\u901a\u4fe1\u4f5c\u8005\uff1a\u738b\u5b87\u6559\u6388\uff08\u5de6\uff09\uff0c\u7530\u6587\u6559\u6388\uff08\u53f3\uff09<\/p>\n
\u3010\u5f15\u7528\u672c\u6587\u3011\u4e2d\u56fd\u533b\u5e08\u534f\u4f1a\u5916\u79d1\u533b\u5e08\u5206\u4f1a\u7532\u72b6\u817a\u5916\u79d1\u533b\u5e08\u59d4\u5458\u4f1a\uff0c\u4e2d\u56fd\u7814\u7a76\u578b\u533b\u9662\u5b66\u4f1a\u7532\u72b6\u817a\u75be\u75c5\u4e13\u4e1a\u59d4\u5458\u4f1a\uff0c\u4e2d\u56fd\u533b\u7597\u4fdd\u5065\u56fd\u9645\u4ea4\u6d41\u4fc3\u8fdb\u4f1a\u666e\u901a\u5916\u79d1\u5b66\u5206\u4f1a\uff0c\u7b49. \u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u65b0\u8f85\u52a9\u6cbb\u7597\u4e2d\u56fd\u4e13\u5bb6\u5171\u8bc6\uff082023\u7248\uff09[J]. \u4e2d\u56fd\u5b9e\u7528\u5916\u79d1\u6742\u5fd7,2023,43(8):841-848.<\/p>\n
\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u65b0\u8f85\u52a9\u6cbb\u7597\u4e2d\u56fd\u4e13\u5bb6\u5171\u8bc6\uff082023\u7248\uff09\u4e2d\u56fd\u533b\u5e08\u534f\u4f1a\u5916\u79d1\u533b\u5e08\u5206\u4f1a\u7532\u72b6\u817a\u5916\u79d1\u533b\u5e08\u59d4\u5458\u4f1a\u4e2d\u56fd\u7814\u7a76\u578b\u533b\u9662\u5b66\u4f1a\u7532\u72b6\u817a\u75be\u75c5\u4e13\u4e1a\u59d4\u5458\u4f1a\u4e2d\u56fd\u533b\u7597\u4fdd\u5065\u56fd\u9645\u4ea4\u6d41\u4fc3\u8fdb\u4f1a\u666e\u901a\u5916\u79d1\u5b66\u5206\u4f1a\u4e2d\u56fd\u6297\u764c\u534f\u4f1a\u7532\u72b6\u817a\u764c\u4e13\u4e1a\u59d4\u5458\u4f1a\u4e2d\u56fd\u5b9e\u7528\u5916\u79d1\u6742\u5fd7,2023,43(8):841-848<\/p>\n
\u57fa\u91d1\u9879\u76ee\uff1a\u56fd\u5bb6\u81ea\u7136\u79d1\u5b66\u57fa\u91d1\u9762\u4e0a\u9879\u76ee\uff08No.82072951\uff09\uff1b\u4e0a\u6d77\u5e02\u79d1\u59d4\u91cd\u70b9\u9886\u57df\u521b\u65b0\u8ba1\u5212\u9879\u76ee\uff08No. 22Y21900100\uff09<\/p>\n
\u901a\u4fe1\u4f5c\u8005\uff1a\u738b\u5b87\uff0cE-mail\uff1aneck130@hotmail.com\uff1b\u7530\u6587\uff0cE-mail\uff1atianwen301_cta01@163.com<\/p>\n
\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u662f\u6307\u80bf\u7624\u660e\u663e\u4fb5\u72af\u5468\u56f4\u91cd\u8981\u7ed3\u6784\u6216\u5668\u5b98\u7684\u7532\u72b6\u817a\u764c\uff0c\u6d89\u53ca\u5404\u79cd\u7532\u72b6\u817a\u764c\u7c7b\u578b\uff0c\u90e8\u5206\u80bf\u7624\u4e0d\u53ef\u624b\u672f\u6216\u624b\u672f\u96be\u4ee5\u5b8c\u6574\u5207\u9664