Aygün Nurcihan, İşgör Adnan, Uludağ Mehmet
Department of General Surgery, Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Department of General Surgery, Bahcesehir University Faculty of Medicine, Istanbul, Turkey; Department of General Surgery, Sisli Memorial Hospital, Istanbul, Turkey.
Sisli Etfal Hastan Tıp Bul. 2018 Dec 28;52(4):233-243. doi: 10.14744/SEMB.2018.15428. eCollection 2018.
Papillary thyroid carcinoma is the most common endocrine malignancy. Papillary thyroid microcarcinomas (PTMCs) are tumors with a size of ≤1 cm. The biological behavior of these tumors differs due to the presence of their aggressive features. The prognosis of PTMCs with high-risk features, such as clinical node metastasis, distant metastasis, and significant extrathyroidal extension to the tracheal or recurrent laryngeal nerve invasion, is poor, even if a sufficient immediate surgery is performed at diagnosis. However, PTMCs without these aggressive features are low-risk tumors because of their indolent and slow growth behaviors. The increase in thyroid cancer incidence is mostly a result of overdiagnosis of small low-risk PTMCs with indolent clinical course. Despite the sudden increase in thyroid cancer incidence worldwide, cancer mortality did not increase. Although the traditional treatment strategy for PTMC is immediate surgery at diagnosis, because of the rather low disease-specific mortality rate, low recurrence rate, and potential risk for postoperative complications, active surveillance has been proposed recently as an alternative option for PTMCs without invasion, metastasis, or cytological or molecular characteristics. The recent data support that active surveillance of low-risk PTMC should be the initial treatment modality, because only a small percentage of low-risk PTMCs show signs of progression, and delayed surgery has not caused significant recurrence. However, recent management guidelines are shifting toward more conservative treatments, such as active surveillance. Although there is an increase in the number of studies related to active surveillance, prospective studies have been mostly from academic referral centers in Japan. The world still needs class 1 evidence extended prospective studies originating from different geographic regions. Active surveillance may be a good alternative to immediate surgery for appropriately selected patients with PTMC.
甲状腺乳头状癌是最常见的内分泌恶性肿瘤。甲状腺微小乳头状癌（PTMC）是大小≤1cm的肿瘤。由于这些肿瘤具有侵袭性特征，其生物学行为有所不同。具有高风险特征的PTMC，如临床淋巴结转移、远处转移以及明显的甲状腺外侵犯至气管或喉返神经侵犯，即使在诊断时进行了充分的即刻手术，其预后也较差。然而，没有这些侵袭性特征的PTMC由于其惰性和缓慢生长行为，属于低风险肿瘤。甲状腺癌发病率的增加主要是由于对临床病程惰性的小的低风险PTMC过度诊断所致。尽管全球范围内甲状腺癌发病率突然增加，但癌症死亡率并未上升。虽然PTMC的传统治疗策略是诊断时即刻手术，但由于疾病特异性死亡率相当低、复发率低以及术后并发症的潜在风险，最近有人提出对没有侵袭、转移或细胞学或分子特征的PTMC进行主动监测作为一种替代选择。最近的数据支持，对低风险PTMC进行主动监测应作为初始治疗方式，因为只有一小部分低风险PTMC会出现进展迹象，且延迟手术并未导致显著复发。然而，最近的管理指南正朝着更保守的治疗方法转变，如主动监测。尽管与主动监测相关的研究数量有所增加，但前瞻性研究大多来自日本的学术转诊中心。世界仍需要来自不同地理区域的1级证据扩展前瞻性研究。对于适当选择的PTMC患者，主动监测可能是即刻手术的一个良好替代方案。
