来源：Endocrine 2020 Mar 08。

题目：

Locally unresectable differentiated thyroid cancer: outcomes and perspectives.

局部不可切除的分化型甲状腺癌:结局与展望。

目的：

Differentiated thyroid cancer (DTC) patients with an unresectable primary tumor cannot benefit from curative surgery, and radioiodine treatment for locoregional and distant disease is not possible with the thyroid gland still in place. Due to local invasion, these patients cannot be included in clinical trials, so that treatment options are limited. The aim of this study was to describe the characteristics and the prognosis of patients with these locally unresectable DTC.

分化型甲状腺癌的治疗模式为：手术、碘131治疗和TSH抑制治疗。对于局部肿瘤无法切除干净的情况下，因为有残留甲状腺这类患者，就不能采取碘131治疗。由于局部侵袭，这些患者不能纳入临床试验，因此治疗选择有限。本研究的目的是描述这些局部不可切除的DTC的特征和预后。

资料和方法:

A retrospective and multicentric analysis of consecutive cases of unresectable DTC diagnosed between 2000 and 2015 was performed.

对2000年至2015年连续确诊的不能切除的分化型甲癌病例进行回顾性多中心分析。

研究结果

The study population consisted in 22 patients, 13 females (59%); median age: 77 years (range: 52-91).Thyroid tumors were papillary in six, follicular in seven, Hürthle cell in one and poorly differentiated in eight patients. Patients were treated with external beam radiation therapy (EBRT) (57%), locoregional therapy of distant metastases (41%), cytotoxic chemotherapy (38%) and tyrosine kinase inhibitors (TKIs) (33%). TKI treatment resulted in median disease control duration of 7 months with a grade 3-4 toxicity rate of 44%. Only one patient had a total thyroidectomy after neo-adjuvant EBRT. The 1, 3 and 5-year cumulative survival rate was 81%, 27.7% and 21.5%, respectively. The cause of death was DTC in 11 cases (local progression in 7), and to other causes in 7 cases; no patient died from treatment toxicity.

研究人群包括22名患者,13个女性(59%);中位年龄:77岁(范围:52-91)。甲状腺肿瘤6例为乳头状癌，7例为滤泡性癌，1例为Hurthle细胞，8例未分化型甲状腺癌。患者接受外照射治疗(EBRT)(57%)，局部转移治疗(41%)，细胞毒性化疗(38%)和酪氨酸激酶抑制剂(TKIs)(33%)。 酪氨酸激酶抑制剂治疗的中位疾病控制时间为7个月，3-4级的毒性率为44%。仅有1例患者在新辅助外照射治疗治疗后行甲状腺全切除术。1年、3年和5年累计生存率分别为81%、27.7%和21.5%。11例死亡原因为DTC(7例为局部进展)，7例为其他原因;没有病人死于治疗毒性。

研究结论：

Clinical trials and approved treatments are lacking for unresectable DTC. TKI treatment may allow prolonged disease control with acceptable toxicity.

无法切除的分化型甲癌缺乏临床试验和正规的治疗。酪氨酸激酶抑制剂治疗可延长疾病控制时间，且治疗的毒副作用在可接受范围内。