Current practice in intermediate risk differentiated thyroid cancer - a review.

IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Reviews in Endocrine & Metabolic Disorders Pub Date : 2024-02-01 Epub Date: 2023-11-23 DOI:10.1007/s11154-023-09852-y
Rosalia do Prado Padovani, Fernanda Barbosa Duarte, Camila Nascimento
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Abstract

Although the overall prognosis for differentiated thyroid cancer (DTC) is excellent, a subset of patients will experience disease recurrence or may not respond to standard treatments. In recent years, DTC management has become more personalized in order to enhance treatment efficacy and avoid unnecessary interventions.In this context, major guidelines recommend post-surgery staging to assess the risk of disease persistence, recurrence, and mortality. Consequently, risk stratification becomes pivotal in determining the necessity of postoperative adjuvant therapy, which may include radioiodine therapy (RIT), the degree of TSH suppression, additional imaging studies, and the frequency of follow-up.However, the intermediate risk of recurrence is a highly heterogeneous category that encompasses various risk criteria, often combined, resulting in varying degrees of aggressiveness and a recurrence risk ranging from 5 to 20%. Furthermore, there is not enough long-term prognosis data for these patients. Unlike low- and high-risk DTC, the available literature is contradictory, and there is no consensus regarding adjuvant therapy.We aim to provide an overview of intermediate-risk differentiated thyroid cancer, focusing on criteria to consider when deciding on adjuvant therapy in the current context of personalized approach, including molecular analysis to enhance the accuracy of patient management.

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中危分化型甲状腺癌的治疗现状综述。
虽然分化型甲状腺癌(DTC)的总体预后很好,但一部分患者会经历疾病复发或可能对标准治疗无效。近年来,为了提高治疗效果,避免不必要的干预,DTC的管理越来越个性化。在这种情况下,主要的指南推荐手术后分期来评估疾病持续、复发和死亡的风险。因此,风险分层在确定术后辅助治疗的必要性时至关重要,辅助治疗可能包括放射性碘治疗(RIT)、TSH抑制程度、额外的影像学检查和随访频率。然而,复发的中度风险是一个高度异质性的类别,包括各种风险标准,通常合并,导致不同程度的侵袭性和复发风险从5%到20%不等。此外,这些患者的长期预后数据不足。与低风险和高风险的DTC不同,现有的文献是矛盾的,关于辅助治疗没有共识。我们的目标是提供一个中等风险分化甲状腺癌的概述,重点是在当前个性化方法的背景下决定辅助治疗时考虑的标准,包括分子分析以提高患者管理的准确性。
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来源期刊
Reviews in Endocrine & Metabolic Disorders
Reviews in Endocrine & Metabolic Disorders 医学-内分泌学与代谢
CiteScore
14.70
自引率
1.20%
发文量
75
审稿时长
>12 weeks
期刊介绍: Reviews in Endocrine and Metabolic Disorders is an international journal dedicated to the field of endocrinology and metabolism. It aims to provide the latest advancements in this rapidly advancing field to students, clinicians, and researchers. Unlike other journals, each quarterly issue of this review journal focuses on a specific topic and features ten to twelve articles written by world leaders in the field. These articles provide brief overviews of the latest developments, offering insights into both the basic aspects of the disease and its clinical implications. This format allows individuals in all areas of the field, including students, academic clinicians, and practicing clinicians, to understand the disease process and apply their knowledge to their specific areas of interest. The journal also includes selected readings and other essential references to encourage further in-depth exploration of specific topics.
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