Interpretation of the 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer: precision treatment guided by genotyping

Hao WANG; Jun LIANG

doi:10.19401/j.cnki.1007-3639.2025.09.003

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Interpretation of the 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer: precision treatment guided by genotyping

Specialist's Commentary | 更新时间：2025-12-31

- Interpretation of the 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer: precision treatment guided by genotyping
- China Oncology Vol. 35, Issue 9, Pages: 833-840(2025)
- 作者机构：
  
  1. 康复大学青岛医院（青岛市市立医院）本部肿瘤放射治疗科，山东青岛 266012
  2. 北京大学国际医院肿瘤中心，北京 102206
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2025.09.003
  CLC： R736.1
- Received：10 September 2025，
  
  Revised：2025-09-14，
  
  Published：30 September 2025
- 稿件说明：
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Hao WANG, Jun LIANG. Interpretation of the 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer: precision treatment guided by genotyping[J]. China Oncology, 2025, 35(9): 833-840.
DOI：

Hao WANG, Jun LIANG. Interpretation of the 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer: precision treatment guided by genotyping[J]. China Oncology, 2025, 35(9): 833-840. DOI： 10.19401/j.cnki.1007-3639.2025.09.003.

摘要

2025年美国甲状腺学会发布的《2025版美国甲状腺学会成人分化型甲状腺癌管理指南》，在基因分型方面做出了重大更新。本文以根据基因突变进行医疗决策为主线，系统解读了基因分型在确诊前鉴别诊断、确诊后家系分析、手术方式指导、术后复发风险评级、靶向治疗及免疫治疗中的作用及应用。指南更新了基因分型的规范化应用内容：① 病理学诊断方面，基因分型最早应用于病理学鉴别诊断，2025版ATA指南进一步明确了不同基因突变在不同病理学类型中的分布特征，协助病理科医师实现更精确分型，特别是对极低恶性潜能肿瘤的诊断，避免过度治疗。② 家系分析和遗传咨询方面，确诊后建议进行系统家系评估，2025版ATA指南建议根据临床证据严格分类并选择性进行胚系基因检测，根据分型执行相对应的遗传咨询策略。③ 手术和复发风险分层方面，2025版ATA指南进一步细化了基因分型在手术方式决策和复发风险分层中的辅助应用，继续强调基因分型是对传统危险度分层系统的补充。④ 靶向治疗方面，2025版ATA指南推荐治疗前进行基因分型，根据靶点精确指导靶向治疗。要求所有放射性碘难治性分化型甲状腺癌（differentiated thyroid cancer，DTC）患者在靶向治疗前均需进行基因检测，以突变类型为依据选择靶向药物；对使用靶点特异性药物后再次进展者，建议重新活检寻找可干预靶点；如无可治疗靶点，则推荐使用多激酶抑制剂。⑤ 免疫治疗方面，2025版ATA指南推荐治疗前进行基因检测，免疫治疗用于高肿瘤突变负荷（high tumor mutational burden，TMB-H）的放射性碘难治性DTC患者。本文对2025版ATA指南中基因分型在DTC临床管理中的应用要点进行了全面梳理和深入解读。

Abstract

The “2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer” introduce significant updates in genotyping. This article systematically interpreted the role and clinical applications of genotyping in pre-diagnostic differentiation

post-diagnostic familial analysis

surgical approach guidance

postoperative recurrence risk stratification

as well as targeted therapy and immunotherapy with a focus on mutation-based medical decision-making. Key updates on standardized genotyping applications include: ① In pathological diagnosis

genotyping was first applied in pathological differentiation. The 2025 ATA guidelines further clarify the distribution patterns of different genetic mutations across pathological subtypes

enabling more precise classification

particularly for tumors of very low malignant potential

to avoid overtreatment.② In familial analysis and genetic counseling

systematic familial evaluation is recommended post-diagnosis. The 2025 ATA guidelines propose strict clinical evidence-based categorization and selective germline genetic testing

with tailored genetic counseling strategies based on genotype. ③ In surgical approach and recurrence risk stratification

the 2025 ATA guidelines refine the auxiliary role of genotyping in surgical decision-making and recurrence risk stratification

reiterating that genotyping complements traditional risk stratification systems. ④ In targeted therapy

the 2025 ATA guidelines establish genotyping-guided precision therapy

mandating genetic testing for all radioiodine-refractory differentiated thyroid cancer (DTC) patients before targeted therapy to select mutation-specific agents. For patients progressing on target-specific drugs

re-biopsy is recommended to identify actionable targets. If no treatable target exists

multi-kinase inhibitors are advised. ⑤ In immunotherapy

pre-treatment genetic testing is recommended

with immunotherapy indicated for radioiodine-refractory DTC patients exhibiting high tumor mutational burden (TMB-H). This article provided a comprehensive review and in-depth analysis of the clinical applications of genotyping in DTC management as outlined in the 2025 ATA guidelines.

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references

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