Papillary thyroid cancer (PTC), the most common thyroid malignancy, is associated with an excellent prognosis. Overall survival is more than 90%. The first-line treatment is surgical excision, and although the debate continues as to whether a total thyroidectomy or thyroid lobectomy should be recommended, most patients at the University of California, San Francisco are treated with a total thyroidectomy. Not only has this been shown to be superior for overall survival in select patient populations, but local recurrence is also significantly lower with this approach. Total thyroidectomy also optimizes the adjuvant treatment options that are unique to "differentiated" thyroid cancer because these malignant cells retain many of the features of the native thyroid follicular cell. These cellular features are used for specialized investigations and treatment options in patients with PTC. For example, PTC cells retain the ability to produce thyroglobulin, to be stimulated by thyroid-stimulating hormone (TSH), and to take up iodine. These features are vital and separate differentiated thyroid cancer from other epithelial malignancies because such features can be used in clinical follow-up (monitoring serum thyroglobulin levels, whole body radioactive iodine scans) and in the treatment of patients with PTC (TSH suppression, radioactive iodine ablation of thyroid remnant, local recurrences, and regional or distant metastases). In summary, the wide array of treatment options for patients with PTC includes surgery, radioactive iodine, thyroid hormone suppression of TSH, external beam radiation (less commonly), and rarely, chemotherapy. This continues to be an area of exciting research for emerging therapy, much of which concentrates on enhancing or re-establishing the differentiated features of the thyroid cancer cell, in an effort to optimize the adjuvant treatment options. The treatment options that are chosen depend on patient factors, disease factors, and the decisions of the patient and treatment team.

译文

甲状腺乳头状癌 (PTC) 是最常见的甲状腺恶性肿瘤,预后良好。总生存率超过90%。一线治疗是手术切除,尽管关于是否应推荐全甲状腺切除术或甲状腺叶切除术的争论仍在继续,但加利福尼亚大学旧金山分校的大多数患者都接受了全甲状腺切除术。这不仅被证明在选定的患者人群中优于总体生存率,而且这种方法的局部复发率也明显降低。全甲状腺切除术还优化了 “分化” 甲状腺癌独有的辅助治疗方案,因为这些恶性细胞保留了天然甲状腺滤泡细胞的许多特征。这些细胞特征用于PTC患者的专门研究和治疗选择。例如,PTC细胞保留产生甲状腺球蛋白,受促甲状腺激素 (TSH) 刺激以及摄取碘的能力。这些特征是重要的,并且与其他上皮恶性肿瘤分开分化的甲状腺癌,因为这些特征可用于临床随访 (监测血清甲状腺球蛋白水平,全身放射性碘扫描) 和PTC患者的治疗 (TSH抑制,放射性碘消融甲状腺残余,局部复发,和区域或远处转移)。总之,PTC患者的多种治疗选择包括手术,放射性碘,TSH的甲状腺激素抑制,外束辐射 (较少见) 以及很少的化学疗法。这仍然是新兴疗法令人兴奋的研究领域,其中大部分集中于增强或重建甲状腺癌细胞的分化特征,以努力优化辅助治疗方案。选择的治疗方案取决于患者因素,疾病因素以及患者和治疗团队的决定。

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