分化型甲状腺癌诊疗新进展
Journal: Basic Medical Theory Research DOI: 10.32629/bmtr.v8i3.20484
Abstract
甲状腺癌作为内分泌系统最常见的恶性肿瘤，发病率在全球范围内逐年升高。分化型甲状腺癌（DTC）是最常见的病理类型；采取以外科手术为主的多学科综合治疗协作组（MDT）模式是治疗DTC的重要策略。术前精准评估是实施外科手术治疗的关键，从传统开放手术到微创治疗、主动监测的演变及新技术的应用，推动了甲状腺癌外科治疗的新进展。术后规范化管理，动态评估治疗反应，及时调整治疗方案，可以进一步提高存活率和生存质量。DTC分子生物学深入研究，针对参与DTC进展的特定基因和途径为新型诊断和治疗策略打开了大门。人工智能诊疗系统的研发为DTC精准诊治提供了新的技术和思路。建立DTC诊疗规范，科学地实施个体化诊疗。
Keywords
分化型甲状腺癌；人工智能；主动监测；靶向治疗
Full Text
PDF - Viewed/Downloaded: 0 TimesReferences
[1] Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022.J Natl Cancer Cent. 2024;4(1):47-53. Published 2024 Feb 2.
[2] RINGEL M D, SOSA J A, BALOCH Z, et al. 2025 American thyroid association management guidelines for adult patients with differentiated thyroid cancer[J]. Thyroid, 2025, 35(8):841-985.
[3] 中国医师协会外科医师分会甲状腺外科专家工作组，中国研究型医院学会甲状腺疾病专业委员会. 超声引导下甲状腺结节和颈部淋巴结细针穿刺活检中国专家共识及操作指南（2025版）[J].中国实用外科杂志,2025,45(1):34-41.
[4] Wang D, Liu B, Zhang Z. Accelerating the understanding of cancer biology through the lens of genomics. Cell. 2023, 186(8):1755-1771.
[5] Singarayer R, Mete O, Perrier L, et al. A Systematic Review and Meta-Analysis of the Diagnostic Performance of BRAF V600E Immunohistochemistry in Thyroid Histopathology. Endocr Pathol. 2019,30(3):201-218.
[6] Liu LP, Hao JY, Pan H, et al. Zhonghua Bing Li Xue Za Zhi. 2020,49(3):256-261.
[7] Grabellus F, Worm K, Schmid KW, et al. The BRAF V600E mutation in papillary thyroid carcinoma is associated with glucose transporter 1 overexpression.Thyroid. 2012,22(4):377-382.
[8] Yang X, Wu H. RAS signaling in carcinogenesis, cancer therapy and resistance mechanisms.J Hematol Oncol. 2024,17(1):108. Published 2024 Nov 9.
[9] Tartaglia M, Gelb BD. Disorders of dysregulated signal traffic through the RASMAPK pathway: Phenotypic spectrum and molecular mechanisms. Ann N Y Acad Sci 1214:99-121,2010.
[10] Kang N, Zhao Z, Wang Z, et al. METTL3 regulates thyroid cancer differentiation and chemosensitivity by modulating PAX8. Int J Biol Sci 20:3426-3441,2024.
[11] Li Q, Wang Y, Meng X, et al. METTL16 inhibits papillary thyroid cancer tumorigenicity through m6A/YTHDC2/SCD1regulated lipid metabolism. Cell Mol Life Sci 81: 81, 2024.
[12] Wen J, Lin B, Lin L, et al. KCNN4 is a diagnostic and prognostic biomarker that promotes papillary thyroid cancer progression. Aging (Albany NY). 2020,12(16):16437-16456.
[13] 张亚靖,邓娟,罗斯,等.分子检测在甲状腺癌诊疗中的应用进展[J].中国普外基础与临床杂志,2025,32(10):1285-1290.
[14] 田文.人工智能时代下甲状腺结节诊治的发展现状与展望[J].中国普外基础与临床杂志,2025,32(10):1204-1207.
[15] Wang J, Zheng N, Wan H, et al. Deep learning models for thyroid nodules diagnosis of fine-needle aspiration biopsy: a retrospective, prospective, multicentre study in China. Lancet Digit Health. 2024,6(7):e458-e469.
[16] Hu G, Niu W, Ge J, et al. Identification of thyroid cancer biomarkers using WGCNA and machine learning. Eur J Med Res. 2025,30(1):244. Published 2025 Apr 5.
[17] Chou R, Dana T, Haymart MR, et al. Active surveillance versus thyroid surgery for differentiated thyroid cancer: A systematic review. Thyroid 2022,32(4):351–367.
[18] 张大林,董文武,张浩.2024年版日本《甲状腺肿瘤诊疗指南》外科治疗部分更新解读[J].中国实用外科杂志,2025,45(1):42-47.
