Lin Yan-Song, Wang Ren-Fei, Huang Rui, Wen Qiang, Cao Wei, Chen Li-Bo, Guo Ye, Hou Xiao-Rong, Li Li, Li Xiao-Yi, Lin Cheng-He, Liu Zhi-Yan, Wang Hao, Wang Xu-Fu, Wang Zhuo-Ying, Wu Xiao-Hong, Xu Shu-Hang, Yang Ai-Min, Zhang Bo, Zhang Yue-Lun
Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Eur J Nucl Med Mol Imaging. 2025 Mar 25. doi: 10.1007/s00259-025-07222-1.
Radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC) has become a challenge in clinical practice, particularly in China with a high incidence and undesirable survival outcome. Since the publication of first China consensus on the diagnosis and treatment of RAIR-DTC in 2019, significant and rapid advances have occurred in the field both in China and internationally. This guideline aims to inform Chinese clinicians, researchers, patients, and health policy makers on the latest evidence and recommendations, to further standardize the clinical diagnosis and treatment of RAIR-DTC.
The structured clinical questions addressed in this guideline were derived from clinical diagnostic and treatment processes, with references to study, prior guidelines, expert consensus, and systematic reviews, etc. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used for quantitative and qualitative evaluation of the evidence. The editorial process was completely independent of the guideline development group.
The guideline addressed 26 clinical questions and formed 35 recommendations. In this guideline, the definition criteria for RAIR-DTC was optimized, prediction and identification was based on evidence including molecular testing, dynamic biochemical changes, and multimodal imaging. Comprehensive pre-treatment clinical evaluation was emphasized and tailored for individualized decision-making. The combination of systematic therapy and surgery, and the redifferentiation followed by RAI therapy were also reviewed and updated. Molecular imaging plays a unique role in the pre-assessing and therapeutic response evaluation for RAIR-DTC.
We have updated and developed evidence-based recommendations with the aim of providing scientific, rigorous, and comprehensive guidance for the clinical diagnosis and treatment of RAIR-DTC patients in China. We hope to share our guideline with colleagues out of China, with the expectation of further comments and suggestions.
放射性碘难治性分化型甲状腺癌（RAIR-DTC）已成为临床实践中的一项挑战，在中国尤其如此，其发病率高且生存结局不理想。自2019年中国首部RAIR-DTC诊断与治疗共识发布以来，国内外该领域均取得了显著且快速的进展。本指南旨在让中国临床医生、研究人员、患者及卫生政策制定者了解最新证据和建议，以进一步规范RAIR-DTC的临床诊断与治疗。
本指南中涉及的结构化临床问题源自临床诊断和治疗过程，参考了研究、既往指南、专家共识及系统评价等。采用推荐分级的评估、制定与评价（GRADE）方法对证据进行定量和定性评估。编辑过程完全独立于指南制定组。
该指南涉及26个临床问题并形成35条推荐意见。本指南优化了RAIR-DTC的定义标准，基于包括分子检测、动态生化变化及多模态成像等证据进行预测和识别。强调了全面的治疗前临床评估，并针对个体化决策进行调整。还对系统治疗与手术的联合应用以及再分化后行放射性碘治疗进行了回顾和更新。分子成像在RAIR-DTC的预评估和治疗反应评估中发挥着独特作用。
我们更新并制定了基于证据的推荐意见，旨在为中国RAIR-DTC患者的临床诊断和治疗提供科学、严谨且全面的指导。我们希望与国外同行分享本指南，期待得到更多的意见和建议。
