险甲状腺癌的发病率正在上升，可能是由于能够发现大量亚临床疾病的成像技术的应用。尽管这些肿瘤预后良好，但通常还是会对其进行积极的治疗。尽管手术传统上被视为这些肿瘤的基石治疗方法，但对于手术范围（叶切除术与近全甲状腺切除术）以及是否需要预防性中央颈部淋巴结清扫术以切除淋巴结，仍存在较少的共识。许多这样的肿瘤采用放射性碘消融和促甲状腺激素抑制治疗，尽管这些治疗方法对更具侵袭性的甲状腺癌有效，但对于这些病变的管理并没有显示出益处。本综述提供了一种基于证据的低风险甲状腺乳头状癌的管理方法。它还探讨了有前途的替代手术技术、非手术性局部微创治疗（乙醇消融和激光消融）以及主动监测的未来，所有这些都构成了针对低风险甲状腺乳头状肿瘤的更个体化治疗方法的一部分。
