Langfristige Prognose des differenzierten Schilddrüsenkarzinoms

Zusammenfassung

Das differenzierte Schilddrüsenkarzinom hat insgesamt eine ausgezeichnete Prognose. Das liegt neben der Biologie des Tumors vor allem an der erfolgreichen Diagnostik, der optimierten und standardisierten Therapie sowie der Nachsorge dieser Tumorentität. Die Kombination aus Operation, Radioiodtherapie und Levothyroxin-Medikation ist die Methode der Wahl und wird in nationalen und internationalen Leitlinien empfohlen. Durch diese Therapieschemata lassen sich Überlebensraten von 80–100% erreichen. Besondere Bedeutung kommt der Risikostratifizierung zu. Diese orientiert sich an der UCC/AJCC TNM-Klassifikation zur Ermittlung der lokalen Tumorausdehnung und Erfassung von Lymphknoten- oder Fernmetastasen. In der Literatur wird eine Reihe differenzierender Prognosescores beschrieben, bei denen zum Teil unterschiedliche Risikofaktoren Berücksichtigung finden. Das Alter der Patienten, Tumorgröße, extrathyreoidales Wachstum, Lymphknoten- und Fernmetastasen sind die am häufigsten genannten Parameter, die in diese Scores integriert werden. Prospektive Studien zur Langzeitprognose von Patienten mit differenzierten Schilddrüsenkarzinomen sind wegen der guten Prognose rar, da sie sowohl sehr lange Nachbeobachtungszeiten als auch große Patientenzahlen voraussetzen. Dies ist in der Regel nur durch Multicenter-Studien zu erreichen. Aber auch retrospektive Analysen großer Patientenkollektive können helfen, valide Risikofaktoren für das differenzierte Schilddrüsenkarzinom zu identifizieren.

Abstract

In general, differentiated thyroid carcinomas have an excellent prognosis. In addition to the biological behavior of this tumor entity this is based on optimized diagnostic procedures as well as a standardized therapeutic management and after-care. The combination of surgery, radioiodine ablation and levothyroxine medication is an effective therapeutic algorithm recommended by national and international guidelines. Thereby, survival rates of 80–100% can be achieved. In this respect, a correct risk-stratification is of particular importance which relies primarily on the UICC/AJCC TNM-classification to determine the local tumor extent and lymph node or distant metastasis. In the literature, several distinct prognostic scores have been defined accounting for different risk factors. Patient age at diagnosis, tumor size, extrathyroidal growth, lymph node and distant metastases are the most commonly used parameters integrated into these scores. Prospective studies on the long-term prognosis of patients with differentiated thyroid carcinomas are rare because of the favourable prognosis requiring long-term follow-up times and large patients cohorts. In general, this can only be achieved by multicentre studies. Retrospective analyses of large patient populations, however, can help to identify reliable risk factors of patients with differentiated thyroid carcinomas.

Schlüsselwörter

Prognose - Schilddrüsenkarzinom - individualisierte Medizin

Key words

prognosis - thyroid cancer - individualized medicine

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