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期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2023.26348

摘要内容如下：

重要性

预计到2023年，美国将诊断出大约43720例甲状腺癌新病例。5年相对存活率约为98.5%。这篇综述总结了目前关于早期和晚期甲状腺癌的病理生理学、诊断和治疗的证据。

观察

甲状腺乳头状癌约占所有甲状腺癌的84%。乳头状癌、滤泡癌（≈4%）和嗜酸细胞癌（≈2%）由甲状腺滤泡细胞产生，被称为分化良好的甲状腺癌。滤泡细胞源性甲状腺癌的侵袭性形式为低分化甲状腺癌（≈5%）和未分化癌（≈1%）。甲状腺髓样癌（≈4%）起源于滤泡旁C细胞。大多数分化型甲状腺癌是无症状的，在体检中发现或在诊断性影像学检查中偶然发现。对于微小癌（≤1cm），可以考虑不手术切除的观察。对于大于1厘米且伴有或不伴有淋巴结转移的肿瘤，在大多数情况下，使用或不使用放射性碘的手术是可以治愈的。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体照射优于全身治疗（如乐伐替尼、达拉非尼）。抗血管生成多激酶抑制剂（如索拉非尼、乐伐替尼、卡博替尼）被批准用于治疗对放射性碘无反应的甲状腺癌，反应率为12%至65%。达拉非尼（Dabrafenib）和赛帕替尼（Selpercatinib）等靶向治疗针对引起甲状腺癌的基因突变（BRAF、RET、NTRK、MEK），用于晚期甲状腺癌患者。

结论

在美国，每年大约有44000个新诊断的甲状腺癌病例，5年相对生存率为98.5%。在大多数分化型甲状腺癌病例中，手术是可以治愈的。手术后放射性碘治疗可提高高复发风险患者的总生存率。抗血管生成多激酶抑制剂和针对引起甲状腺癌的基因突变的靶向治疗越来越多地用于治疗转移性疾病。

英文原文如下：

Abstracts

Importance  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.

Observations  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.

Conclusions  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.

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