Abstract：
Approximately 43 720 new cases of thyroid carcinoma are expected to be diagnosed in 2023 in the US. Five-year relative survival is approximately 98.5%. This review summarizes current evidence regarding pathophysiology, diagnosis, and management of early-stage and advanced thyroid cancer.
Papillary thyroid cancer accounts for approximately 84% of all thyroid cancers. Papillary, follicular (≈4%), and oncocytic (≈2%) forms arise from thyroid follicular cells and are termed well-differentiated thyroid cancer. Aggressive forms of follicular cell-derived thyroid cancer are poorly differentiated thyroid cancer (≈5%) and anaplastic thyroid cancer (≈1%). Medullary thyroid cancer (≈4%) arises from parafollicular C cells. Most cases of well-differentiated thyroid cancer are asymptomatic and detected during physical examination or incidentally found on diagnostic imaging studies. For microcarcinomas (≤1 cm), observation without surgical resection can be considered. For tumors larger than 1 cm with or without lymph node metastases, surgery with or without radioactive iodine is curative in most cases. Surgical resection is the preferred approach for patients with recurrent locoregional disease. For metastatic disease, surgical resection or stereotactic body irradiation is favored over systemic therapy (eg, lenvatinib, dabrafenib). Antiangiogenic multikinase inhibitors (eg, sorafenib, lenvatinib, cabozantinib) are approved for thyroid cancer that does not respond to radioactive iodine, with response rates 12% to 65%. Targeted therapies such as dabrafenib and selpercatinib are directed to genetic mutations (BRAF, RET, NTRK, MEK) that give rise to thyroid cancer and are used in patients with advanced thyroid carcinoma.
Approximately 44 000 new cases of thyroid cancer are diagnosed each year in the US, with a 5-year relative survival of 98.5%. Surgery is curative in most cases of well-differentiated thyroid cancer. Radioactive iodine treatment after surgery improves overall survival in patients at high risk of recurrence. Antiangiogenic multikinase inhibitors and targeted therapies to genetic mutations that give rise to thyroid cancer are increasingly used in the treatment of metastatic disease.
Papillary thyroid cancer accounts for approximately 84% of all thyroid cancers. Papillary, follicular (≈4%), and oncocytic (≈2%) forms arise from thyroid follicular cells and are termed well-differentiated thyroid cancer. Aggressive forms of follicular cell-derived thyroid cancer are poorly differentiated thyroid cancer (≈5%) and anaplastic thyroid cancer (≈1%). Medullary thyroid cancer (≈4%) arises from parafollicular C cells. Most cases of well-differentiated thyroid cancer are asymptomatic and detected during physical examination or incidentally found on diagnostic imaging studies. For microcarcinomas (≤1 cm), observation without surgical resection can be considered. For tumors larger than 1 cm with or without lymph node metastases, surgery with or without radioactive iodine is curative in most cases. Surgical resection is the preferred approach for patients with recurrent locoregional disease. For metastatic disease, surgical resection or stereotactic body irradiation is favored over systemic therapy (eg, lenvatinib, dabrafenib). Antiangiogenic multikinase inhibitors (eg, sorafenib, lenvatinib, cabozantinib) are approved for thyroid cancer that does not respond to radioactive iodine, with response rates 12% to 65%. Targeted therapies such as dabrafenib and selpercatinib are directed to genetic mutations (BRAF, RET, NTRK, MEK) that give rise to thyroid cancer and are used in patients with advanced thyroid carcinoma.
Approximately 44 000 new cases of thyroid cancer are diagnosed each year in the US, with a 5-year relative survival of 98.5%. Surgery is curative in most cases of well-differentiated thyroid cancer. Radioactive iodine treatment after surgery improves overall survival in patients at high risk of recurrence. Antiangiogenic multikinase inhibitors and targeted therapies to genetic mutations that give rise to thyroid cancer are increasingly used in the treatment of metastatic disease.
摘要：
■预计2023年美国将诊断出大约43720例新的甲状腺癌病例。五年相对生存率约为98.5%。这篇综述总结了目前关于病理生理学的证据，诊断,以及早期和晚期甲状腺癌的治疗。
■甲状腺乳头状癌约占所有甲状腺癌的84%。乳头状，卵泡（约4%），和嗜酸细胞（约2％）的形式来自甲状腺滤泡细胞，被称为高分化甲状腺癌。滤泡细胞源性甲状腺癌的侵袭性形式是低分化甲状腺癌（约5％）和间变性甲状腺癌（约1％）。甲状腺髓样癌（约4％）来自滤泡旁C细胞。大多数分化良好的甲状腺癌病例无症状，在体格检查中发现或在诊断性影像学检查中偶然发现。对于微癌（≤1厘米），可以考虑不进行手术切除的观察。对于有或没有淋巴结转移的大于1cm的肿瘤，在大多数情况下，有或没有放射性碘的手术是治愈的。手术切除是复发性局部区域疾病患者的首选方法。对于转移性疾病，手术切除或立体定向身体照射优于全身治疗(例如，lenvatinib,dabrafenib）。抗血管生成多激酶抑制剂（如，索拉非尼,lenvatinib,卡博替尼）被批准用于对放射性碘无反应的甲状腺癌，应答率12%到65%。靶向治疗，如dabrafenib和selpercatinib针对基因突变（BRAF，RET,NTRK,MEK）引起甲状腺癌，用于晚期甲状腺癌患者。
■在美国，每年大约有44000例新的甲状腺癌被诊断出来。5年相对生存率为98.5%。在大多数分化良好的甲状腺癌病例中，手术是治愈的。手术后放射性碘治疗可改善复发高危患者的总体生存率。抗血管生成多激酶抑制剂和引起甲状腺癌的基因突变的靶向疗法越来越多地用于治疗转移性疾病。
■甲状腺乳头状癌约占所有甲状腺癌的84%。乳头状，卵泡（约4%），和嗜酸细胞（约2％）的形式来自甲状腺滤泡细胞，被称为高分化甲状腺癌。滤泡细胞源性甲状腺癌的侵袭性形式是低分化甲状腺癌（约5％）和间变性甲状腺癌（约1％）。甲状腺髓样癌（约4％）来自滤泡旁C细胞。大多数分化良好的甲状腺癌病例无症状，在体格检查中发现或在诊断性影像学检查中偶然发现。对于微癌（≤1厘米），可以考虑不进行手术切除的观察。对于有或没有淋巴结转移的大于1cm的肿瘤，在大多数情况下，有或没有放射性碘的手术是治愈的。手术切除是复发性局部区域疾病患者的首选方法。对于转移性疾病，手术切除或立体定向身体照射优于全身治疗(例如，lenvatinib,dabrafenib）。抗血管生成多激酶抑制剂（如，索拉非尼,lenvatinib,卡博替尼）被批准用于对放射性碘无反应的甲状腺癌，应答率12%到65%。靶向治疗，如dabrafenib和selpercatinib针对基因突变（BRAF，RET,NTRK,MEK）引起甲状腺癌，用于晚期甲状腺癌患者。
■在美国，每年大约有44000例新的甲状腺癌被诊断出来。5年相对生存率为98.5%。在大多数分化良好的甲状腺癌病例中，手术是治愈的。手术后放射性碘治疗可改善复发高危患者的总体生存率。抗血管生成多激酶抑制剂和引起甲状腺癌的基因突变的靶向疗法越来越多地用于治疗转移性疾病。