[19] Rajjoub SR, Yan H, Calcatera NA, et al. Thyroid lobectomy is not sufficient for T2 papillary thyroid cancers. Surgery 2018,163(5):1134-1143.
[20] Sun W,Lan X,Zhang H,et al. Risk factors for central lymph node metastasis in CN0 papillary thyroid carcinoma: a systematic review and metaanalysis[J]. PLoS One,2015,10(10):e0139021.
[21] Hughes DT, Rosen JE, Evans DB, et al. Prophylactic central compartment neck dissection in papillary thyroid cancer and effect on locoregional recurrence. Ann Surg Oncol 2018,25(9):2526–2534;
[22] Moo TA，McGill J，Allendorf J，et al. Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma[J]. World J Surg,2010,34(6):1187- 1191.
[23] 李玉姝,单忠艳,滕卫平.《甲状腺结节和分化型甲状腺癌诊治指南(第二版)》解读[J].中国实用内科杂志,2023,43(11):884-889.
[24] Yan L, Li Y, Li XY, et al. Clinical outcomes of ultrasoundguided radiofrequency ablation for solitary T1N0M0 papillary thyroid carcinoma: A retrospective study with more than 5 years of follow-up[J]. Cancer, 2023,129(16):2469-2478.
[25] 中国抗癌协会肿瘤消融治疗专业委员会,中国临床肿瘤学会(CSCO)肿瘤消融专家委员会,中国医师协会介入医师分会肿瘤消融专业委员会,等.甲状腺乳头状癌热消融治疗专家共识(2024版)[J].中华内科杂志,2024,63(4):355364.
[26] 张浩，曲萌,孙威.警惕热消融初始治疗甲状腺乳头状癌适应证的肆意扩大：思考与担忧[J].中华外科杂志,2025,63(4):289-293.
[27] 张宇,王宇.局部晚期甲状腺癌新辅助治疗的现状与展望.中国普外基础与临床杂志,2024,31(11):1295-1299.
[28] Pitoia F, Abelleira E, Román-González A, et al. Neoadjuvant treatment of locally advanced thyroid cancer: a preliminary Latin American experience. Thyroid, 2024, 34(7): 949-952.
[29] Kim J, Graves CE, Jin C, et al. Intraoperative nerve monitoring is associated with a lower risk of recurrent laryngeal nerve injury: A national analysis of 17,610 patients. Am J Surg 2021;221(2):472–477;
[30] Liu YC,Shen CL, Fu ZY, et al. Effectiveness of the recurrent laryngeal nerve monitoring during endoscopic thyroid surgery: systematic review and metaanalysis[J].Int J Surg,2023,109(7):20702081.
[31] Giordano D , Botti C , Piana S ,et al. Postoperative hypoparathyroidism after completion thyroidectomy for well-differentiated thyroid cancer[J].Eur J Endocrinol, 2021,185(3):413-419.
[32] 中华医学会内分泌学分会,中华医学会外科学分会甲状腺及代谢外科学组,中国抗癌协会头颈肿瘤专业委员会等.甲状腺结节和分化型甲状腺癌诊治指南(第二版)[J].中华内分泌代谢杂志,2023,39(3):181-226.
[33] 陶星儒,石臣磊,石铁锋,等.示踪用盐酸米托蒽醌在甲状腺乳头状癌术中应用研究[J].中国实用外科杂志,2024,44(6):685-691.
[34] 刁建华,龚利花,邵志伟,等.无充气锁骨下入路腔镜甲状腺术与传统开放性手术的疗效比较[J].中国肿瘤外科杂志,2025,17(3):257-266.
[35] Zhang D, Xie L, He G, et al. A comparative study of the surgical outcomes between video-assisted and open lateral neck dissection for papillary thyroid carcinoma with lateral neck lymph node metastases［J］.Am J Otolaryngol, 2017, 38(2):115-120．
[36] Cho JS,Na YM,Kim HK.Age and postlobectomy recurrence after endoscopic or robotic thyroid surgery: a retrospective cohort study of 2348 papillary thyroid carcinoma patients[J].Cancers (Basel),2023,15(23):5506.
[37] Kim DG, Kim K, Lee JE, et al. Redo operation using a robotic system due to locoregional recurrence after initial thyroidectomy for thyroid cancer[J].Sci Rep,2022,12(1):11531.
[38] 高明,李大鹏.夯实学科厚度，潜修专科底蕴——甲状腺肿瘤学科高质量可持续发展之思考[J].中华普通外科杂志,2023,38(10):721-723.
[39] 张腾,李娇,林岩松.分化型甲状腺癌131I治疗简述与展望.中国普外基础与临床杂志,2024,31(11):1300-1306.
[40] 杨伟伟,只璟泰,郑向前.局部转移性晚期甲状腺癌分子靶向药物治疗[J].中国实用外科杂志,2019,39(3):209-212.
