高分化甲状腺癌预后良好,5年生存率超过95%。然而,未分化或间变性类型占<0.2%,通常在老年人中,表现出令人沮丧的预后,快速增长和令人失望的结果。它是甲状腺癌最具侵袭性的形式,中位生存期为5个月,生活质量差(气道阻塞,吞咽困难,声音嘶哑,持续性疼痛)。早期诊断和分期至关重要。诊断工具包括活检(细针穿刺,芯针,开放手术),高分辨率超声波,计算机断层扫描,磁共振成像,[(18)F]氟-D-葡萄糖正电子发射断层摄影/计算机断层扫描,液体活检和microRNA。BRAF基因(BRAF-V600E和BRAF野生型)是最常见的分子因子。其他包括RET基因,KRAS,HRAS,和NRAS。最近的管理政策是基于手术,甚至是剔除,化疗(顺铂或阿霉素),放射治疗(辅助或确定性),靶向生物制剂和免疫治疗。最后两种选择构成了新颖的有希望的管理方式,可改善这些原本受到谴责的患者的总体生存率。抗程序性死亡-配体1抗体免疫治疗,干细胞靶向治疗,纳米技术成就和人工智能实现提供了新的有希望的替代方案。基因突变决定了分子通路,因此表明了新的治疗策略,如抗BRAF,抗血管内皮生长因子A,和抗表皮生长因子受体。在BRAF-V600E基因突变的情况下,使用BRAF抑制剂dabrafenib和MEK抑制剂trametinib的组合进行治疗已获得食品和药物管理局的批准,目前是标准治疗。这种新辅助治疗后的手术确保了80%的两年总生存率。已发现改善预后的预后因素是年龄较小,早期肿瘤分期和放射治疗。多学科方法是必要的,治疗计划应根据监测和流行病学最终结果进行个体化.
Well-differentiated thyroid carcinoma has a favorable prognosis with a 5-year survival rate of over 95%. However, the undifferentiated or anaplastic type accounting for < 0.2%, usually in elderly individuals, exhibits a dismal prognosis with rapid growth and disappointing outcomes. It is the most aggressive form of thyroid carcinoma, with a median survival of 5 mo and poor quality of life (airway obstruction, dysphagia, hoarseness, persistent pain). Early diagnosis and staging are crucial. Diagnostic tools include biopsy (fine needle aspiration, core needle, open surgery), high-resolution ultrasound, computed tomography, magnetic resonance imaging, [(18)F]fluoro-D-glucose positron emission tomo-graphy/computed tomography, liquid biopsy and microRNAs. The BRAF gene (BRAF-V600E and BRAF wild type) is the most often found molecular factor. Others include the genes RET, KRAS, HRAS, and NRAS. Recent management policy is based on surgery, even debulking, chemotherapy (cisplatin or doxorubicin), radiotherapy (adjuvant or definitive), targeted biological agents and immunotherapy. The last two options constitute novel hopeful management modalities improving the overall survival in these otherwise condemned patients. Anti-programmed death-ligand 1 antibody immunotherapy, stem cell targeted therapies, nanotechnology achievements and artificial intelligence imple-mentation provide novel promising alternatives. Genetic mutations determine molecular pathways, thus indicating novel treatment strategies such as anti-BRAF, anti-vascular endothelial growth factor-A, and anti-epidermal growth factor receptor. Treatment with the combination of the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib has been approved by the Food and Drug Administration in cases with BRAF-V600E gene mutations and is currently the standard care. This neoadjuvant treatment followed by surgery ensures a two-year overall survival of 80%. Prognostic factors for improved outcomes have been found to be younger age, earlier tumor stage and radiation therapy. A multidisciplinary approach is necessary, and the therapeutic plan should be individualized based on surveillance and epidemiology end results.