\uff0c\u662f\u76ee\u524d\u7532\u72b6\u817a\u764c\u6cbb\u7597\u7684\u96be\u70b9\u3002\u968f\u7740\u7532\u72b6\u817a\u764c\u7cfb\u7edf\u6cbb\u7597\u7684\u8fdb\u5c55\uff0c\u5df2\u6709\u591a\u9879\u6587\u732e\u62a5\u9053\uff0c\u65b0\u8f85\u52a9\u6cbb\u7597\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u53ef\u4ee5\u4f7f\u90e8\u5206\u75c5\u4eba\u80bf\u7624\u9000\u7f29\uff0c\u83b7\u5f97\u624b\u672f\u5b8c\u6574\u5207\u9664\u7684\u673a\u4f1a\uff0c\u6539\u5584\u4e86\u75c5\u4eba\u7684\u9884\u540e\uff3b1-3\uff3d\u3002\u7531\u4e8e\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u7684\u6cbb\u7597\u5177\u6709\u9ad8\u5ea6\u7684\u4e13\u4e1a\u6027\uff0c\u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u8bc4\u4f30\u3001\u7528\u836f\u4ee5\u53ca\u540e\u7eed\u7684\u624b\u672f\u901a\u5e38\u7531\u5177\u6709\u4e30\u5bcc\u4e34\u5e8a\u7ecf\u9a8c\u7684\u7532\u72b6\u817a\u764c\u591a\u5b66\u79d1\u7efc\u5408\u6cbb\u7597\u534f\u4f5c\u7ec4\uff08multidisciplinary treatment\uff0cMDT\uff09\u8fdb\u884c\u3002\u4e2d\u56fd\u533b\u5e08\u534f\u4f1a\u5916\u79d1\u533b\u5e08\u5206\u4f1a\u7532\u72b6\u817a\u5916\u79d1\u533b\u5e08\u59d4\u5458\u4f1a\u7b49\u7ec4\u7ec7\u56fd\u5185\u76f8\u5173\u9886\u57df\u90e8\u5206\u4e13\u5bb6\u7efc\u5408\u56fd\u5185\u5916\u6700\u65b0\u4e34\u5e8a\u7814\u7a76\u6210\u679c\u548c\u56fd\u5185\u7532\u72b6\u817a\u764c\u7684\u8bca\u6cbb\u73b0\u51b5\u5236\u5b9a\u672c\u5171\u8bc6\uff0c\u65e8\u5728\u8fdb\u4e00\u6b65\u63d0\u9ad8\u7532\u72b6\u817a\u764c\u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u6709\u6548\u6027\u53ca\u5b89\u5168\u6027\uff0c\u4e3a\u6211\u56fd\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u75c5\u4eba\u7684\u6cbb\u7597\u63d0\u4f9b\u53c2\u8003\u3002\u672c\u5171\u8bc6\u5171\u5f62\u621021\u6761\u63a8\u8350\u6761\u6b3e\uff0c\u5e76\u5bf9\u8bc1\u636e\u7b49\u7ea7\uff08\u88681\uff09\u548c\u63a8\u8350\u7b49\u7ea7\uff08\u88682\uff09\u8fdb\u884c\u6807\u6ce8\u3002<\/p>\n<\/p>\n
1 \u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u65f6\u673a<\/p>\n
