The Management of Differentiated Thyroid Carcinoma: Multidisciplinary Decisions

分化良好型甲狀腺癌之處置：跨科部評估

林曜祥(Yaoh-Shiang Lin) ； 俞志誠(Jyh-Cherng Yu) ； 謝宗保(Chung-Bao Hsieh) ； 劉耀基(Yao-Chi Liu) ； 洪乙仁(Yi-Zen Hung) ； 石光中(Kuang-Chung Shih) ； 諶鴻遠(Hueng-Yuan Shen) ； 鄭澄意(Cheng-Yi Cheng) ； 黃文盛(Wen-Sheng Huang)

《核子醫學雜誌》 18卷1期 (2005/03) Pp. 35-42

https://doi.org/10.6332/ANMS.1801.005

摘要

隨著健康檢查在一般民眾的普及以及民眾對自身健康的重視，加以診斷工具以及醫事人員專業的進步，在國外分化良好型甲狀腺癌的發生率雖有逐年增加趨勢，但由於病患可獲得早期診斷與適切治療，其癌症復發與死亡率長期以來仍趨穩定或有降低趨勢，在國內這方面則仍有待努力。由於分化良好型甲狀腺癌的獨特生物特性、病程以及多樣化治療方式，目前在臨床診療上仍有許多爭議之處，因此需要有一跨科部團隊對此一疾病的處置包括：初期手術、輔助治療、甲狀腺刺激素抑制，以及長期追蹤上等取得共識。在歐美有關分化良好型甲狀腺癌之指引已由不同醫學組織結合外科、內分泌科、腫瘤及核醫醫師，並在病理、生化、放射及特殊護理科部的支援下，對臨床爭議與疑慮提出解決方案，這些指引也協助病人更了解病況，獲致更好醫療照護與生活品質，進而增加存活率。由於目前對分化良好型甲狀腺癌之相關報告很多，結果亦不甚一致。本文即依上述指引以及可獲得此一疾病資料之發生率、復發、轉移情形、代表意義以及建議之診療計畫作部分綜整，提供卓參。

關鍵字

分化良好型甲狀腺癌 ； 跨科部評估 ； 指引

並列摘要

With the increase of physical screening and health awareness in the public, the incidence of well differentiated thyroid carcinoma (DTC) is increasing. However, owing to the early diagnosis and appropriate treatment, the recurrence and mortality rates of patients with DTC have decreased in the past decades. Controversy remains because of the unique biological behavior of DTC, this needs a multidisciplinary team to provide a rational, patient focused management protocol including initial surgery, adjuvant therapies, subsequently thyrotropin suppression, and long-term follow-up and surveillance. In Europe and northern America, consensus reports (guidelines) in the clinical management of DTC were provided by organizations of related disciplines comprised surgeon, endocrinologist, oncologist and nuclear medicine physician with the support from pathologist, biochemist, radiologist and special nurse to deal controversial issues in this aspect. The guidelines help patients understand WDT well, be treated appropriately, get better care and life quality and subsequently improve survival. Taking advantage of previous reports and available guidelines, we summarized data in incidence, recurrence and distal metastasis, and regimens in appropriate treatment of patients with DTC.

並列關鍵字

differentiated thyroid carcinoma ； multidisciplinary decisions ； guideline