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摘要
近年来，随着分子生物学、影像学及循证医学证据的不断积累，甲状腺癌的诊疗模式正经历系统性重塑。分化型甲状腺癌（differentiated thyroid carcinoma，DTC）整体预后良好，但在不同风险人群中呈现出显著的生物学与临床异质性；与此同时，低分化甲状腺癌（poorly differentiated thyroid carcinoma，PDTC）和未分化甲状腺癌（anaplastic thyroid carcinoma，ATC）仍以高度侵袭性、进展迅速和治疗选择有限为特征，构成甲状腺癌相关死亡的主要来源。如何基于肿瘤生物学特征与疾病演进阶段，实现精准分层管理与治疗策略优化，已成为当前领域关注的核心问题。
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2025 年，循证医学证据的积累与技术革新共同推动了这一领域的系统性重塑。一方面，临床诊疗指南持续更新，以风险分层和动态评估为核心，推动早期 DTC 向个体化和长期生存质量导向的管理模式转型；另一方面，人工智能（artificial intelligence
AI）辅助诊断、新型分子显像技术及多组学分析的快速发展，正在重塑甲状腺癌的诊断路径与风险评估体系。对于晚期及放射性碘难治性（radioiodine-refractory
RAIR）患者，分子靶向治疗、免疫治疗及再分化策略不断拓展治疗边界，而以嵌合抗原受体T(chimeric antigen receptor T
CAR-T)等细胞治疗为代表的创新疗法也开始进入临床探索阶段。与此同时，基础研究的研究范式正在发生转变：研究焦点从单一驱动突变逐步拓展至肿瘤代谢重塑、表观遗传调控及肿瘤微环境（tumor microenvironment
TME）的系统互作。多组学整合与空间转录组技术揭示，ATC的高度侵袭性并非仅由肿瘤细胞内在异常决定，而是依赖于免疫抑制性微环境、代谢重编程及细胞间信号网络的协同塑造，为联合治疗和微环境靶向干预提供了新的理论基础。基于上述背景，本文将系统梳理 2025 年甲状腺癌领域在临床诊疗指南更新、诊断技术革新、系统治疗策略演进及基础研究机制突破等方面的关键进展，旨在为临床实践与未来研究方向提供综合性的参考框架。
Abstract
In recent years
the continuous accumulation of evidence from molecular biology
medical imaging
and evidence-based medicine has driven a systematic reshaping of diagnostic and therapeutic paradigms for thyroid cancer. Differentiated thyroid carcinoma (DTC) is generally associated with a favorable prognosis; however
marked biological and clinical heterogeneity exists across different risk populations. In contrast
poorly differentiated thyroid carcinoma (PDTC) and anaplastic thyroid carcinoma (ATC) remain characterized by high aggressiveness
rapid progression
and limited therapeutic options
accounting for the majority of thyroid cancer–related mortality. How to achieve precise risk stratification and optimize therapeutic strategies based on tumor biology and disease stage has therefore emerged as a central challenge in the field.
Entering 2025
the integration of expanding evidence-based data and technological innovation has further accelerated this paradigm shift. On the one hand
continuous updates to clinical practice guidelines—centered on risk stratification and dynamic assessment—have promoted a transition in early-stage DTC management toward individualized care and long-term quality-of-life–oriented strategies. On the other hand
advances in artificial intelligence (AI)–assisted diagnostics
novel molecular imaging techniques
and multi-omics analyses are redefining diagnostic pathways and risk assessment frameworks for thyroid cancer. For patients with advanced disease and radioiodine-refractory (RAIR) thyroid cancer
the therapeutic landscape continues to expand with the development of molecular targeted therapies
immunotherapy
and redifferentiation strategies. In parallel
innovative approaches such as cell-based therapies
exemplified by chimeric antigen receptor T (CAR-T) cell therapy
have begun to enter early-phase clinical exploration.
Meanwhile
fundamental research paradigms are undergoing a notable shift. Research focus is moving beyond single driver mutations toward a systems-level understanding encompassing tumor metabolic reprogramming
epigenetic regulation
and complex interactions within the tumor microenvironment (TME). Integrative multi-omics and spatial transcriptomic analyses have revealed that the extreme aggressiveness of ATC is not solely determined by tumor cell–intrinsic abnormalities
but rather arises from the coordinated influence of immunosuppressive microenvironments
metabolic remodeling
and intercellular signaling networks. These insights provide a theoretical foundation for combination therapies and microenvironment-targeted interventions.
Against this background
this review systematically summarizes the key advances in thyroid cancer research in 2025
including updates to clinical practice guidelines
innovations in diagnostic technologies
evolution of systemic treatment strategies
and breakthroughs in mechanistic studies
with the aim of providing a comprehensive reference framework for clinical practice and future research directions.
关键词
Keywords
references
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