Ulisse Salvatore, Baldini Enke, Lauro Augusto, Pironi Daniele, Tripodi Domenico, Lori Eleonora, Ferent Iulia Catalina, Amabile Maria Ida, Catania Antonio, Di Matteo Filippo Maria, Forte Flavio, Santoro Alberto, Palumbo Piergaspare, D'Andrea Vito, Sorrenti Salvatore
Department of Surgical Sciences, "Sapienza" University of Rome, 00161 Rome, Italy.
Urology Department, M.G. Vannini Hospital, 00177 Rome, Italy.
Cancers (Basel). 2021 Nov 7;13(21):5567. doi: 10.3390/cancers13215567.
Over the last few years, a great advance has been made in the comprehension of the molecular pathogenesis underlying thyroid cancer progression, particularly for the papillary thyroid cancer (PTC), which represents the most common thyroid malignancy. Putative cancer driver mutations have been identified in more than 98% of PTC, and a new PTC classification into molecular subtypes has been proposed in order to resolve clinical uncertainties still present in the clinical management of patients. Additionally, the prognostic stratification systems have been profoundly modified over the last decade, with a view to refine patients' staging and being able to choose a clinical approach tailored on single patient's needs. Here, we will briefly discuss the recent changes in the clinical management of thyroid nodules, and review the current staging systems of thyroid cancer patients by analyzing promising clinicopathological features (i.e., gender, thyroid auto-immunity, multifocality, PTC histological variants, and vascular invasion) as well as new molecular markers (i.e., BRAF/TERT promoter mutations, miRNAs, and components of the plasminogen activating system) potentially capable of ameliorating the prognosis of PTC patients.
在过去几年中,我们对甲状腺癌进展的分子发病机制的理解取得了巨大进展,尤其是对于乳头状甲状腺癌(PTC),它是最常见的甲状腺恶性肿瘤。在超过98%的PTC中已鉴定出假定的癌症驱动突变,并且为了解决患者临床管理中仍然存在的临床不确定性,已提出将PTC重新分类为分子亚型。此外,在过去十年中,预后分层系统已被深刻修改,以便完善患者的分期,并能够根据单个患者的需求选择量身定制的临床方法。在此,我们将简要讨论甲状腺结节临床管理的最新变化,并通过分析有前景的临床病理特征(即性别、甲状腺自身免疫、多灶性、PTC组织学变体和血管侵犯)以及可能改善PTC患者预后的新分子标志物(即BRAF/TERT启动子突变、miRNA和纤溶酶原激活系统的成分)来回顾甲状腺癌患者的当前分期系统。