晚期分化型甲状腺癌系统治疗的10年演进：2015与2025年版ATA指南对比分析

杨舒雯; 季冬梅; 王宇

doi:10.19401/j.cnki.1007-3639.2025.10.005

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晚期分化型甲状腺癌系统治疗的10年演进：2015与2025年版ATA指南对比分析

专家述评 | 更新时间：2025-12-31

- 晚期分化型甲状腺癌系统治疗的10年演进：2015与2025年版ATA指南对比分析
- The ten-year evolution of systemic therapy for advanced differentiated thyroid cancer: a comparison between the 2015 and 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer
- 中国癌症杂志 2025年35卷第10期页码：935-940
- 作者机构：
  
  1. 复旦大学附属肿瘤医院头颈外科，复旦大学上海医学院肿瘤学系，上海 200032
  2. 复旦大学附属肿瘤医院肿瘤内科，复旦大学上海医学院肿瘤学系，上海 200032
- 作者简介：
  
  [ "杨舒雯（ORCID: 0000-0001-6712-2879），主治医师。" ]
  [ "王宇，主任医师，教授，博士研究生导师，复旦大学附属肿瘤医院头颈外科主任。担任国家癌症中心国家肿瘤质控中心甲状腺癌质控专家委员会委员及国家肿瘤头颈肿瘤外科质控中心质控专家委员会委员，中国抗癌协会甲状腺肿瘤专业委员会、甲状腺肿瘤整合康复专业委员会、整合肿瘤相关结节专业委员会副主任委员及头颈肿瘤专业委员会常务委员，中国医药教育协会头颈肿瘤专业委员会副主任委员，中国医疗保健国际交流促进会普通外科学分会、甲状腺疾病学分会副主任委员，中国残疾人康复协会无喉者康复专业委员会副主任委员、中国健康管理协会甲状腺健康管理分会副会长，上海市抗癌协会头颈肿瘤专业委员会候任主任委员等。主持或参与30余项国家级、省部级科研项目及国际合作项目等。以第一作者及通信作者发表论文60余篇。" ]
- 基金信息：
  
  国家自然科学基金(82473361);中华人民共和国科学技术部四大慢病重大专项(2024ZD0525600)
- DOI：10.19401/j.cnki.1007-3639.2025.10.005
  中图分类号： R736.1
- 收稿：2025-10-14，
  
  修回：2025-10-20，
  
  纸质出版：2025-10-30
- 稿件说明：
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杨舒雯, 季冬梅, 王宇. 晚期分化型甲状腺癌系统治疗的10年演进：2015与2025年版ATA指南对比分析[J]. 中国癌症杂志, 2025,35(10):935-940.

Shuwen YANG, Dongmei JI, Yu WANG. The ten-year evolution of systemic therapy for advanced differentiated thyroid cancer: a comparison between the 2015 and 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer[J]. China Oncology, 2025, 35(10): 935-940.
杨舒雯, 季冬梅, 王宇. 晚期分化型甲状腺癌系统治疗的10年演进：2015与2025年版ATA指南对比分析[J]. 中国癌症杂志, 2025,35(10):935-940. DOI： 10.19401/j.cnki.1007-3639.2025.10.005.

Shuwen YANG, Dongmei JI, Yu WANG. The ten-year evolution of systemic therapy for advanced differentiated thyroid cancer: a comparison between the 2015 and 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer[J]. China Oncology, 2025, 35(10): 935-940. DOI： 10.19401/j.cnki.1007-3639.2025.10.005.

摘要

分化型甲状腺癌（differentiated thyroid carcinoma，DTC）患者总体预后良好，大部分DTC患者经手术联合放射性碘（radioactive iodine，RAI）治疗可获得良好预后，10年生存率超过90%。然而，5%~10%的患者在诊疗过程中出现局部无法切除或远处转移，甚至逐渐发展为放射性碘难治性（radioiodine-refractory，RAIR）状态。对于这类晚期且不可手术的患者，传统治疗手段难以控制疾病进展，系统性药物治疗成为主要选择。10年来，分子靶向治疗与免疫治疗的进展显著改变了晚期DTC的治疗格局。2025年美国甲状腺学会（American Thyroid Association，ATA）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》（简称2025年版ATA指南）提出以分子分型为核心的精准治疗模式，本文对比2015与2025年版ATA指南在晚期DTC系统治疗中的主要差异，结合关键临床试验和真实世界数据，分析10年来治疗策略的演进并对未来的治疗进行展望。

Abstract

Differentiated thyroid carcinoma (DTC) generally has a favorable prognosis. Most patients with DTC achieve good outcomes with surgery combined with radioactive iodine (RAI) therapy

with a 10-year survival rate exceeding 90%. However

about 5%-10% of patients develop unresectable local disease or distant metastases during the course of treatment

and may even gradually progress to a radioiodine-refractory (RAIR) state. For these advanced and inoperable patients

traditional treatments are difficult to control disease progression

making systemic drug therapy the mainstay of treatment. Over the past decade

significant advances in molecular targeted therapy and immunotherapy have transformed the landscape of advanced DTC. The2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer (abbreviation ATA guideline) propose a precision treatment model centered on molecular subtyping. This article compares the main differences in systemic therapy for advanced DTC between the 2015 and 2025 ATA guidelines

and

by integrating key clinical trials and real-world data

analyzes the evolution of treatment strategies over the past ten years and future directions.

关键词

Keywords

references

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