Lohia Shivangi, Hanson Martin, Tuttle R Michael, Morris Luc G T
Department of Surgery, Head and Neck Service Memorial Sloan Kettering Cancer Center New York New York.
Department of Medicine, Endocrine Service Memorial Sloan Kettering Cancer Center New York New York.
Laryngoscope Investig Otolaryngol. 2020 Feb 7;5(1):175-182. doi: 10.1002/lio2.356. eCollection 2020 Feb.
Over the past 30 years in the United States, increasing identification of small thyroid nodules has led to a dramatic rise in the detection of small thyroid cancers, many of which are unlikely to progress to overt clinical disease. Because autopsy studies reveal that up to 30% of people harbor clinically occult thyroid cancers, the growing use of diagnostic technologies has identified an increasing number of small, clinically low risk papillary thyroid cancers (PTCs). In recent years, clinical practice has evolved to de-intensify the treatment for PTCs, with fewer total thyroidectomy and nodal dissection procedures being performed, in favor of more limited operations. In addition, vigilant observation of selected low risk cancers has demonstrated outcomes comparable to those patients who undergo immediate surgical intervention. Active surveillance has emerged as a new option within the treatment algorithm of PTCs. There is now robust data from cancer centers in Japan and Korea which have reported excellent oncologic outcomes among patients undergoing active surveillance for PTC, as well as more recent, similar data from the United States. American Thyroid Association guidelines now include the option of active surveillance for appropriately selected patients with low-risk PTC. With active surveillance now one option within the standard of care for patients with certain thyroid cancers, surgeons have become critical to facilitating shared decision-making for patients facing this diagnosis.
在美国过去30年里，对甲状腺小结节的识别增加，导致微小甲状腺癌的检出率急剧上升，其中许多不太可能发展为明显的临床疾病。尸检研究表明，高达30%的人患有临床隐匿性甲状腺癌，诊断技术使用的增加已发现越来越多的微小、临床低风险的甲状腺乳头状癌（PTC）。近年来，临床实践已演变为对PTC进行降阶梯治疗，全甲状腺切除术和淋巴结清扫术的实施减少，转而采用更有限的手术。此外，对部分低风险癌症进行密切观察显示，其结果与立即接受手术干预的患者相当。主动监测已成为PTC治疗方案中的一种新选择。日本和韩国癌症中心已有有力数据报告了接受PTC主动监测患者的良好肿瘤学结果，美国也有了近期类似的数据。美国甲状腺协会指南现在将对适当选择的低风险PTC患者进行主动监测作为一种选择。由于主动监测现已成为某些甲状腺癌患者标准治疗方案中的一种选择，外科医生对于为面临这种诊断的患者促进共同决策变得至关重要。
