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甲状腺髓样癌(medullary thyroid carcinoma,MTC)占所有甲状腺恶性肿瘤的5%~10%[1-2],分为散发型和遗传型两类[3-4],恶性程度介于乳头状癌和未分化癌之间,属于中等恶性肿瘤,其复发率和早期转移率较高,预后相对较差[5-6]。可触及肿瘤的MTC患者,81%存在颈部淋巴结转移,15%出现声音嘶哑或吞咽困难等局部神经浸润的症状,10%发生远处转移[7]。MTC在世界范围内的10年生存率为65%~70%[8],其与病灶是否发生转移直接相关,因此早期诊断及治疗是取得较好疗效的前提。
甲状腺髓样癌的诊治现状及研究进展
Recent advances in the diagnosis and treatment of medullary thyroid carcinoma
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摘要: 甲状腺髓样癌(MTC)是一种来源于甲状腺滤泡旁细胞的中度恶性肿瘤。目前常用的诊断方法包括降钙素及其他肿瘤标志物(如癌胚抗原)检测、超声、细针穿刺细胞学检查(FNAC)等,但这些方法的特异度均不高,且FNAC对技术的要求较高。MTC的治疗以及时根治性外科手术为主,对于手术难以切除的侵袭性、转移性及复发性病灶应选择综合治疗,但疗效不明确。目前降钙素原及新型分子靶向探针在MTC的诊治方面有了新的突破,但缺乏临床转化的支撑。因此,MTC的诊治目前依然是医学难题,笔者就MTC的诊治现状及研究进展作一综述。Abstract: Medullary thyroid carcinoma (MTC) is a type of neuroendocrine tumor that originates from calcitonin-producing parafollicular C cells of the thyroid. It is a moderate malignant thyroid carcinoma with a high recurrence rate and an early metastasis rate. The common diagnostic methods include detection of calcitonin, and tumor markers (such as carcinoembryonic antigen), ultrasound, fine needle aspiration cytology(FNAC), which have low specificity. And FNAC has high technical requirements. Radical surgery is currently the first choice of treatment of MTC. However, invasive and metastatic lesions are difficult to completely remove. Procalcitonin and novel molecular targeting probes provide new ideas for the early diagnosis and effective treatment of MTC. This review comprehensively discussed the recent advances in the diagnosis and treatment of this disease.
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Key words:
- Carcinoma, medullary /
- Thyroid neoplasms /
- Calcitonin /
- Diagnosis /
- Treatment
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