《2025年韩国甲状腺协会低风险甲状腺乳头状癌主动监测临床管理指南》解读

doi:10.3760/cma.j.cn371439-20251229-00065

摘要/Abstract

摘要：

近年来，对于低风险甲状腺乳头状癌临床主动监测（AS），国内外指南一贯持非常谨慎的态度，甚至存在争议。《2025年韩国甲状腺协会低风险甲状腺乳头状癌主动监测临床管理指南》全面概述了低风险甲状腺乳头状癌AS适宜人群的评估和筛选，推荐了AS临床管理方案及AS期间手术治疗指征。现结合国内外相关指南对其中AS适宜人群年龄≥19岁患者的特征、以超声检查为主导的随访策略和AS期间出现肿瘤进展时手术时机选择等内容进行分析解读，以期为临床实践提供参考。

关键词: 甲状腺肿瘤, 主动监测, 手术治疗, 随访

Abstract:

In recent years， the clinical active surveillance （AS） for low-risk papillary thyroid carcinoma has been approached with extreme caution by both domestic and international guidelines， and there has even been controversy. The "2025 Korean Thyroid Association clinical management guideline on active surveillance for low-risk papillary thyroid carcinoma" comprehensively delineate the assessment and screening of the appropriate population for AS in low-risk papillary thyroid carcinoma. The guidelines recommend clinical management protocols during AS， and outline the indications for surgical intervention during the AS period. Based on relevant domestic and international guidelines， a comparative analysis is now conducted on the characteristics of patients with AS who are suitable for treatment at the age of 19 or above， the follow-up strategy dominated by ultrasound examinations， and the timing of surgical intervention in the event of tumor progression during AS， with the aim of offering references for clinical practice.

Key words: Thyroid neoplasms, Active surveillance, Surgical treatment, Follow-up

王兴越, 刘勤江. 《2025年韩国甲状腺协会低风险甲状腺乳头状癌主动监测临床管理指南》解读[J]. 国际肿瘤学杂志, 2026, 53(7): 398-403.

Wang Xingyue, Liu Qinjiang. Interpretation of the "2025 Korean Thyroid Association clinical management guideline on active surveillance for low-risk papillary thyroid carcinoma"[J]. Journal of International Oncology, 2026, 53(7): 398-403.