1.1 \u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u7684\u5b9a\u4e49\u548c\u8303\u7574 \u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u6307\u521d\u8bca\u65f6\u6216\u6301\u7eed\u6216\u590d\u53d1\u75c5\u7076\u5bf9\u5468\u56f4\u91cd\u8981\u5668\u5b98\u6216\u7ed3\u6784\u5448\u4fb5\u88ad\u72b6\u6001\uff0c\u5373\u539f\u53d1\u7076\u6216\u8f6c\u79fb\u6dcb\u5df4\u7ed3\u4fb5\u72af\u5589\u8fd4\u795e\u7ecf\u3001\u6c14\u7ba1\u3001\u98df\u7ba1\u3001\u5589\u3001\u9888\u90e8\u5927\u8840\u7ba1\u3001\u4e0a\u7eb5\u9694\u6216\u5e7f\u6cdb\u76ae\u80a4\u808c\u8089\u7684\u7532\u72b6\u817a\u764c\uff0c\u4f34\u6216\u4e0d\u4f34\u6709\u8fdc\u5904\u8f6c\u79fb\u3002\u6839\u636e\u7b2c8\u7248\u7f8e\u56fd\u764c\u75c7\u8054\u5408\u59d4\u5458\u4f1a\uff08American Joint Committee on Cancer\uff0cAJCC\uff09\u7532\u72b6\u817a\u764cTNM\u5206\u671f\u7cfb\u7edf\uff0c\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u53ef\u5206\u4e3aT4a\u671f\uff08\u80bf\u7624\u4fb5\u72af\u76ae\u4e0b\u8f6f\u7ec4\u7ec7\u3001\u5589\u3001\u6c14\u7ba1\u3001\u98df\u7ba1\u3001\u5589\u8fd4\u795e\u7ecf\uff09\u53caT4b\u671f\uff08\u80bf\u7624\u4fb5\u72af\u690e\u524d\u7b4b\u819c\u3001\u5305\u7ed5\u9888\u603b\u52a8\u8109\u6216\u4e0a\u7eb5\u9694\u8840\u7ba1\uff09\uff3b4\uff3d\u3002\u4f46\u8be5\u5206\u671f\u7cfb\u7edf\u4e2d\u5c40\u90e8\u8fdb\u5c55\u671f\u7684\u5b9a\u4e49\u4ec5\u9650\u4e8e\u7532\u72b6\u817a\u764c\u539f\u53d1\u7076\uff0c\u5efa\u8bae\u5c06\u9888\u90e8\u8f6c\u79fb\u6dcb\u5df4\u7ed3\u4fb5\u72af\u5468\u56f4\u7ed3\u6784\u5668\u5b98\u8005\u4e5f\u7eb3\u5165\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u7684\u8303\u7574\u3002\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u5360\u6240\u6709\u7532\u72b6\u817a\u764c\u76845%\uff5e10%\uff3b5-6\uff3d\uff0c\u9884\u540e\u8f83\u5dee\uff0c10\u5e74\u75be\u75c5\u7279\u5f02\u6027\u6b7b\u4ea1\u7387\u53ef\u9ad8\u8fbe41%\uff5e42%\uff3b7\uff3d\u3002<\/p>\n
1.2 \u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u884c\u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u4e34\u5e8a\u610f\u4e49 \u65b0\u8f85\u52a9\u6cbb\u7597\u662f\u6307\u5728\u5b9e\u65bd\u5c40\u90e8\u6cbb\u7597\u65b9\u6cd5\u524d\u6240\u8fdb\u884c\u7684\u5168\u8eab\u6cbb\u7597\uff0c\u7528\u4ee5\u63d0\u9ad8\u75c5\u4eba\u540e\u7eed\u6839\u6cbb\u6027\u6cbb\u7597\u673a\u4f1a\uff0c\u5305\u62ec\u65b0\u8f85\u52a9\u5316\u7597\u3001\u65b0\u8f85\u52a9\u9776\u5411\u6cbb\u7597\u4ee5\u53ca\u65b0\u8f85\u52a9\u514d\u75ab\u6cbb\u7597\u7