甲状腺癌总体预后良好，但进展为晚期甲状腺癌将成为威胁病人生命的主要因素。晚期甲状腺癌的诊治涉及多学科、多模态等复杂诊疗过程，2024年欧洲内分泌外科学会（ESES）以晚期甲状腺癌的定义、术前管理以及治疗策略的相关问题组成专家组，形成共识意见。这一共识声明的发布充分说明了欧美学者对晚期甲状腺癌的重视态度。该共识从局部、区域及远处转移三个维度对晚期甲状腺癌进行界定，并将甲状腺未分化癌（ATC）明确纳入晚期类型。该共识强调术前应通过多模态影像学、内镜及分子检测进行全面评估，同时重视病人合并症及营养状态的优化。多学科综合治疗协作组（MDT）在个体化治疗方案制定中具有核心地位。治疗策略以尽可能根治性切除原发灶和转移灶为基础，并结合靶向治疗、放疗及新辅助治疗进行综合管理。对于分化型甲状腺癌（DTC）、甲状腺髓样癌（MTC）和ATC，手术仍是关键，但需兼顾局部控制与生活质量平衡。分子检测结果指导靶向药物的合理应用，包括多激酶抑制剂（MKI）及RET、BRAF、NTRK等靶向治疗。该共识为晚期甲状腺癌的定义与管理提供了系统框架，凸显了精准医疗理念和MDT模式在提高病人生存率与生活质量中的重要作用。
Abstract
The overall prognosis of thyroid cancer is favorable. However, once it progresses to advanced disease, it becomes a major threat to patient survival. Diagnosis and treatment of advanced thyroid cancer involve complex, multidisciplinary and multimodal processes. In 2024, the European Society of Endocrine Surgeons (ESES) convened an expert panel to address issues related to the definition, preoperative management, and therapeutic strategies for advanced thyroid cancer, culminating in a consensus statement that reflects the heightened attention of European and North American experts to this entity. The consensus defines advanced thyroid cancer across three domains—local, regional, and distant metastatic disease—and explicitly includes anaplastic thyroid carcinoma (ATC) within the advanced category. It emphasizes comprehensive preoperative evaluation using multimodal imaging, endoscopy, and molecular testing, together with optimization of comorbidities and nutritional status. Multidisciplinary team (MDT) care is central to crafting individualized treatment plans. Therapeutic strategies are anchored in achieving the greatest possible curative-intent resection of the primary tumor and metastatic foci, integrated with targeted therapy, radiotherapy, and neoadjuvant therapy as appropriate. For differentiated thyroid carcinoma (DTC), medullary thyroid carcinoma (MTC), and ATC, surgery remains pivotal, with careful attention to balancing local control and quality of life. Molecular testing guides the rational use of targeted agents, including multikinase inhibitors (MKIs) and therapies directed at RET, BRAF, and NTRK alterations. Overall, the consensus provides a structured framework for defining and managing advanced thyroid cancer and underscores the roles of precision medicine and MDT care in improving survival and quality of life.
关键词
晚期甲状腺癌 /
共识声明 /
术前评估 /
多学科综合治疗协作组 /
靶向治疗 /
甲状腺未分化癌 /
分子检测 /
精准医疗
Key words
advanced thyroid cancer /
consensus statement /
preoperative assessment /
multidisciplinary team (MDT) /
targeted therapy /
anaplastic thyroid cancer /
molecular testing /
precision medicine
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