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甲状腺癌是内分泌系统最常见的恶性肿瘤,占所有恶性肿瘤的1.1%[1]。DTC约占所有类型甲状腺癌的90%,其中以甲状腺乳头状癌(papillary thyroid cancer,PTC)最为多见,约占80%,甲状腺滤泡癌(follicular thyroid carcinoma,FTC)约占10%[2]。PTC较易发生颈部淋巴结转移,预后较好;而FTC预后仅次于PTC;但也有部分DTC患者会发生肺、骨、脑等远处转移或失分化,预后较差。近年来,随着对甲状腺癌的研究深入到基因层面,许多基因如V-raf鼠类肉瘤滤过性病毒致癌基因同源体B1(V-raf murine sarcoma viral oncogene homolog B1,BRAF)、端粒酶逆转录酶(telomerase reverse transcriptase,TERT)、大鼠肉瘤(rat sarcoma,RAS)、受体酪氨酸激酶(receptor tyrosine kinase,RET)/PTC、配对盒基因8抗原(paired box 8,PAX8)/过氧化物酶体增殖物激活受体γ(peroxisome proliferator-activated receptor γ,PPARγ)等被发现与甲状腺癌的发生、发展以及预后有着密切的关系,在甲状腺癌的诊断、治疗以及预后评估等方面起着重要作用[3]。我们对在DTC病程中发挥重要作用的一些基因进行综述。
分化型甲状腺癌相关基因的研究进展
Research progress of genes related to differentiated thyroid carcinoma
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摘要: 近年来,随着高分辨率超声和甲状腺细针抽吸细胞学检查技术的应用,甲状腺癌的检出率逐渐升高。虽然分化型甲状腺癌(DTC)患者多数预后较好,但也有部分患者易发生颈部淋巴结转移或肺、骨、脑等远处转移,甚至出现病灶的失分化,从而导致预后不良。目前,国内外许多研究结果表明,基因突变在DTC的发生、发展以及预后等方面发挥着重要的作用,且相关基因的抑制剂可以为一些病灶失分化的患者带来新希望,对临床医师的决策具有重大指导意义。笔者对目前DTC中常见的基因突变的机制及其临床意义进行综述。
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关键词:
- 甲状腺肿瘤 /
- 分化型甲状腺癌 /
- 原癌基因蛋白质B-raf /
- 末端转移酶端粒 /
- 原癌基因蛋白质c-ret
Abstract: Over the recent years, the detection rate of thyroid cancer gradually increases due to the application of high resolution ultrasound and fine-needle aspiration cytology. Although most of the patients with differentiated thyroid cancer (DTC) have sound prognosis, some patients easily develop cervical lymph node metastasis or distant metastasis to lung, bone and brain. In worse cases, dedifferentiation of lesions will occur, leading to poor prognosis. At present, many studies at home and abroad have shown that gene mutation plays an important role in DTC occurring and developing process, as well as in its prognosis. Inhibitors of relevant genes are regarded as a new hope to patients with dedifferentiation of focus, and they are of great significance to the guidance of clinician’s decision. The mechanism and clinical significance of common gene mutations in DTC are reviewed in this paper. -
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