[41] Busaidy NL, Konda B, Wei L, et al.Dabrafenib versus dabrafenib +trametinib in BRAF-mutated radioactive iodine refractory differentiated thyroid cancer: Results of a randomized, phase 2, open-label multicenter trial[J].Thyroid,2022,32(10):1184-1192.
[42] Ming J, Zhu JQ, Zhang H, et al. A multicenter, prospective study to observe the initial management of patients with differentiated thyroid cancer in China (DTCC study)[J]. BMC Endocr Disord,2021,21(1):208.
[2] RINGEL M D, SOSA J A, BALOCH Z, et al. 2025 American thyroid association management guidelines for adult patients with differentiated thyroid cancer[J]. Thyroid, 2025, 35(8):841-985.
[3] 中国医师协会外科医师分会甲状腺外科专家工作组，中国研究型医院学会甲状腺疾病专业委员会. 超声引导下甲状腺结节和颈部淋巴结细针穿刺活检中国专家共识及操作指南（2025版）[J].中国实用外科杂志,2025,45(1):34-41.
[4] Wang D, Liu B, Zhang Z. Accelerating the understanding of cancer biology through the lens of genomics. Cell. 2023, 186(8):1755-1771.
[5] Singarayer R, Mete O, Perrier L, et al. A Systematic Review and Meta-Analysis of the Diagnostic Performance of BRAF V600E Immunohistochemistry in Thyroid Histopathology. Endocr Pathol. 2019,30(3):201-218.
[6] Liu LP, Hao JY, Pan H, et al. Zhonghua Bing Li Xue Za Zhi. 2020,49(3):256-261.
[7] Grabellus F, Worm K, Schmid KW, et al. The BRAF V600E mutation in papillary thyroid carcinoma is associated with glucose transporter 1 overexpression.Thyroid. 2012,22(4):377-382.
[8] Yang X, Wu H. RAS signaling in carcinogenesis, cancer therapy and resistance mechanisms.J Hematol Oncol. 2024,17(1):108. Published 2024 Nov 9.
[9] Tartaglia M, Gelb BD. Disorders of dysregulated signal traffic through the RASMAPK pathway: Phenotypic spectrum and molecular mechanisms. Ann N Y Acad Sci 1214:99-121,2010.
[10] Kang N, Zhao Z, Wang Z, et al. METTL3 regulates thyroid cancer differentiation and chemosensitivity by modulating PAX8. Int J Biol Sci 20:3426-3441,2024.
[11] Li Q, Wang Y, Meng X, et al. METTL16 inhibits papillary thyroid cancer tumorigenicity through m6A/YTHDC2/SCD1regulated lipid metabolism. Cell Mol Life Sci 81: 81, 2024.
[12] Wen J, Lin B, Lin L, et al. KCNN4 is a diagnostic and prognostic biomarker that promotes papillary thyroid cancer progression. Aging (Albany NY). 2020,12(16):16437-16456.
[13] 张亚靖,邓娟,罗斯,等.分子检测在甲状腺癌诊疗中的应用进展[J].中国普外基础与临床杂志,2025,32(10):1285-1290.
[14] 田文.人工智能时代下甲状腺结节诊治的发展现状与展望[J].中国普外基础与临床杂志,2025,32(10):1204-1207.
[15] Wang J, Zheng N, Wan H, et al. Deep learning models for thyroid nodules diagnosis of fine-needle aspiration biopsy: a retrospective, prospective, multicentre study in China. Lancet Digit Health. 2024,6(7):e458-e469.
[16] Hu G, Niu W, Ge J, et al. Identification of thyroid cancer biomarkers using WGCNA and machine learning. Eur J Med Res. 2025,30(1):244. Published 2025 Apr 5.
[17] Chou R, Dana T, Haymart MR, et al. Active surveillance versus thyroid surgery for differentiated thyroid cancer: A systematic review. Thyroid 2022,32(4):351–367.
[18] 张大林,董文武,张浩.2024年版日本《甲状腺肿瘤诊疗指南》外科治疗部分更新解读[J].中国实用外科杂志,2025,45(1):42-47.
[19] Rajjoub SR, Yan H, Calcatera NA, et al. Thyroid lobectomy is not sufficient for T2 papillary thyroid cancers. Surgery 2018,163(5):1134-1143.
[20] Sun W,Lan X,Zhang H,et al. Risk factors for central lymph node metastasis in CN0 papillary thyroid carcinoma: a systematic review and metaanalysis[J]. PLoS One,2015,10(10):e0139021.
[21] Hughes DT, Rosen JE, Evans DB, et al. Prophylactic central compartment neck dissection in papillary thyroid cancer and effect on locoregional recurrence. Ann Surg Oncol 2018,25(9):2526–2534;
[22] Moo TA，McGill J，Allendorf J，et al. Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma[J]. World J Surg,2010,34(6):1187- 1191.
