Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, The Royal College of Surgeons in Ireland, Ireland.
Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, The Royal College of Surgeons in Ireland, Ireland.
Eur J Surg Oncol. 2018 Mar;44(3):286-296. doi: 10.1016/j.ejso.2017.07.013. Epub 2017 Aug 3.
WDTC (papillary and follicular thyroid cancer) make up around 90% of all thyroid tumours. Overall, the prognosis in patients with WDTC is excellent. However, there are small cohorts of patients who experience a more aggressive form of disease which is often associated with certain poor prognostic factors. Identifying these patients at an early stage is imperative for guiding treatment decisions. With recent developments in this area we plan to discuss the current evidence surrounding prognostic markers.
The literature regarding prognostic factors in WDTC was reviewed using an electronic database Medline - Pubmed. Using the MeSH search engine specific prognostic factors including age, size, grade, lymph node involvement, distant metastasis, extension/invasion, ethnic background, radioactive iodine avidity, and thyroglobulin level and their association with WDTC were evaluated. A broader search of prognostic markers in thyroid cancer was also carried out to avoid missing other pertinent markers.
Multiple clinical and pathologic variables have been shown to be poor prognostic factors in WDTC with statistical significance. Extensive extrathyroidal extension and age may be the most important factors when predicting clinical outcomes in WDTC, although the age threshold may be increased from 45 to 55 years in due course.
Management of WDTC has changed considerably over the last two years as reflected in evolving British and American Thyroid Guidelines. In all cases a combined multi-disciplinary approach, with consideration of the available guidelines and stratification systems should be utilised when planning an individualised treatment program to offer the best contemporary care to WDTC patients.
WDTC（甲状腺乳头状和滤泡状癌）约占所有甲状腺肿瘤的 90%。总的来说，WDTC 患者的预后极好。然而，有一小部分患者患有更具侵袭性的疾病，这种疾病通常与某些不良预后因素有关。早期识别这些患者对于指导治疗决策至关重要。随着该领域的最新进展，我们计划讨论当前关于预后标志物的证据。
使用电子数据库 Medline-Pubmed 回顾了有关 WDTC 预后因素的文献。使用 MeSH 搜索引擎，评估了年龄、大小、分级、淋巴结受累、远处转移、侵犯/扩散、种族背景、放射性碘摄取能力和甲状腺球蛋白水平等特定预后因素及其与 WDTC 的关系。还进行了甲状腺癌预后标志物的更广泛搜索，以避免遗漏其他相关标志物。
多项临床和病理变量已被证明是 WDTC 的不良预后因素，具有统计学意义。广泛的甲状腺外侵犯和年龄可能是预测 WDTC 临床结果的最重要因素，尽管年龄阈值可能会在未来从 45 岁增加到 55 岁。
过去两年，随着英国和美国甲状腺指南的不断发展，WDTC 的治疗管理发生了重大变化。在所有情况下，当制定个体化治疗计划以提供最佳当代护理时，都应采用多学科综合方法，考虑到现有指南和分层系统。
