儿童及青少年分化型甲状腺癌核医学诊治中国专家共识（2022年版）

doi:10.19401/j.cnki.1007-3639.2022.05.011

摘要/Abstract

摘要：

儿童及青少年分化型甲状腺癌（differentiated thyroid carcinoma in children and adolescents,caDTC）与成人存在较大差异,用于指导成人甲状腺癌的指南及治疗策略不完全适用于儿童及青少年。因此,来自核医学科、甲状腺外科、内分泌科、超声科、病理科及分子生物等甲状腺领域的专家组成编委会共同参与针对儿童及青少年人群的分化型甲状腺癌诊治共识的编撰。本共识的制定基于实用性、本土性及治疗手段可及性的原则,内容包括caDTC的流行病学、检查手段、治疗策略（手术、放射性碘、靶向及内分泌治疗）及随访等,基本涵盖caDTC的常见临床管理。

关键词: 儿童及青少年, 分化型甲状腺癌, 核医学, 诊治, 共识

Abstract:

Differentiated thyroid cancer in children and adolescents (caDTC) is different from adult DTC, and the DTC guidelines for adult are not fully applicable to children and adolescent patients. Therefore, experts from nuclear medicine, thyroid surgery, endocrinology, ultrasound, pathology and molecular biology formed the thyroid editorial committee to participate in the compilation of consensus on magagement of caDTC. Based on the principles of practicality, locality and treatment accessibility, this expert consensus is composed of the epidemiology, examinations, treatment strategies (surgery, radioactive iodine, targeted therapy and endocrinotherapy) and follow-up. It basically covers the clinical management of caDTC.

Key words: Children and adolescents, Differentiated thyroid carcinoma, Nuclear medicine, Management, Consensus

中图分类号:

R736.1

中国临床肿瘤学会核医学专家委员会, 中国临床肿瘤学会甲状腺癌专家委员会, 中国医疗保健国际交流促进会甲状腺疾病专业委员会, 中国人口文化促进会甲状腺疾病防治专业委员会. 儿童及青少年分化型甲状腺癌核医学诊治中国专家共识（2022年版）[J]. 中国癌症杂志, 2022, 32(5): 451-468.

Expert Committee of Nuclear Medicine, Chinese society of Clinical Oncology, Expert Committee of Thyroid Cancer, Chinese society of Clinical Oncology, Committee of Thyroid Disease Society, China International Exchange and Promotive Association for Medical and Health Care, Committee of Thyroid Disease Prevention and Treatment Society, China Population Culture Promotion Association. Expert consensus on management of differentiated thyroid carcinoma in children and adolescents (2022 edition)[J]. China Oncology, 2022, 32(5): 451-468.

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复发风险分层	定义
低风险	病变局限于甲状腺（T₁~ T₃期）内,N₀ / N_X或N_1a期转移（淋巴结≤5个且最大径<0.2 cm）
中风险	广泛的N_1a期转移（>5个淋巴结或最大径≥0.2 cm）或小范围的N_1b期转移（侧颈淋巴结≤10个且最大径<3 cm）
高风险	广泛的N_1b期转移（侧颈淋巴结>10个或最大径≥3 cm）或局部侵袭性病灶（T₄期）伴或不伴远处转移

疗效评估	血清学（生化）疗效	影像学疗效-RECIST
完全缓解	抑制性Tg<0.2 ng/mL或s-Tg<1.0 ng/mL且TgAb阴性	阴性
部分缓解	ΔTg%a≥25%	病灶直径总和减少至少30%
疾病稳定	-25%≤ΔTg%^a<25%	病灶变化介于部分缓解与疾病进展之间
疾病进展	ΔTg%^a<-25%或TgAb水平持续增高	病灶增大20%以上或出现新发病灶

病灶摄碘情况	临床情形
病灶不摄碘	① 首次碘-131治疗剂量全身显像中甲状腺床外无摄碘灶
	② 诊断剂量碘-131全身显像见其他影像检查证实的病灶不摄碘
	③ 原本摄碘的功能性转移灶在碘-131治疗后逐渐丧失摄碘能力
	④ 同一患者部分转移灶摄碘,而部分转移灶不摄碘
病灶摄碘	⑤ 病灶虽然保持摄碘能力但仍出现病情进展
	⑥ 累积治疗剂量>22.2 GBq（600 mCi）但仍缓解不佳

组织学分型	作用靶点	药物（获批/临床试验）
RAIR-DTC	非特异性多靶点激酶抑制剂,主要针对VEGFR、FGFR、RET、PDGFR等	索拉非尼（获批）,安罗替尼（获批）,仑伐替尼（获批）,凡德他尼（NCT01876784）,卡博替尼（NCT03690388）,纳非尼（NCT02870569,NCT03602495）,阿帕替尼（NCT03199677,NCT03048877）,索凡替尼（NCT02614495）
RAIR-PTC	BRAF V600E突变	维罗非尼（NCT01286753）,达拉非尼联合曲美替尼（获批）
RAIR-PTC	RET突变和融合	普拉替尼（获批）,LOXO-292（NCT3157128,NCT03899792)
包括甲状腺癌在内的实体肿瘤	NTRK融合	拉罗替尼（NCT02637687,NCT02576431）
RAIR-PTC	ALK融合	克唑替尼（NCT02034981）,色瑞替尼（NCT02289144）,艾乐替尼（NCT03194893）

风险分层^a	临床意义	初始术后分期^b	TSH控制目标^c	术后监测^d
低风险	远处转移风险最低但颈部可能残存病灶,尤其是没有进行中央区清扫者	Tg^e	0.5~1.0 mU/L	超声：术后6个月复查,之后每年1次,持续5年;Tg^e：服用L-T4下每3~6个月检测1次,持续2年,之后每年1次
中风险	远处转移风险低但颈部淋巴结残留和颈部病变持续存在可能性较高	对大多数患者：TSH刺激下Tg^e检测及DxWBS（碘-123）	0.1~0.5 mU/L	超声：术后6个月复查,之后每6~12个月1次,持续5年,之后逐渐降低频率;Tg^e：服用L-T4下每3~6个月检测1次,持续3年,之后每年1次;碘-131治疗过的患者：1~2年检测TSH刺激下Tg^e水平伴/不伴DxWBS（碘-123）
高风险	颈部残存病灶和远处转移风险最高	对所有患者：TSH刺激下Tg^e检测及DxWBS（碘-123）	<0.1 mU/L	同中风险组