[23] 李玉姝,单忠艳,滕卫平.《甲状腺结节和分化型甲状腺癌诊治指南(第二版)》解读[J].中国实用内科杂志,2023,43(11):884-889.
[24] Yan L, Li Y, Li XY, et al. Clinical outcomes of ultrasoundguided radiofrequency ablation for solitary T1N0M0 papillary thyroid carcinoma: A retrospective study with more than 5 years of follow-up[J]. Cancer, 2023,129(16):2469-2478.
[25] 中国抗癌协会肿瘤消融治疗专业委员会,中国临床肿瘤学会(CSCO)肿瘤消融专家委员会,中国医师协会介入医师分会肿瘤消融专业委员会,等.甲状腺乳头状癌热消融治疗专家共识(2024版)[J].中华内科杂志,2024,63(4):355364.
[26] 张浩，曲萌,孙威.警惕热消融初始治疗甲状腺乳头状癌适应证的肆意扩大：思考与担忧[J].中华外科杂志,2025,63(4):289-293.
[27] 张宇,王宇.局部晚期甲状腺癌新辅助治疗的现状与展望.中国普外基础与临床杂志,2024,31(11):1295-1299.
[28] Pitoia F, Abelleira E, Román-González A, et al. Neoadjuvant treatment of locally advanced thyroid cancer: a preliminary Latin American experience. Thyroid, 2024, 34(7): 949-952.
[29] Kim J, Graves CE, Jin C, et al. Intraoperative nerve monitoring is associated with a lower risk of recurrent laryngeal nerve injury: A national analysis of 17,610 patients. Am J Surg 2021;221(2):472–477;
[30] Liu YC,Shen CL, Fu ZY, et al. Effectiveness of the recurrent laryngeal nerve monitoring during endoscopic thyroid surgery: systematic review and metaanalysis[J].Int J Surg,2023,109(7):20702081.
[31] Giordano D , Botti C , Piana S ,et al. Postoperative hypoparathyroidism after completion thyroidectomy for well-differentiated thyroid cancer[J].Eur J Endocrinol, 2021,185(3):413-419.
[32] 中华医学会内分泌学分会,中华医学会外科学分会甲状腺及代谢外科学组,中国抗癌协会头颈肿瘤专业委员会等.甲状腺结节和分化型甲状腺癌诊治指南(第二版)[J].中华内分泌代谢杂志,2023,39(3):181-226.
[33] 陶星儒,石臣磊,石铁锋,等.示踪用盐酸米托蒽醌在甲状腺乳头状癌术中应用研究[J].中国实用外科杂志,2024,44(6):685-691.
[34] 刁建华,龚利花,邵志伟,等.无充气锁骨下入路腔镜甲状腺术与传统开放性手术的疗效比较[J].中国肿瘤外科杂志,2025,17(3):257-266.
[35] Zhang D, Xie L, He G, et al. A comparative study of the surgical outcomes between video-assisted and open lateral neck dissection for papillary thyroid carcinoma with lateral neck lymph node metastases［J］.Am J Otolaryngol, 2017, 38(2):115-120．
[36] Cho JS,Na YM,Kim HK.Age and postlobectomy recurrence after endoscopic or robotic thyroid surgery: a retrospective cohort study of 2348 papillary thyroid carcinoma patients[J].Cancers (Basel),2023,15(23):5506.
[37] Kim DG, Kim K, Lee JE, et al. Redo operation using a robotic system due to locoregional recurrence after initial thyroidectomy for thyroid cancer[J].Sci Rep,2022,12(1):11531.
[38] 高明,李大鹏.夯实学科厚度，潜修专科底蕴——甲状腺肿瘤学科高质量可持续发展之思考[J].中华普通外科杂志,2023,38(10):721-723.
[39] 张腾,李娇,林岩松.分化型甲状腺癌131I治疗简述与展望.中国普外基础与临床杂志,2024,31(11):1300-1306.
[40] 杨伟伟,只璟泰,郑向前.局部转移性晚期甲状腺癌分子靶向药物治疗[J].中国实用外科杂志,2019,39(3):209-212.
[41] Busaidy NL, Konda B, Wei L, et al.Dabrafenib versus dabrafenib +trametinib in BRAF-mutated radioactive iodine refractory differentiated thyroid cancer: Results of a randomized, phase 2, open-label multicenter trial[J].Thyroid,2022,32(10):1184-1192.
[42] Ming J, Zhu JQ, Zhang H, et al. A multicenter, prospective study to observe the initial management of patients with differentiated thyroid cancer in China (DTCC study)[J]. BMC Endocr Disord,2021,21(1):208.
Copyright © 2026 李想, 谢磊
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License