儿童及青少年甲状腺癌远处转移诊治策略OA北大核心CSTPCD
Diagnosis and treatment strategies for distant metastasis of thyroid carcinoma in children and young adolescents
儿童及青少年甲状腺癌发病率近年来呈上升趋势.与成人相比,儿童及青少年甲状腺癌具有更高的恶性程度、远处转移和复发风险.远处转移的诊断和治疗是临床医疗中至关重要的环节.儿童及青少年甲状腺癌远处转移的危险因素包括放射线暴露、年龄、基因改变和病理学类型.诊断远处转移需要准确诊断原发病,包括临床分期、病理学类型和分子学诊断等.对于有放射线暴露史、家族史、遗传易感性和基因改变的高风险病人,应重点筛查远处转移情况.甲状腺球蛋白(Tg)检测和放射性核素扫描检查是评估肿瘤持续存在或复发的重要辅助检查.其治疗策略包括外科治疗、放射性碘(RAI)治疗、促甲状腺激素(TSH)抑制治疗及Tg水平监测、靶向治疗以及长期管理.与成人相比,儿童及青少年甲状腺癌病人的长期预后更好,即使发生远处转移,生存期也较长.因此,完善儿童及青少年甲状腺癌的诊治策略以提高病人生活质量显得尤为重要.动态风险分层对该病的长期管理和预后评估具有重要意义.此外,术后甲状旁腺功能减退的防治、病人的心理健康和生活质量也需要得到关注.
The incidence of thyroid carcinoma in children and adolescents has been on the rise in recent years.Compared to adults,children and adolescent patients with thyroid carcinoma have a higher degree of malignancy as well as increased risks of distant metastasis and recurrence.Diagnosing and treating distant metastases are crucial aspects of clinical medical care.Risk factors for distant metastasis in pediatric and adolescent thyroid carcinoma include radiation exposure,age,genetic alterations,and pathological types.Diagnosing distant metastasis requires an accurate diagnosis of the primary disease,including clinical staging pathological type and molecular diagnosis.For high-risk patients with a history of radiation exposure,family history of genetic susceptibility,and genetic alterations,screening for distant metastases should be emphasized.Thyroglobulin(Tg)testing and radioisotope nucleotide scanning are important for assessing presence and recurrence of tumors.Treatment strategies include surgical treatment,radioactive iodine(RAI)therapy,thyroid-stimulating hormone(TSH)suppression therapy,Tg level monitoring targeted therapy,and long-term management.Compared to adults,children and adolescent thyroid carcinoma patients have a better long-term prognosis,even in the case of distant metastases with more extended survival periods.Hence,improving the diagnosis and treatment strategies for pediatric and adolescent thyroid carcinoma to enhance patients'quality of life is particularly important.Dynamic risk stratification plays a significant role in the disease's long-term management and prognosis assessment.Furthermore,attention should also be given to the prevention and treatment of postoperative hypoparathyroidism patients'mental health and quality of life.
王卓颖;邱茗;钱凯
上海交通大学医学院附属仁济医院头颈外科,上海 200127
临床医学
儿童青少年甲状腺癌远处转移
childrenadolescentsthyroid carcinomadistant metastasis
《中国实用外科杂志》 2024 (006)
669-673 / 5
国家自然科学基金项目(No.81972496);共青团上海交通大学医学院委员会"甲状腺肿瘤防治"青年科技创新工作室项目
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