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甲状腺癌骨转移的诊治现状及展望
Current status and prospect of diagnosis and treatment of bone metastasis of thyroid cancer
- 中国癌症杂志 2025年35卷第1期 页码：12-20
- 作者机构：
中国医学科学院北京协和医学院北京协和医院核医学科，疑难重症及罕见病国家重点实验室，核医学分子靶向诊疗北京市重点实验室，北京 100730
- 作者简介：
[ "赵翊含（ORCID: 0000-0001-1439-4243），博士，住院医师。" ]
[ "林岩松，中国医学科学院北京协和医学院北京协和医院主任医师、教授、博士后导师。中国医疗保健国际交流促进会甲状腺疾病专业委会主任委员，中国临床肿瘤协会核医学专家委员会主任委员，中华医学会核医学分会治疗学组专家指导委员会主任委员，北京医学会核医学分会治疗学组组长，国家癌症中心甲状腺癌质控专家委员会副主任委员，中国抗癌协会甲状腺癌专业委员会常委。近10年来以第一作者或通信作者在相关领域核心期刊及SCI收录期刊上发表文章121篇。" ]
- 基金信息：
DOI：10.19401/j.cnki.1007-3639.2025.01.002
中图分类号： R736.1收稿：2024-12-13，
修回：2025-01-21，
纸质出版：2025-01-30
- 稿件说明：
移动端阅览
赵翊含, 李若尘, 林岩松. 甲状腺癌骨转移的诊治现状及展望[J]. 中国癌症杂志, 2025,35(1):12-20.
Yihan ZHAO, Ruochen LI, Yansong LIN. Current status and prospect of diagnosis and treatment of bone metastasis of thyroid cancer[J]. China Oncology, 2025, 35(1): 12-20.
赵翊含, 李若尘, 林岩松. 甲状腺癌骨转移的诊治现状及展望[J]. 中国癌症杂志, 2025,35(1):12-20. DOI： 10.19401/j.cnki.1007-3639.2025.01.002.
Yihan ZHAO, Ruochen LI, Yansong LIN. Current status and prospect of diagnosis and treatment of bone metastasis of thyroid cancer[J]. China Oncology, 2025, 35(1): 12-20. DOI： 10.19401/j.cnki.1007-3639.2025.01.002.
摘要
对于占比90%以上、预后良好的分化型甲状腺癌（differentiated thyroid cancer，DTC），骨转移不仅是威胁患者生存质量的主要原因，也是现阶段临床诊疗领域亟待解决的难题。目前，国内外现有临床指南尚未能提供针对甲状腺癌骨转移的综合管理建议和精准诊疗策略，推动系统化与个性化诊疗方案的实施势在必行。因此，了解流行病学特征、明确发病机制、掌握常用诊断技术、探究最新治疗进展和评估疗效对于甲状腺癌骨转移的管理至关重要。在发病机制中，甲状腺癌骨转移多为溶骨性，通过释放多种细胞因子调控骨微环境与癌细胞间的相互作用，从而形成骨转移的恶性循环。DTC骨转移的早期识别对改善患者预后至关重要，其诊断可基于临床表现（如骨痛、病理性骨折、脊髓压迫和高钙血症等）、实验室检查（如红细胞和血小板计数、血清钙/磷和骨转换标志物等）及影像学检查[如X线、计算机体层成像（computed tomography，CT）、磁共振成像（magnetic resonance imaging，MRI）、单光子发射计算机断层成像（single photon emission computed tomography，SPECT）/CT和正电子发射计算机体层成像（positron emission tomography，PET）/CT等
]
结果。针对DTC骨转移的治疗涉及多种方式，如通过外科手术、放射介入治疗及外照射放射治疗处理局部病灶，或采用放射性核素（
131
I、
89
Sr和
153
Sm）、酪氨酸激酶抑制剂（仑伐替尼、索拉非尼等）或骨靶向药物（包括唑来膦酸、地舒单抗和
99
TC-亚甲基二膦酸盐）控制全身骨转移病灶的发展。DTC骨转移治疗后应进行疗效评估，以指导后续治疗决策及预测预后。目前多学科协作的诊疗模式日趋成熟，骨转移性DTC的诊治应纳入外科、核医学科、放射介入科、外放射治疗科、肿瘤内科及临床检验科等，以确保对患者疾病情况的全面评估，客观地制订个体化治疗方案，达到预防疾病进展和缓解症状的目的。本文主要针对骨转移的流行病学现状、发生机制、诊断方法、治疗策略及疗效评估进行综述，以期理清甲状腺癌骨转移的诊疗思路，协助临床管理，为临床医师提供有益的参考和借鉴，面对骨转移性DTC患者时能迅速地做出准确诊断和精准的治疗决策。
Abstract
For differentiated thyroid cancer (DTC)
which accounts for over 90% of cases and usually has a good prognosis
bone metastasis is not only the main threat to patients’ survival and quality of life
but also a difficult problem that needs to be solved urgently in clinical diagnosis and treatment at this stage. Currently
existing clinical guidelines at home and abroad have not yet provided comprehensive management recommendations and precise diagnostic and treatment strategies for bone metastasis in thyroid cancer
making it imperative to promote the implementation of systematic and personalized diagnostic and treatment plans. Therefore
understanding epidemiological characteristics
clarifying the pathogenesis
mastering commonly used diagnostic
techniques
exploring the latest treatment progress and evaluating treatment efficacy are crucial for the management of bone metastasis in thyroid cancer. In terms of pathogenesis
bone metastasis in thyroid cancer is mostly osteolytic
regulating the interaction between the bone microenvironment and cancer cells through the release of various cytokines
thus forming a vicious cycle of bone metastasis. Early identification of bone metastasis in DTC is crucial for improving patient prognosis. Its diagnosis can be based on clinical manifestations (such as bone pain
pathological fractures
spinal cord compression and hypercalcemia)
laboratory tests (such as red blood cell and platelet counts
serum calcium/phosphorus and bone turnover markers)
and imaging examination results [such as X-ray
computed tomography (CT)
magnetic resonance imaging (MRI)
single photon emission computed tomography (SPECT)/CT
and positron emission tomography (PET)/CT
]
. The treatment of DTC bone metastasis involves multiple modalities
such as surgical treatment
interventional radiological treatment and external beam radiation therapy for local lesions
or the use of radionuclides (
131
I
89
Sr and
153
Sm)
tyrosine kinase inhibitors (lenvatinib
sorafenib
etc.)
or bone-targeting agents (including zoledronic acid
denosumab and
99
Tc-methylene diphosphonate) to control the development of systemic bone metastasis. After the treatment of DTC bone metastasis
an efficacy evaluation should be conducted to guide subsequent treatment decisions and predict prognosis. With the increasingly mature multidisciplinary collaborative diagnosis and treatment model today
the diagnosis and treatment of bone metastatic DTC should include surgery
nuclear medicine
radiation and interventional therapy
external beam radiation therapy
medical oncology and clinical laboratory testing to ensure a comprehensive assessment of the patient’s condition
make objective decisions on individualized treatment plans
and ac
hieve the goal of preventing disease progression and alleviating symptoms. This article mainly reviewed the epidemiology
pathogenesis
diagnostic methods
treatment strategies and efficacy evaluation of bone metastasis
aiming to clarify the diagnostic and treatment thinking of bone metastasis in thyroid cancer
assist in clinical management
and provide useful references for clinicians to make rapid and accurate diagnosis and precise treatment decisions when facing patients with bone metastatic DTC.
关键词
Keywords
references
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