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ENGLISH ABSTRACT
甲状腺乳头状癌热消融治疗专家共识（2024版）
中国抗癌协会肿瘤消融治疗专业委员会
中国临床肿瘤学会（CSCO）肿瘤消融专家委员会
中国医师协会介入医师分会肿瘤消融专业委员会
白求恩精神研究会内分泌和糖尿病学分会介入内分泌专业委员会
作者及单位信息
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DOI： 10.3760/cma.j.cn112138-20231104-00296
Expert consensus on thermal ablation of papillary thyroid cancer (2024 edition)
Society of Tumor Ablation Therapy of the Chinese Anti-Cancer Association
the Ablation Expert Committee of the Chinese Society of Clinical Oncology (CSCO)
Chinese Medical Doctor Association College of Interventionalists Tumor Ablation Committee
Chinese Bethune Spirit Research Association Endocrinology and Diabetes Branch Interventional Endocrine Committee
Yu Mingan
Fan Weijun
Authors Info & Affiliations
Society of Tumor Ablation Therapy of the Chinese Anti-Cancer Association
the Ablation Expert Committee of the Chinese Society of Clinical Oncology (CSCO)
Chinese Medical Doctor Association College of Interventionalists Tumor Ablation Committee
Chinese Bethune Spirit Research Association Endocrinology and Diabetes Branch Interventional Endocrine Committee
Yu Mingan
Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing 100029, China
Fan Weijun
Department of Minimally Invasive Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
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DOI： 10.3760/cma.j.cn112138-20231104-00296
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摘要

超声引导下甲状腺乳头状癌热消融治疗已经在临床推广。热消融技术具有微创、安全、有效等优势，但是目前的指南或共识仅局限于低危甲状腺微小乳头状癌。随着临床广泛应用和科研数据的积累，越来越多的证据表明热消融可以治疗较大肿瘤，服务更多甲状腺乳头状癌患者。为了拓展甲状腺乳头状癌热消融治疗的适应证、规范技术细节和围手术期患者管理方案，由中国抗癌协会肿瘤消融治疗专业委员会、中国临床肿瘤学会（CSCO）肿瘤消融专家委员会、中国医师协会介入医师分会肿瘤消融专业委员会、白求恩精神研究会内分泌和糖尿病学分会介入内分泌专业委员会组织国内相关专家，结合目前甲状腺乳头状癌热消融治疗的最新研究进展，讨论制订了本甲状腺乳头状癌热消融治疗专家共识，以推动超声引导下甲状腺乳头状癌热消融治疗在临床的快速发展。

甲状腺乳头状癌;热消融;超声
ABSTRACT

Ultrasound-guided thermal ablation of papillary thyroid cancer (PTC) has been promoted in clinical practice over the past few years. Thermal ablation has the advantages of being minimally invasive, effective, and safe. However, current guidelines and consensus only focus on low-risk papillary thyroid microcarcinoma. With growing clinical application and accumulating scientific research in thermal ablation for PTC, there is considerable evidence to demonstrate that thermal ablation can treat larger PTC tumors and benefit more patients with PTC. To expand the indications and standardize the technical details and perioperative patient management for PTC ablation, experts from the Society of Tumor Ablation Therapy of the Chinese Anti-Cancer Association, the Ablation Expert Committee of the Chinese Society of Clinical Oncology (CSCO), Chinese Medical Doctor Association College of Interventionalists Tumor Ablation Committee, and Chinese Bethune Spirit Research Association Endocrinology and Diabetes Branch Interventional Endocrine Committee discussed and developed a consensus on thermal ablation of PTC based on the latest research results. This consensus aims to promote the rapid development of thermal ablation for PTC in the clinic.

Papillary thyroid cancer;Thermal ablation;Ultrasound
Yu Mingan, Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing 100029, China, Email: mocdef.3ab61103amy
Fan Weijun, Department of Minimally Invasive Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China, Email: mocdef.6ab214691nujiewnaf
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引用本文

中国抗癌协会肿瘤消融治疗专业委员会,中国临床肿瘤学会（CSCO）肿瘤消融专家委员会,中国医师协会介入医师分会肿瘤消融专业委员会,等. 甲状腺乳头状癌热消融治疗专家共识（2024版）[J]. 中华内科杂志,2024,63(04)：355-364.

