Progress in active surveillance for adult low-risk papillary thyroid microcarcinoma
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摘要: 甲状腺微小乳头状癌(PTMC)的发病率迅速增长，然而，流行病学和尸检研究结果显示，低危型PTMC(LR-PTMC)的人群患病率很高，但致死率很低，LR-PTMC存在一定程度的过度诊断和过度治疗。对LR-PTMC采取主动监测而非立即手术，70%以上的病灶在临床观察中保持稳定或缩小，于是，世界多个学术团体在临床诊疗指南中，将主动监测作为LR-PTMC的推荐方案之一。然而，甲状腺微小癌并不等于低危癌，主动监测的实施需要严格掌握适应证，并充分考虑人群特征，以保证患者的最大获益。本文就成人LR-PTMC临床主动监测的研究进展作一综述。Abstract: The incidence of papillary thyroid microcarcinoma (PTMC) increases rapidly. However, epidemiological and autopsy studies show that the prevalence of low-risk papillary thyroid microcarcinoma (LR-PTMC) is very high, but the mortality is very low. There is over-diagnosis and over-treatment for LR-PTMC. Active surveillance (AS) was adopted for LR-PTMCs instead of immediate surgery, and more than 70% of the lesions remained stable or shrank in clinical observation. Therefore, AS is recommended for LR-PTMCs in clinical guidelines of several academic organizations around the world. However, PTMC is not equal to low-risk cancer. The implementation of AS strategy requires a strict grasp of indications and full consideration of population characteristics to ensure the maximum benefit of patients. This paper summarizes the present clinical progress of active surveillance for adult LR-PTMC.
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Key words:
- papillary thyroid microcarcinoma /
- active surveillance /
- qver-diagnosis /
- autopsy study
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