b49\u3002\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u4e3b\u8981\u76ee\u7684\u5305\u62ec\uff1a\uff081\uff09\u964d\u671f\uff0c\u63d0\u9ad8\u80bf\u7624\u7684\u53ef\u5207\u9664\u6027\uff0c\u4f7f\u75c5\u4eba\u83b7\u5f97\u6839\u6cbb\u6027\u624b\u672f\u5207\u9664\u7684\u53ef\u80fd\u3002\uff082\uff09\u63d0\u9ad8\u75c5\u4eba\u9888\u90e8\u5668\u5b98\u7684\u529f\u80fd\u4fdd\u7559\uff0c\u6539\u5584\u751f\u6d3b\u8d28\u91cf\u3002\uff083\uff09\u53ca\u65e9\u6740\u706d\u5fae\u8f6c\u79fb\u7076\uff0c\u6539\u5584\u75c5\u4eba\u957f\u671f\u751f\u5b58\u3002\uff084\uff09\u5206\u5316\u578b\u7532\u72b6\u817a\u764c\u7ecf\u65b0\u8f85\u52a9\u6cbb\u7597\u540e\uff0c\u5c40\u90e8\u624b\u672f\u53ef\u4f7f\u75c5\u4eba\u83b7\u5f97\u540e\u7eed\u653e\u5c04\u6027\u6838\u7d20\u6cbb\u7597\u7684\u673a\u4f1a\u3002\uff085\uff09\u836f\u654f\u89c2\u5bdf\uff0c\u4e3a\u90e8\u5206\u9700\u8981\u540e\u7eed\u8f85\u52a9\u6cbb\u7597\u75c5\u4eba\u63d0\u4f9b\u9009\u62e9\u4f9d\u636e\u3002<\/p>\n
1.3 \u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u80bf\u7624\u53ef\u5207\u9664\u6027\u7684\u8bc4\u4f30 \u5728\u5236\u5b9a\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u7684\u6cbb\u7597\u65b9\u6848\u524d\uff0c\u9700\u8981\u5bf9\u80bf\u7624\u7684\u53ef\u5207\u9664\u6027\u8fdb\u884c\u8bc4\u4f30\u3002\u9888\u90e8\u589e\u5f3aCT\u5bf9\u9888\u90e8\u8840\u7ba1\u3001\u6c14\u7ba1\u53ca\u98df\u7ba1\u7684\u53d7\u7d2f\u7a0b\u5ea6\uff0c\u4ee5\u53ca\u6dcb\u5df4\u7ed3\u8f6c\u79fb\u8303\u56f4\u5747\u80fd\u63d0\u4f9b\u8f83\u4e3a\u51c6\u786e\u7684\u663e\u50cf\uff3b8\uff3d\u3002MRI\u4e5f\u6709\u8f83\u597d\u7684\u8f6f\u7ec4\u7ec7\u5206\u8fa8\u7387\uff0c\u5bf9\u4e8e\u5589\u8fd4\u795e\u7ecf\u3001\u6c14\u7ba1\u3001\u98df\u7ba1\u53d7\u4fb5\u8bc4\u4f30\u7684\u51c6\u786e\u7387\u4e0eCT\u76f8\u8fd1\uff3b9\uff3d\u3002\u5589\u3001\u6c14\u7ba1\u53ca\u98df\u7ba1\u7684\u5185\u955c\u68c0\u67e5\u53ca\u6d3b\u68c0\u53ef\u4ee5\u63d0\u4f9b\u5668\u5b98\u53d7\u7d2f\u7684\u76f4\u63a5\u8bc1\u636e\uff3b8\uff3d\u3002<\/p>\n
