甲状腺癌精准诊疗现状及展望

Current status and future perspectives of precision medicine in thyroid cancer

摘要:

甲状腺癌是最常见的内分泌系统恶性肿瘤，近年来其发病率持续上升。随着我国甲状腺癌诊疗规范化与同质化进程的不断推进，患者5年生存率已由2003年的67.5%显著提升至2021年的92.9%。然而，甲状腺癌具有明显的生物学异质性，不同患者在临床表现、发生、发展、转归及预后等方面差异显著，传统的诊疗模式已难以满足精准治疗需求。当前，甲状腺癌的诊疗理念正由经验医学逐步向以分子分型和风险分层为基础的个体化、精准化诊疗模式转变。本文围绕甲状腺癌精准诊疗的关键环节，从术前精准诊断、风险分层、治疗方式选择、手术范围个体化确定及术后综合治疗（包括促甲状腺素抑制治疗、碘-131治疗及靶向治疗等）等多个维度进行系统阐述，旨在为甲状腺癌规范化、精准化诊疗的临床实践提供参考。

Abstract:

Thyroid cancer is the most common malignancy of the endocrine system, with a continuously rising incidence worldwide. Over the past decade, the implementation of standardized and homogeneous diagnostic and therapeutic strategies in China has led to a remarkable improvement in the 5-year survival rate of thyroid cancer patients, increasing from 67.5% in 2003 to 92.9% in 2021. Nevertheless, thyroid cancer is characterized by significant biological heterogeneity, with substantial variability in clinical presentation, disease progression, therapeutic response, and prognosis among different individuals. Consequently, the traditional treatment paradigm can no longer meet the demands of modern clinical practice. At present, the management of thyroid cancer is gradually shifting toward an individualized and precision medicine-based approach driven by molecular profiling and risk stratification. This review systematically summarizes the current status of precision diagnosis and treatment of thyroid cancer from multiple perspectives, including preoperative accurate diagnosis, risk stratification, selection of treatment modalities, individualized determination of surgical extent, and postoperative comprehensive management (such as thyroid-stimulating hormone suppression therapy, radioactive iodine therapy, and targeted therapy), aiming to provide a reference for clinical precision management of thyroid cancer.