图/表 1

参考文献 28

[1]	Lee EK, Kim MJ, Kang SH, et al. 2025 Korean Thyroid Association clinical management guideline on active surveillance for low-risk papillary thyroid carcinoma[J]. Endocrinol Metab (Seoul), 2025, 40(3): 307-341. DOI: 10.3803/EnM.2025.2461.
[2]	Miyauchi A, Ito Y, Fujishima M, et al. Long-term outcomes of active surveillance and immediate surgery for adult patients with low-risk papillary thyroid microcarcinoma: 30-year experience[J]. Thyroid, 2023, 33(7): 817-825. DOI: 10.1089/thy.2023.0076.
[3]	Durante C, Hegedüs L, Czarniecka A, et al. 2023 European Thyroid Association Clinical Practice Guidelines for thyroid nodule management[J]. Eur Thyroid J, 2023, 12(5): e230067. DOI: 10.1530/ETJ-23-0067.
[4]	Haddad RI, Bischoff L, Ball D, et al. Thyroid carcinoma, version 2.2022, NCCN Clinical Practice Guidelines in Oncology[J]. J Natl Compr Canc Netw, 2022, 20(8): 925-951. DOI: 10.6004/jnccn.2022.0040.
[5]	Ringel MD, Sosa JA, Baloch Z, et al. 2025 American Thyroid Association management guidelines for adult patients with differentiated thyroid cancer[J]. Thyroid, 2025, 35(8): 841-985. DOI: 10.1177/10507256251363120.
[6]	中华人民共和国国家卫生健康委员会医政医管局. 甲状腺癌诊疗指南(2022年版)[J]. 中国实用外科杂志, 2022, 42(12): 1343-1357. DOI: 10.19538/j.cjps.issn1005-2208.2022.12.02.
[7]	中华医学会内分泌学分会, 中华医学会外科学分会甲状腺及代谢外科学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南(第二版)[J]. 中华内分泌代谢杂志, 2023, 39(3): 181-226. DOI: 10.3760/cma.j.cn311282-20221023-00589.
[8]	中国抗癌协会甲状腺癌专业委员会. 中国抗癌协会甲状腺癌整合诊治指南(2022精简版)[J]. 中国肿瘤临床, 2023, 50(7): 325-330. DOI: 10.12354/j.issn.1000-8179.2023.20221410.
[9]	Sugitani I, Kiyota N, Ito Y, et al. The 2024 revised clinical guidelines on the management of thyroid tumors by the Japan Association of Endocrine Surgery[J]. Endocr J, 2025, 72(5): 545-635. DOI: 10.1507/endocrj.EJ24-0644. pmid: 40058844
[10]	Yang J, Gong YP, Yan SP, et al. Association between TERT promoter mutations and clinical behaviors in differentiated thyroid carcinoma: a systematic review and meta-analysis[J]. Endocrine, 2019, 67(1): 44-57. DOI: 10.1007/s12020-019-02117-2.
[11]	Jeong SY, Chung SR, Baek JH, et al. Sonographic assessment of minor extrathyroidal extension of papillary thyroid microcarcinoma involving the posterior thyroid capsule[J]. Eur Radiol, 2022, 32(9): 6090-6096. DOI: 10.1007/s00330-022-08765-9. pmid: 35380227
[12]	Sugitani I, Ito Y, Takeuchi D, et al. Indications and strategy for active surveillance of adult low-risk papillary thyroid microcarcinoma: consensus statements from the Japan Association of Endocrine Surgery task force on management for papillary thyroid microcarcinoma[J]. Thyroid, 2021, 31(2): 183-192. DOI: 10.1089/thy.2020.0330. pmid: 33023426
[13]	Lee JY, Lee MK, Lim HK, et al. Standardized ultrasound evaluation for active surveillance of low-risk thyroid microcarcinoma in adults: 2024 Korean Society of Thyroid Radiology consensus statement[J]. Korean J Radiol, 2024, 25(11): 942-958. DOI: 10.3348/kjr.2024.0871. pmid: 39473087
[14]	Pérez-Soto RH, Velázquez-Fernández D, Arellano-Gutiérrez G, et al. Preoperative and postoperative risk stratification of thyroid papillary microcarcinoma: a comparative study between Kuma criteria and 2015 American Thyroid Association guidelines risk stratification[J]. Thyroid, 2020, 30(6): 857-862. DOI: 10.1089/thy.2019.0698. pmid: 32031061
[15]	Feng JW, Qin AC, Ye J, et al. Predictive factors for lateral lymph node metastasis and skip metastasis in papillary thyroid carcinoma[J]. Endocr Pathol, 2020, 31(1): 67-76. DOI: 10.1007/s12022-019-09599-w.
[16]	Seok J, Choi JY, Yu HW, et al. Papillary thyroid cancers of the thyroid isthmus: the pattern of nodal metastasis and the significance of extrathyroidal extension[J]. Ann Surg Oncol, 2020, 27(6): 1937-1944. DOI: 10.1245/s10434-020-08215-0. pmid: 31970571
[17]	Ito Y, Miyauchi A, Fujishima M, et al. Thyroid-stimulating hormone, age, and tumor size are risk factors for progression during active surveillance of low-risk papillary thyroid microcarcinoma in adults[J]. World J Surg, 2022, 47(2): 392-401. DOI: 10.1007/s00268-022-06770-z. pmid: 36182976
[18]	Nagaoka R, Ebina A, Toda K, et al. Multifocality and progression of papillary thyroid microcarcinoma during active surveillance[J]. World J Surg, 2021, 45(9): 2769-2776. DOI: 10.1007/s00268-021-06185-2. pmid: 34100116
[19]	Lee EK, Moon JH, Hwangbo Y, et al. Progression of low-risk papillary thyroid microcarcinoma during active surveillance: interim analysis of a multicenter prospective cohort study of active surveillance on papillary thyroid microcarcinoma in Korea[J]. Thyroid, 2022, 32(11): 1328-1336. DOI: 10.1089/thy.2021.0614. pmid: 36205563
[20]	Yamamoto M, Miyauchi A, Ito Y, et al. Active surveillance outcomes of patients with low-risk papillary thyroid microcarcinoma according to levothyroxine treatment status[J]. Thyroid, 2023, 33(10): 1182-1189. DOI: 10.1089/thy.2023.0046. pmid: 37310904
[21]	Kim HI, Jin M, Ko NG, et al. Effect of TSH levels during active surveillance of PTMC according to age[J]. Endocr Relat Cancer, 2022, 29(4): 191-200. DOI: 10.1530/ERC-21-0403.
[22]	Heng Y, Yang Z, Lin J, et al. Risks of central lymph node metastasis in papillary thyroid carcinoma with or without multifocality in at least one lobe: a multi-center analysis[J]. Oral Oncol, 2022, 134: 106185. DOI: 10.1016/j.oraloncology.2022.106185.
[23]	Shu XJ, Tang LF, Hu DX, et al. Prediction model of pathologic central lymph node negativity in cN₀ papillary thyroid carcinoma[J]. Front Oncol, 2021, 11: 727984. DOI: 10.3389/fonc.2021.727984.
[24]	Jeon MJ, Kim WG, Kim TY, et al. Active surveillance as an effective management option for low-risk papillary thyroid microcarcinoma[J]. Endocrinol Metab (Seoul), 2021, 36(4): 717-724. DOI: 10.3803/EnM.2021.1042.
[25]	Chaves N, Broekhuis JM, Fligor SC, et al. Delay in surgery and papillary thyroid cancer survival in the United States: a SEER-medicare analysis[J]. J Clin Endocrinol Metab, 2023, 108(10): 2589-2596. DOI: 10.1210/clinem/dgad163. pmid: 36987566
[26]	Yoon JH, Choi W, Park JY, et al. Active surveillance for low-risk papillary thyroid carcinoma as an acceptable management option with additional benefits: a comprehensive systematic review[J]. Endocrinol Metab (Seoul), 2024, 39(1): 152-163. DOI: 10.3803/EnM.2023.1794.
[27]	Kim K, Choi JY, Kim SJ, et al. Active surveillance versus immediate surgery for low-risk papillary thyroid microcarcinoma patients in South Korea: a cost-minimization analysis from the MAeSTro study[J]. Thyroid, 2022, 32(6): 648-656. DOI: 10.1089/thy.2021.0679.
[28]	Leboulleux S, Lamartina L, Sokol EL, et al. SFE-AFCE-SFMN 2022 consensus on the management of thyroid nodules: follow-up: how and how long?[J]. Ann Endocrinol (Paris), 2022, 83(6): 407-414. DOI: 10.1016/j.ando.2022.10.010.