Current status and prospect of diagnosis and treatment of bone metastasis of thyroid cancer

Yihan ZHAO; Ruochen LI; Yansong LIN

doi:10.19401/j.cnki.1007-3639.2025.01.002

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Current status and prospect of diagnosis and treatment of bone metastasis of thyroid cancer

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

- Current status and prospect of diagnosis and treatment of bone metastasis of thyroid cancer
- China Oncology Vol. 35, Issue 1, Pages: 12-20(2025)
- 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：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2025.01.002
  CLC： R736.1
- Received：13 December 2024，
  
  Revised：2025-01-21，
  
  Published：30 January 2025
- 稿件说明：
移动端阅览
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：

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、

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

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

Sr and

153

Sm)

tyrosine kinase inhibitors (lenvatinib

sorafenib

etc.)

or bone-targeting agents (including zoledronic acid

denosumab and

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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