Section of Endocrinology and Metabolism, Department of Medicine, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Doutor Cesário Mota Junior, , 61 - SAO PAULO -CEP, São Paulo, 1221020, Brazil.
Nuclear Medicine Department, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France.
Rev Endocr Metab Disord. 2024 Feb;25(1):95-108. doi: 10.1007/s11154-023-09852-y. Epub 2023 Nov 23.
Although the overall prognosis for differentiated thyroid cancer (DTC) is excellent, a subset of patients will experience disease recurrence or may not respond to standard treatments. In recent years, DTC management has become more personalized in order to enhance treatment efficacy and avoid unnecessary interventions.In this context, major guidelines recommend post-surgery staging to assess the risk of disease persistence, recurrence, and mortality. Consequently, risk stratification becomes pivotal in determining the necessity of postoperative adjuvant therapy, which may include radioiodine therapy (RIT), the degree of TSH suppression, additional imaging studies, and the frequency of follow-up.However, the intermediate risk of recurrence is a highly heterogeneous category that encompasses various risk criteria, often combined, resulting in varying degrees of aggressiveness and a recurrence risk ranging from 5 to 20%. Furthermore, there is not enough long-term prognosis data for these patients. Unlike low- and high-risk DTC, the available literature is contradictory, and there is no consensus regarding adjuvant therapy.We aim to provide an overview of intermediate-risk differentiated thyroid cancer, focusing on criteria to consider when deciding on adjuvant therapy in the current context of personalized approach, including molecular analysis to enhance the accuracy of patient management.
尽管分化型甲状腺癌（DTC）的总体预后良好，但仍有一部分患者会出现疾病复发或对标准治疗无反应。近年来，为了提高治疗效果并避免不必要的干预，DTC 的管理变得更加个体化。在此背景下，主要指南建议在手术后进行分期，以评估疾病持续存在、复发和死亡的风险。因此，风险分层对于确定是否需要术后辅助治疗至关重要，辅助治疗可能包括放射性碘治疗（RIT）、TSH 抑制的程度、额外的影像学研究以及随访的频率。然而，复发的中度风险是一个高度异质的类别，包含各种风险标准，通常是组合在一起的，导致侵袭性程度不同，复发风险在 5%至 20%之间。此外，这些患者的长期预后数据不足。与低风险和高风险的 DTC 不同，现有文献存在矛盾，对于辅助治疗，目前没有达成共识。我们旨在概述中度风险分化型甲状腺癌，重点介绍在当前个体化方法的背景下，决定辅助治疗时需要考虑的标准，包括分子分析以提高患者管理的准确性。
