综述

甲状腺髓样癌的诊治现状

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  • 上海交通大学附属第六人民医院甲乳疝外科 甲状腺疾病诊治中心,上海 200233

收稿日期: 2020-09-14

  网络出版日期: 2022-08-03

基金资助

上海交通大学优秀专病诊治中心资助基金(2014年4号);中国科学院大学宁波生命与健康产业研究院合作项目(2019YJY0201)

Diagnosis and treatment of medullary thyroid carcinoma-an update

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  • Department of Thyroid, Breast and Hernia Surgery, Thyroid Disease Diagnosis and Treatment Center, Sixth People′s Hospital, Shanghai Jiao Tong University, Shanghai 200233, China

Received date: 2020-09-14

  Online published: 2022-08-03

摘要

甲状腺髓样癌(medullary thyroid carcinoma,MTC)是起源于甲状腺滤泡旁细胞(C细胞)的少见特殊甲状腺癌,属于侵袭性神经内分泌肿瘤。降钙素和癌胚抗原仍是目前常用的标志物,其升高能可靠诊断MTC。其术前测定值,术后倍增时间对手术淋巴结清扫范围、预后判断有重要意义。手术治疗建议甲状腺全切除和中央区淋巴结清扫,必要时侧区清扫。推荐常规进行RET基因检测。对无法手术或远处转移病人,考虑靶向治疗。仍需加强MTC病理机制研究。

本文引用格式

陈承坤 综述, 郭伯敏, 邓先兆, 伍波, 樊友本 审校 . 甲状腺髓样癌的诊治现状[J]. 外科理论与实践, 2022 , 27(03) : 276 -280 . DOI: 10.16139/j.1007-9610.2022.03.019

Abstract

Medullary thyroid carcinoma (MTC) arising from the parafollicular cell (C cell) of the thyroid gland, is an aggressive neuroendocrine tumor and a special rare thyroid malignancy. Calcitonin and carcinoembryonic antigen are still commonly used markers now, whose elevation can reliably diagnose MTC. The preoperative value and postoperative doubling time of these markers are of great significance for range of lymph node dissection and evaluation of prognosis. It is recommended that total thyroidectomy and central lymph node dissection would be needed and lateral lymph node dissection would be added when necessary. Routine detection of RET gene is recommended. Targeted therapy is considered for non-operable patients or the patients with distant metastasis. The pathological mechanism of MTC still needs to be paid attention.

