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甲状腺髓样癌诊断与管理的最新进展:近年来有哪些变化?

Update on the Diagnosis and Management of Medullary Thyroid Cancer: What Has Changed in Recent Years?

作者信息

Kaliszewski Krzysztof, Ludwig Maksymilian, Ludwig Bartłomiej, Mikuła Agnieszka, Greniuk Maria, Rudnicki Jerzy

机构信息

Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland.

出版信息

Cancers (Basel). 2022 Jul 27;14(15):3643. doi: 10.3390/cancers14153643.

Abstract

Medullary thyroid carcinoma (MTC) is a neoplasm originating from parafollicular C cells. MTC is a rare disease, but its prognosis is less favorable than that of well-differentiated thyroid cancers. To improve the prognosis of patients with MTC, early diagnosis and prompt therapeutic management are crucial. In the following paper, recent advances in laboratory and imaging diagnostics and also pharmacological and surgical therapies of MTC are discussed. Currently, a thriving direction of development for laboratory diagnostics is immunohistochemistry. The primary imaging modality in the diagnosis of MTC is the ultrasound, but opportunities for development are seen primarily in nuclear medicine techniques. Surgical management is the primary method of treating MTCs. There are numerous publications concerning the stratification of particular lymph node compartments for removal. With the introduction of more effective methods of intraoperative parathyroid identification, the complication rate of surgical treatment may be reduced. The currently used pharmacotherapy is characterized by high toxicity. Moreover, the main limitation of current pharmacotherapy is the development of drug resistance. Currently, there is ongoing research on the use of tyrosine kinase inhibitors (TKIs), highly specific RET inhibitors, radiotherapy and immunotherapy. These new therapies may improve the prognosis of patients with MTCs.

摘要

甲状腺髓样癌(MTC)是一种起源于滤泡旁C细胞的肿瘤。MTC是一种罕见疾病,但其预后比高分化甲状腺癌更差。为改善MTC患者的预后,早期诊断和及时的治疗管理至关重要。在接下来的论文中,将讨论MTC在实验室和影像学诊断以及药物和手术治疗方面的最新进展。目前,实验室诊断蓬勃发展的一个方向是免疫组织化学。MTC诊断的主要影像学方法是超声,但主要在核医学技术方面有发展机会。手术治疗是治疗MTC的主要方法。有许多关于特定淋巴结分区切除分层的出版物。随着术中甲状旁腺识别更有效方法的引入,手术治疗的并发症发生率可能会降低。目前使用的药物治疗具有高毒性。此外,当前药物治疗的主要局限性是耐药性的产生。目前正在进行关于酪氨酸激酶抑制剂(TKIs)、高度特异性RET抑制剂、放射治疗和免疫治疗的研究。这些新疗法可能会改善MTC患者的预后。

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