\u80bf\u7624\u7684\u53ef\u5207\u9664\u6027\u8bc4\u4f30\u5177\u6709\u8f83\u5f3a\u7684\u4e3b\u89c2\u6027\uff0c\u7f3a\u4e4f\u5ba2\u89c2\u7684\u8bc4\u4f30\u7cfb\u7edf\u3002\u6709\u7814\u7a76\u62a5\u9053\u5229\u7528\u9888\u90e8\u589e\u5f3aCT\u5bf9\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u4fb5\u72af\u5468\u56f4\u7ed3\u6784\u7684\u7a0b\u5ea6\u8fdb\u884c\u8bc4\u5206\uff0c\u5efa\u7acb\u80bf\u7624\u53ef\u5207\u9664\u6027\u7684\u8bc4\u4f30\u6a21\u578b\uff0c\u5bf9\u6cbb\u7597\u51b3\u7b56\u6709\u4e00\u5b9a\u53c2\u8003\u4ef7\u503c\uff3b10\uff3d\u3002\u5efa\u8bae\u7531\u6709\u4e30\u5bcc\u4e34\u5e8a\u7ecf\u9a8c\u7684\u7532\u72b6\u817a\u764cMDT\u8fdb\u884c\u53ef\u5207\u9664\u6027\u8bc4\u4f30\uff0c\u82e5\u9884\u4f30\u80bf\u7624\u53ef\u4ee5\u8fbe\u5230R0\u6216R1\u5207\u9664\uff0c\u5e94\u9996\u9009\u624b\u672f\u6cbb\u7597\uff0c\u901a\u8fc7\u9002\u5f53\u7684\u624b\u672f\u5904\u7406\u548c\u53ca\u65f6\u6709\u6548\u7684\u672f\u540e\u968f\u8bbf\u7ba1\u7406\u6539\u5584\u5176\u9884\u540e\uff3b11\uff3d\u3002\u82e5\u9884\u8ba1\u96be\u4ee5\u8fbe\u5230R0\u6216R1\u5207\u9664\u6216\u56e0\u624b\u672f\u8303\u56f4\u8f83\u5927\u96be\u4ee5\u4fdd\u7559\u90bb\u8fd1\u7ed3\u6784\u6216\u5668\u5b98\u529f\u80fd\uff0c\u5219\u53ef\u8003\u8651\u8fdb\u884c\u65b0\u8f85\u52a9\u6cbb\u7597\uff0c\u4ee5\u63d0\u9ad8\u540e\u7eed\u80bf\u7624\u7684\u624b\u672f\u5207\u9664\u7387\uff0c\u540c\u65f6\u63d0\u9ad8\u5668\u5b98\u4fdd\u62a4\u7387\u4ee5\u6539\u5584\u75c5\u4eba\u751f\u6d3b\u8d28\u91cf\u3002<\/p>\n
\u63a8\u8350\u610f\u89c11\uff1a\u5efa\u8bae\u7531\u6709\u4e30\u5bcc\u4e34\u5e8a\u7ecf\u9a8c\u7684\u7532\u72b6\u817a\u764cMDT\u8fdb\u884c\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u8bc4\u4f30\u3001\u5b9e\u65bd\u53ca\u6cbb\u7597\u540e\u7684\u624b\u672f\u3002\uff08\u8bc1\u636e\u7b49\u7ea7\uff1aD; \u63a8\u8350\u7b49\u7ea7\uff1aA\uff09<\/p>\n
\u63a8\u8350\u610f\u89c12\uff1a\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u5e94\u8fdb\u884c\u624b\u672f\u7684\u53ef\u5207\u9664\u6027\u8bc4\u4f30\uff0c\u589e\u5f3aCT\u3001MRI\u53ca\u5185\u955c\u68c0\u67e5\u662f\u5e38\u7528\u7684\u8bc4\u4f30\u65b9\u5f0f\u3002\uff08\u8bc1\u636e\u7b49\u7ea7\uff1aC\uff1b\u63a8\u8350\u7b49\u7ea7\uff1aA\uff09<\/p>\n