参考文献

[1] Wells SA Jr, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma[J]. Thyroid, 2015, 25(6):567-610.
[2] Mathiesen JS, Kroustrup JP, Vestergaard P, et al. Incidence and prevalence of sporadic and hereditary MTC in Denmark 1960-2014: a nationwide study[J]. Endocr Connect, 2018, 7(6):829-839.
[3] Torresan F, Mian C, Cavedon E, et al. Cure and survival of sporadic medullary thyroid carcinoma following systematic preoperative calcitonin screening[J]. Langenbecks Arch Surg, 2019, 404(4):411-419.
[4] Kihara M, Miyauchi A, Kudo T, et al. Serum calcitonin reference values for calcium stimulation tests by electrochemiluminescence immunoassay in Japanese men with non-medullary thyroid carcinoma[J]. Surg Today, 2018, 48(2):223-228.
[5] Giovanella L, Imperiali M, Piccardo A, et al. Procalcitonin measurement to screen medullary thyroid carcinoma: a prospective evaluation in a series of 2 705 patients with thyroid nodules[J]. Eur J Clin Invest, 2018, 48(6):e12934.
[6] Parmer M, Milan S, Torabi A. Calcitonin-negative neuroendocrine tumor of the thyroid[J]. Int J Surg Pathol, 2017, 25(2):191-194.
[7] Liang X, Zhu J, Cai M, et al. Progrp as a novel biomar-ker for the differential diagnosis of medullary thyroid carcinoma in patients with thyroid nodules[J]. Endocr Pract, 2020, 26(5):514-522.
[8] Turkdogan S, Forest VI, Hier MP, et al. Carcinoembryo-nic antigen levels correlated with advanced disease in medullary thyroid cancer[J]. J Otolaryngol Head Neck Surg, 2018, 47(1):55.
[9] Parra-Robert M, Orois A, Augé JM, et al. Utility of proGRP as a tumor marker in the medullary thyroid carcinoma[J]. Clin Chem Lab Med, 2017, 55(3):441-446.
[10] Maleki Z, Abram M, Dell′Aquila M, et al. Insulinoma-associated protein 1 (INSM-1) expression in medullary thy-roid carcinoma FNA: a multi-institutional study[J]. J Am Soc Cytopathol, 2020, 9(3):185-190.
[11] Suzuki A, Hirokawa M, Takada N, et al. Fine-needle aspiration cytology for medullary thyroid carcinoma: a single institutional experience in Japan[J]. Endocr J, 2017, 64(11):1099-1104.
[12] Liu MJ, Liu ZF, Hou YY, et al. Ultrasonographic characteristics of medullary thyroid carcinoma: a comparison with papillary thyroid carcinoma[J]. Oncotarget, 2017, 8(16):27520-27528.
[13] Wang L, Kou H, Chen W, et al. The diagnostic value of ultrasound in medullary thyroid carcinoma: a comparison with computed tomography[J]. Technol Cancer Res Treat, 2020, 19:1533033820905832.
[14] Kushchayev SV, Kushchayeva YS, Tella SH, et al. Medullary thyroid carcinoma: an update on imaging[J]. J Thyroid Res, 2019, 2019:1893047.
[15] Yamaga LYI, Cunha ML, Campos Neto GC, et al. 68Ga-DOTATATE PET/CT in recurrent medullary thyroid carcinoma: a lesion-by-lesion comparison with 111In-octreotide SPECT/CT and conventional imaging[J]. Eur J Nucl Med Mol Imaging, 2017, 44(10):1695-1701.
[16] Giovanella L, Treglia G, Iakovou I, et al. EANM practice guideline for PET/CT imaging in medullary thyroid carcinoma[J]. Eur J Nucl Med Mol Imaging, 2020, 47(1):61-77.
[17] Zhang X, Yan D, Wang J, et al. Is new American Thyroid Association risk classification for hereditary medullary thyroid carcinoma applicable to Chinese patients? a single-center study[J]. Chin J Cancer Res, 2017, 29(3):223-230.
[18] Elisei R, Bottici V, Cappagli V, et al. Clinical utility of genetic diagnosis for sporadic and hereditary medullary thyroid carcinoma[J]. Ann Endocrinol (Paris), 2019, 80(3):187-190.
[19] Kihara M, Miyauchi A, Yoshioka K, et al. Germline RET mutation carriers in Japanese patients with apparently sporadic medullary thyroid carcinoma: a single institution experience[J]. Auris Nasus Larynx, 2016, 43(5):551-555.
[20] Mathiesen JS, Kroustrup JP, Vestergaard P, et al. Completeness of RET testing in patients with medullary thyroid carcinoma in Denmark 1997-2013: a nationwide study[J]. Clin Epidemiol, 2019, 11:93-99.
[21] Essig GF Jr, Porter K, Schneider D, et al. Multifocality in sporadic medullary thyroid carcinoma: an international multicenter study[J]. Thyroid, 2016, 26(11):1563-1572.
[22] de Crea C, Raffaelli M, Milano V, et al. Intraoperative high-dose calcium stimulation test in patients with sporadic medullary thyroid carcinoma is highly accurate in predicting lateral neck metastases[J]. Surgery, 2016, 159(1):70-76.
[23] Filimon S, Payne RJ, Black MJ, et al. Calcitonin secretory index and unsuspected nodal disease in medullary thyroid carcinoma[J]. Endocr Pract, 2018, 24(5):460-467.
[24] Fan W, Xiao C, Wu F. Analysis of risk factors for cervical lymph node metastases in patients with sporadic medullary thyroid carcinoma[J]. J Int Med Res, 2018, 46(5):1982-1989.
[25] Ye L, Zhou X, Lu J, et al. Combining serum calcitonin, carcinoembryonic antigen, and neuron-specific enolase to predict lateral lymph node metastasis in medullary thyroid carcinoma[J]. J Clin Lab Anal, 2020, 34(7):e23278.
[26] Wang S, Wang B, Xie C, et al. RET Proto-oncogene gene mutation is related to cervical lymph node metastasis in medullary thyroid carcinoma[J]. Endocr Pathol, 2019, 30(4):297-304.
[27] 史亚飞, 张颖超, 樊友本, 等. 甲状腺髓样癌手术切除范围的研究[J]. 中华普通外科杂志, 2020, 35(11):856-861.
[28] Werner RA, Schmid JS, Higuchi T, et al. Predictive va-lue of 18F-FDG PET in patients with advanced medullary thyroid carcinoma treated with vandetanib[J]. J Nucl Med, 2018, 59(5):756-761.
[29] Kocsis J, Szekanecz É, Bassam A, et al. First line sorafenib treatment for metastatic medullary thyroid cancer: efficacy and safety analysis[J]. Exp Clin Endocrinol Diabetes, 2019, 127(4):240-246.
[30] Drilon AE, Subbiah V, Oxnard GR, et al. A phase 1 study of LOXO-292, a potent and highly selective RET inhibitor, in patients with RET-altered cancers[J]. J Clin Oncol, 2018, 36:102.
[31] Gainor JF, Lee DH, Curigliano G, et al. Clinical activity and tolerability of BLU-667, a highly potent and selective RET inhibitor, in patients(pts) with advanced RET-fusion+ non-small cell lung cancer(NSCLC)[J]. J Clin Oncol, 2019, 37:9008.
[32] Meng K, Luo H, Chen H, et al. Prognostic value of numbers of metastatic lymph node in medullary thyroid car-cinoma: a population-based study using the SEER 18 database[J]. Medicine (Baltimore), 2019, 98(1):e13884.
[33] Hassan A, Siddique M, Riaz S, et al. Medullary thyroid carcinoma: prognostic variables and tumour markers affecting survival[J]. J Ayub Med Coll Abbottabad, 2018, 30(Suppl 1)(4):S627-S632.
[34] Trimboli P, Lauretta R, Barnabei A, et al. Procalcitonin as a postoperative marker in the follow-up of patients affected by medullary thyroid carcinoma[J]. Int J Biol Markers, 2018, 33(2):156-160.
[35] Chen L, Sun W, Qian K, et al. High ratio of early postoperative calcitonin to preoperative calcitonin could be a novel indicator of poor prognosis in patients with biochemical incomplete responses in sporadic medullary thyroid cancer[J]. Endocr Pract, 2020, 26(7):738-747.
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