中国实用外科杂志

中国实用外科杂志

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局部进展期分化型甲状腺癌术后复发的处理策略

刘绍严，朱一鸣   

  1. 国家癌症中心 国家肿瘤临床医学研究中心 中国医学科学院北京协和医学院肿瘤医院头颈外科，北京100021
  • 出版日期:2023-08-01

  • Online:2023-08-01

摘要： 局部进展期分化型甲状腺癌初次治疗后再次复发者，预后相对较差，局部复发率高，远处转移率相对较高。发现复发后，应对既往诊治经过、病理学检查结果等做全面回顾，同时详细评估目前病情，可通过颈部超声、增强CT、增强MR、正电子发射型计算机断层显像（PET-CT）、鼻咽喉镜、气管镜、食管镜等全面评估病变的可切除性。如有可能达到R0或R1切除，仍然首选手术治疗。手术常需要多学科协作，并做好修复重建准备。术后需要行促甲状腺激素（TSH）抑制、131I治疗（既往无131I治疗史者）、外照射放疗等辅助治疗。对于临界可切除和部分不可切除者，新辅助治疗后可能获得手术机会。姑息性手术通常难以使病人获益。如气管切开等缓解症状的姑息性手术有一定价值。对于远处转移病例，孤立病灶可考虑切除，多发病灶如进展缓慢则建议观察。严格把握靶向治疗适应证，才可使病人最大获益。不可手术的局部复发和远处转移病灶，如进展较快或威胁生命，建议开始靶向治疗。靶向治疗期间应注意评估和处理副反应。

关键词: 分化型甲状腺癌, 局部进展期甲状腺癌, 复发, 远处转移, 外科治疗

Abstract: Management strategies for postoperative recurrence of locally advanced differentiated thyroid cancer        LIU Shao-yan,ZHU Yi-ming. Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Corresponding author:ZHU Yi-ming,E-mail:yimingzhu@
cicams.ac.cn
Abstract    Patients who have recurrence after initial treatment of locally advanced differentiated thyroid cancers have relatively poor prognosis, high local recurrence rate and relatively high distant metastasis rate. After recurrence being identified, a comprehensive review of previous treatment and pathological results should be done, and the current status should be evaluated in detail. The resectability can be comprehensively evaluated by neck ultrasound, enhanced CT, enhanced MR,positron emission tomography-computed tomography(PET-CT), nasopharyngolaryngoscopy, tracheoscopy, esophagoscopy, etc. If R0/R1 resection is possible, surgical treatment is preferred. Multidisciplinary collaboration is usually required, operation and reconstruction methods must be planned. Postoperative adjuvant therapy such as thyroid stimulating hormon(TSH) suppression, radioiodine therapy (for those with no previous history of 131I therapy), and external radiation radiotherapy are required. For the borderline resectable cases and some unresectable cases, surgery may be available after neoadjuvant therapy. Few palliative surgery will benefit patients. Palliative surgery to relieve symptoms such as tracheotomy is still valuable. For cases of distant metastasis, resection may be considered for isolated lesions, and observation is recommended for multiple lesions if they progress slowly. Indications for targeted therapy must be strictly followed in order to maximize patient benefit. For inoperable local recurrence and distant metastatic lesions, it is recommended to start targeted therapy if the progression is rapid or life-threatening. Care should be taken to assess and manage side effects during targeted therapy.

Key words: differentiated thyroid cancer, locally advanced thyroid cancer, recurrence, distant metastasis, surgical treatment