\u63a8\u8350\u610f\u89c13\uff1a\u7ecf\u8bc4\u4f30\u9884\u8ba1\u53ef\u8fbe\u5230R0\u6216R1\u5207\u9664\u7684\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u9996\u9009\u624b\u672f\u6cbb\u7597\u3002\u96be\u4ee5\u8fbe\u5230R0\u6216R1\u5207\u9664\u6216\u56e0\u624b\u672f\u8303\u56f4\u8f83\u5927\u96be\u4ee5\u4fdd\u7559\u90bb\u8fd1\u7ed3\u6784\u6216\u5668\u5b98\u529f\u80fd\u65f6\uff0c\u53ef\u8003\u8651\u65b0\u8f85\u52a9\u6cbb\u7597\u3002\uff08\u8bc1\u636e\u7b49\u7ea7\uff1aC\uff1b\u63a8\u8350\u7b49\u7ea7\uff1aB\uff09<\/p>\n
1.4 \u5206\u5b50\u8bca\u65ad\u5728\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u65b0\u8f85\u52a9\u6cbb\u7597\u4e2d\u7684\u5e94\u7528<\/p>\n
1.4.1 \u65b0\u8f85\u52a9\u6cbb\u7597\u524d\u7684\u6d3b\u68c0\u65b9\u6cd5 \u5728\u51b3\u5b9a\u8fdb\u884c\u65b0\u8f85\u52a9\u6cbb\u7597\u524d\uff0c\u6240\u6709\u75c5\u4eba\u5747\u5e94\u8fdb\u884c\u80bf\u7624\u7ec4\u7ec7\u7684\u6d3b\u68c0\uff0c\u9996\u8981\u76ee\u7684\u662f\u660e\u786e\u7532\u72b6\u817a\u764c\u7684\u75c5\u7406\u5b66\u8bca\u65ad\u3001\u75c5\u7406\u5b66\u7c7b\u578b\u3001\u7ec4\u7ec7\u5b66\u4e9a\u578b\u53ca\u68c0\u6d4b\u76f8\u5173\u5206\u5b50\u75c5\u7406\u5b66\u6307\u6807\uff0c\u4e3a\u65b0\u8f85\u52a9\u6cbb\u7597\u836f\u7269\u7684\u9009\u62e9\u63d0\u4f9b\u75c5\u7406\u5b66\u4f9d\u636e\u3002\u7531\u4e8e\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u53ef\u80fd\u5b58\u5728\u5206\u5316\u5dee\u7684\u6210\u5206\u6216\u591a\u79cd\u75c5\u7406\u5b66\u7c7b\u578b\u7684\u6df7\u5408\uff0c\u6545\u9996\u9009\u8d85\u58f0\u5f15\u5bfc\u6216CT\u5f15\u5bfc\u4e0b\u7684\u7a7a\u82af\u9488\u6216\u7c97\u9488\u7a7f\u523a\u6d3b\u68c0\uff08core needle biopsy\uff0cCNB\uff09\u8fdb\u884c\u7ec4\u7ec7\u5b66\u8bca\u65ad\u3002\u82e5CNB\u4e0d\u53ef\u884c\u65f6\uff0c\u53ef\u8003\u8651\u8fdb\u884c\u76f4\u89c6\u4e0b\u6216\u8d85\u58f0\u5f15\u5bfc\u4e0b\u7684\u7ec6\u9488\u7a7f\u523a\u6d3b\u68c0\uff08fine needle aspiration biopsy\uff0cFNAB\uff09\u3001\u5c40\u90e8\u75c5\u7076\u7684\u5207\u53d6\u6d3b\u68c0\u3001\u5207\u9664\u6d3b\u68c0\u53ca\u5185\u955c\u5f15\u5bfc\u4e0b\u7684\u6d3b\u68c0\u4f5c\u4e3a\u8865\u5145\u3002<\/p>\n
\u63a8\u8350\u610f\u89c14\uff1a\u65b0\u8f85\u52a9\u6cbb\u7597\u524d\u6240\u6709\u75c5\u4eba\u5747\u5e94\u8fdb\u884c\u80bf\u7624\u7ec4\u7ec7\u7684\u6d3b\u68c0\uff0c\u9996\u9009\u7a7a\u82af\u9488\u7a7f\u523a\u8fdb\u884c\u7ec4\u7ec7\u5b66\u8bca\u65ad\u3002\uff08\u8bc1\u636e\u7b49\u7ea7\uff1aD\uff1b\u63a8\u8350\u7b49\u7ea7\uff1aA\uff09<\/p>\n
