Leeper R D
Med Clin North Am. 1985 Sep;69(5):1079-96. doi: 10.1016/s0025-7125(16)31007-0.
Thyroid cancer encompasses some forms that practically have no identifiable mortality to one of the most lethal soft tissue cancers known. Because of this variation, a knowledge of the role that age, histology, and extent of disease play in establishing a prognosis is necessary to provide a rational therapeutic program. Younger patients (under age 40) with differentiated cancer, even those with lymph node metastases, should not be overtreated with extensive surgery and 131I or external beam therapy because the prognosis in these patients is so extremely good. Thyroid hormone suppression is probably adequate therapy for patients in this group after obvious disease has been resected. Recurrences can usually be effectively treated with 131I. On the other hand, older patients should be treated more aggressively, especially with the routine use of 131I ablation and therapy after resection of disease. Radiation therapy as described for recurrent disease should be considered at an early point and should be used immediately once the diagnosis of anaplastic cancer has been established. Finally, patience and observation alone should be considered a good therapeutic alternative, for example, in hypercalcitoninemic patients with medullary cancer that has been apparently adequately resected. Repeat operations in these patients fail to eliminate elevated serum calcitonin levels in the majority of cases, and the patients may live for many years with a good quality of life.
甲状腺癌涵盖了一些实际上没有可识别死亡率的类型，到已知的最致命的软组织癌之一。由于这种差异，了解年龄、组织学和疾病范围在确定预后中所起的作用对于提供合理的治疗方案是必要的。年轻患者（40岁以下）患有分化型癌，即使是那些有淋巴结转移的患者，也不应过度接受广泛手术、131I或外照射治疗，因为这些患者的预后非常好。对于这组患者，在切除明显疾病后，甲状腺激素抑制可能是足够的治疗方法。复发通常可用131I有效治疗。另一方面，老年患者应接受更积极的治疗，尤其是在疾病切除后常规使用131I消融和治疗。对于复发性疾病所描述的放射治疗应尽早考虑，一旦确诊为间变性癌，应立即使用。最后，仅耐心观察应被视为一种好的治疗选择，例如，对于已明显充分切除的髓样癌的高降钙素血症患者。在大多数情况下，这些患者的重复手术未能消除血清降钙素水平升高，并且患者可能以良好的生活质量存活多年。