DOI:10.3760/cma.j.cn112138-20231104-00296

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近几十年来，甲状腺乳头状癌（papillary thyroid cancer，PTC）的发病率逐年升高，在内分泌系统中占恶性肿瘤发病率首位 ［ 1 ］ 。随着体检的普及，PTC的检出率明显升高，其中大部分为微小乳头状癌，少数为T1b及T2期PTC，部分合并颈部淋巴结转移。PTC虽然是惰性肿瘤，但是少数侵袭性肿瘤会造成气管、神经、肌肉侵犯及淋巴结转移，增加治疗难度，影响患者生活质量和生存期。
手术切除是PTC的经典治疗方法，总体预后良好，文献报道术后肿瘤进展率2.0%~13.6% ［ 2 , 3 , 4 ］ ，5年生存率98.9%~100% ［ 2 , 3 , 4 , 5 , 6 ］ ，10年生存率94.3%~98.3% ［ 4 ， 6 , 7 ］ 。但是越来越多的患者顾虑术后甲状腺功能减低及终生激素替代治疗，因此少数国内外专家推荐对于低危组PTC患者随访观察而不进行治疗。但是随访观察会对患者造成心理压力，而且在观察过程中有肿瘤进展和淋巴结转移的风险。
近十余年来，PTC热消融治疗在临床逐渐应用。T1aN0M0 PTC热消融治疗的安全性和疗效已有大量研究报道 ［ 8 , 9 , 10 ］ ，T1bN0M0 PTC热消融的安全性和疗效也得到高质量研究的证实 ［ 11 , 12 ］ ，甚至T2N0M0 PTC热消融治疗的初步研究也已经发表 ［ 13 ］ 。研究表明，热消融PTC疗效不亚于手术切除，T1a期肿瘤进展率4.0%~5.0%（随访期5年） ［ 12 ， 14 ］ ，T1b期肿瘤进展率5.5%~6.8%（随访期5年） ［ 9 ， 12 ， 14 ］ 。而热消融的安全性则优于手术切除，术后主要并发症发生率低，喉返神经暂时性损伤发生率0~6.3% ［ 9 ， 12 ］ ，极少引起喉返神经永久性损伤和甲状旁腺功能减低 ［ 14 ］ ，术后不需要终生激素替代治疗，手术时间短，术后恢复快。研究表明，热消融术后患者的生活质量高于手术切除术后患者 ［ 15 ］ 。鉴于上述诸多优势，越来越多的患者愿意接受热消融治疗。越来越多的临床医生渴望从事PTC热消融工作。鉴于目前PTC热消融治疗技术不断发展，手术方式非同质化，且现有专家共识和指南内容明显滞后于最新研究结果，由中国抗癌协会肿瘤消融治疗专业委员会、中国临床肿瘤学会（CSCO）肿瘤消融专家委员会、中国医师协会介入医师分会肿瘤消融专业委员会、白求恩精神研究会内分泌和糖尿病学分会介入内分泌专业委员会组织国内相关领域专家，在大量临床实践和科研基础上，经过四轮讨论和评分后，制定了本临床专家共识。
本共识基于临床应用实际、临床研究证据及国内知名专家的经验与意见共计提出27条推荐，并根据专家意见及循证医学对其进行评级。其中采用改良德尔菲法 ［ 16 ］ 收集专家对共识中推荐的评分进一步形成推荐等级，推荐级别设定标准见 表1 。同时，结合甲状腺乳头状癌消融治疗当前研究的实际情况与传统循证医学证据等级的标准建立质量证据等级，其设定标准见 表2 。
推荐级别 改良德尔菲法评分
同意
强推荐 8~9
中等强度推荐 7~<8
弱推荐 6~<7
中立 5
反对 1~4
基于德尔菲法分析专家意见的推荐级别
证据级别 定义
高质量 严谨的Meta分析、大型随机对照临床研究、严谨的大型多中心研究
中等质量 一般质量的Meta分析、小型随机对照临床研究、一般质量的大型多中心研究、设计良好的大型回顾性研究、病例-对照研究
低质量 非对照的一般临床研究、病例报告、专家观点
基于现有研究与传统循证医学制定的证据级别
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备注信息
A
于明安，中日友好医院介入医学科，北京 100029，Email： mocdef.3ab61103amy
B
范卫君，中山大学肿瘤防治中心微创介入科，广州 510060，Email： mocdef.6ab214691nujiewnaf
C
中国抗癌协会肿瘤消融治疗专业委员会, 中国临床肿瘤学会（CSCO）肿瘤消融专家委员会, 中国医师协会介入医师分会肿瘤消融专业委员会, 等. 甲状腺乳头状癌热消融治疗专家共识（2024版）[J]. 中华内科杂志, 2024, 63(4): 355-364. DOI: 10.3760/cma.j.cn112138-20231104-00296.
D
所有作者声明无利益冲突
E
国家自然科学基金 (62176268)
中央高水平医院临床科研业务费 (2022-NHLHCRF-PY-07，2023-NHLHCRF-YYPP-TS-01)
北京市研究型病房示范建设项目 (2022-YJXBF-04-04)
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