2025年美国甲状腺协会成人分化型甲状腺癌管理指南核心双语对照

2025年美国甲状腺协会成人分化型甲状腺癌管理指南核心双语对照2025版ATA指南是十年来首次重大更新，核心方向是“降阶梯管理”--从过去“一刀切”式积极治疗，转向基于风险分层的个体化策略。2025AmericanThyroidAssociationManagementGuidelinesforAdultPatientswithDifferentiatedThyroidCancer2025年美国甲状腺协会成人分化型甲状腺癌管理指南本双语版基于执行摘要和关键更新整理。完整指南包含贯穿患者诊疗全程的84条推荐。1.CorePhilosophy&Framework/核心理念与框架The2025guidelinesemphasizeindividualized,risk-adaptedmanagementandintroducetheDATAframework(Diagnosis,risk/benefitAssessment,Treatmentdecisions,andresponseAssessment)toenhanceshareddecision-making.2025版指南强调个体化的、风险适配的管理，并引入了DATA框架（诊断、风险/获益评估、治疗决策、反应评估）以加强医患共同决策。2.RiskStratification(Recurrence)/风险分层（复发）Thetraditionalthree-tiermodel(Low,Intermediate,High)hasbeenreplacedbyafour-tierclassificationtobetterpredictrecurrenceandguideRadioactiveIodine(RAI)use.传统的三层模型（低、中、高）已被四层分类所取代，以更好地预测复发并指导放射性碘（RAI）的使用。ATARiskClass/风险等级EstimatedRecurrenceRisk/预估复发风险Low/低风险<10%Low-Intermediate/低-中风险10-15%Intermediate-High/中-高风险16-30%High/高风险>30%KeyChanges/关键变化:-Histology-specific/组织学特异性:SeparateriskpathsforPapillary(PTC),Follicular(FTC),andOncocytic(OTC)cancer./为乳头状癌、滤泡状癌和嗜酸细胞癌设立了独立的风险路径。-Additiveeffect/叠加效应:Thecombinationoftwolow-intermediateriskfactorsreclassifiesthepatientasintermediate-highrisk./两个低-中风险因素共存会使患者升级为中-高风险。3.MajorShiftsinManagement/管理策略的重大转变The2025guidelinesadvocateforde-escalationinlow-riskpatientsandescalation(targetedtherapies)inhigh-riskpatients.2025版指南倡导对低风险患者进行降阶治疗，对高风险患者进行升阶治疗（靶向治疗）。ect/方面2015Guidelines/2015版指南2025Guidelines/2025版指南ActiveSurveillanceSuggestedformicrocarcinomas(<1cm)./建议用于微小型癌。Explicitlyendorsedforlow-risktumors≤1cm;includescriteriaforprogressionandcrossover./明确支持用于低风险≤1cm肿瘤；包含进展和转手术标准。LobectomyOptionforlow-risktumors./低风险肿瘤可选。Preferredformanylow-riskPTC(e.g.,1-4cmwithoutriskfactors)./许多低风险PTC的首选（如1-4cm无风险因素）。RAI(RadioactiveIodine)RecommendedbasedonATArisk./基于ATA风险推荐。Strongrecommendationagainstroutineuseinlow-riskpatients./强烈反对在低风险患者中常规使用。MonitoringLifelongfollow-upsuggested./建议终身随访。De-escalationaftersustainedexcellentresponse(5-8years);IntroductionofCompleteRemissionconcept./持续优秀反应后降阶监测；引入完全缓解概念。SurgicalMarginNegativemargindesired./要求切缘阴性。Positivemarginisnowanindependentriskfactorforrecurrence./切缘阳性现被视为独立的复发风险因素。4.KeyRecommendations(DATAFramework)/关键推荐（DATA框架）D-Diagnosis/诊断-MolecularTesting/分子检测:Routinepreoperativegenomictestingisnotrecommended(R10),butitisrecommendedforborderlineresectabletumorstoguideneoadjuvanttargetedtherapy./不推荐常规进行术前基因组检测，但推荐用于临界可切除肿瘤以指导新辅助靶向治疗。-NIFTP/非浸润性滤泡性甲状腺肿瘤:Remainsclassifiedasverylowrisk,confirmingthatitshouldnotbetreatedasconventionalcancer./继续归类为极低风险，确认不应作为传统癌症治疗。A-Assessment(Risk/Benefit)/评估（风险/获益）-RiskReclassification/风险重分类:Mustbeperformedat1-2yearspost-opandupdateddynamically.A"non-structural"incompleteresponseisnowrecognized./术后1-2年必须进行动态风险重分类。现在承认“非结构性”不完全反应。T-Treatment/治疗-ActiveSurveillance(R11-R14)/主动监测:Recommendedforpatientswithlow-riskfeatures(≤1cm,noETE,cN0).Ultrasoundprotocolsarestandardized./推荐用于低风险特征患者（≤1cm，无腺外侵犯，临床淋巴结阴性）。标准化了超声方案。-RAI(R32)/放射性碘治疗:RoutineremnantablationisnotrecommendedforATAlow-riskDTC(Strongrecommendation,Highcertainty)./不推荐对ATA低风险DTC进行常规残余消融（强推荐，高确定性）。A-Assessment(Response)/评估（反应）-CompleteRemission(R48)/完全缓解:Patientswithlow-riskDTCtreatedwithtotalthyroidectomyandRAIwhohaveasustainedexcellentresponsefor10-15yearsdonotrequirecontinuedroutinebiochemicalmonitoring./接受全甲状腺切除及RAI治疗的低风险DTC患者，若持续10-15年保持优秀反应，不需要继续进行常规生化监测。-DiscontinuationofImaging(R48)/影像学停止:Routineneckultrasoundcanbediscontinuedafter5-8yearsofexcellentresponse./优秀反应持续5-8年后，可停止常规颈部超声检查。5.AdvancedDisease(RAIR-DTC)/晚期疾病（RAIR-DTC）TheguidelinesprovideaspecificalgorithmforRadioactiveIodine-RefractoryDTC,prioritizingtargetedtherapies.指南提供了针对放射性碘难治性DTC的具体算法，优先考虑靶向治疗。-First-line/一线:LenvatiniborSorafenibfornon-actionabledrivers(R62)./用于无特定驱动基因突变者。-Fusion-specific/融合特异性:LarotrectiniborEntrectinib(forNTRKfusions)andSelpercatinib(forRETfusions)arerecommendedasfirst-linetherapy(R67,R68)./推荐作为一线治疗。-BRAFV600E/BRAF突变:Dabrafenib+Trametinibisrecommended(R70)./推荐达拉非尼+曲美替尼。SummaryofMajorChangesin2025/2025版主要变化总结1.MoreNuancedRiskStratification/更精细的风险分层:Movedfrom3to4tiers,incorporatingspecifichistologicbehaviors(e.g.,FTCvascularinvasion)./从3层变为4层，纳入特定组织学行为。2.LessisMore(De-escalation)/减法策略:ReducedindicationsforRAIandcompletionthyroidectomy;formalrecognitionof"CompleteRemission"allowsfordiscontinuationofsurveillanceinlow-riskpatients./减少RAI和完成性甲状腺切除的指征；正式承认“完全缓解”允许低风险患者停止监测。3.MoreOptionsforLowRisk/低风险更多选择:Activesurveillanceandlobectomyares