1.4.2 \u5206\u5b50\u8bca\u65ad\u7684\u9009\u62e9 \u5728\u80bf\u7624\u7ec4\u7ec7\u6d3b\u68c0\u7684\u540c\u65f6\u63a8\u8350\u8fdb\u884c\u80bf\u7624\u7ec4\u7ec7\u7684\u57fa\u56e0\u68c0\u6d4b\uff0c\u4e3a\u9776\u5411\u836f\u7269\u9009\u62e9\uff0c\u5c24\u5176\u662f\u9ad8\u9009\u62e9\u6027\u6291\u5236\u5242\u7684\u5e94\u7528\u63d0\u4f9b\u4f9d\u636e\u3002\u68c0\u6d4b\u7684\u9776\u70b9\u5e94\u6db5\u76d6\u7532\u72b6\u817a\u764c\u5e38\u89c1\u6cbb\u7597\u9776\u70b9\u57fa\u56e0\u6539\u53d8\uff0c\u5982RET\u3001NTRK\u3001BRAF\u3001VEGFR\u3001RAS\u3001ALK\u7b49\u3002\u76ee\u524d\u56fd\u5185\u5e38\u89c1\u7684\u7532\u72b6\u817a\u764c\u57fa\u56e0\u53d8\u5f02\u68c0\u6d4b\u5e73\u53f0\u4e3b\u8981\u4e3a\u5b9e\u65f6\u8367\u5149\u5b9a\u91cfPCR\uff08real-time fluorescent quantitative PCR, qPCR\uff09\u4ee5\u53ca\u4e8c\u4ee3\u6d4b\u5e8f\uff08next generation sequencing\uff0cNGS\uff09\u3002qPCR\u9002\u7528\u4e8e\u5355\u4e2a\u7279\u5b9a\u57fa\u56e0\u7684\u70b9\u7a81\u53d8\u68c0\u6d4b\uff0c\u7075\u654f\u5ea6\u9ad8\u3002NGS\u53ef\u4e00\u6b21\u6027\u5e73\u884c\u68c0\u6d4b\u591a\u4e2a\u57fa\u56e0\u591a\u79cd\u53d8\u5f02\uff0c\u540c\u65f6\u68c0\u6d4b\u70b9\u7a81\u53d8\u3001\u5c0f\u7247\u6bb5\u63d2\u5165\u3001\u7f3a\u5931\u7a81\u53d8\u6216\u878d\u5408\u7a81\u53d8\u7b49\u591a\u4e2a\u53d8\u5f02\u7c7b\u578b\uff0c\u5728\u9700\u8981\u5bf9\u6cbb\u7597\u9776\u70b9\u8fdb\u884c\u5e7f\u6cdb\u7b5b\u67e5\u7684\u60c5\u51b5\u4e0b\uff0c\u53ef\u4f5c\u4e3a\u68c0\u6d4b\u76ee\u6807\u57fa\u56e0\u53d8\u5f02\u7684\u9996\u9009\u65b9\u6cd5\u3002<\/p>\n
\u63a8\u8350\u610f\u89c15\uff1a\u5728\u65b0\u8f85\u52a9\u6cbb\u7597\u524d\uff0c\u5bf9\u80bf\u7624\u7ec4\u7ec7\u8fdb\u884c\u57fa\u56e0\u68c0\u6d4b\u6709\u52a9\u4e8e\u53d1\u73b0\u5177\u6709\u6cbb\u7597\u6307\u5bfc\u610f\u4e49\u7684\u5f02\u5e38\u57fa\u56e0\u3002\uff08\u8bc1\u636e\u7b49\u7ea7\uff1aB\uff1b\u63a8\u8350\u7b49\u7ea7\uff1aA\uff09<\/p>\n
2 \u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u65b9\u6848\u9009\u62e9\u7531\u4e8e\u7532\u72b6\u817a\u764c\u5bf9\u653e\u5316\u7597\u4e0d\u654f\u611f\uff0c\u76ee\u524d\u9776\u5411\u6cbb\u7597\u662f\u4e3b\u8981\u7684\u65b0\u8f85\u52a9\u6cbb\u7597\u65b9\u5f0f\u3002\u7532\u72b6\u817a\u764c\u7684\u9776\u5411\u6cbb\u7597\u836f\u7269\u4e3b\u8981\u5206\u4e3a\u591a\u9776\u70b9\u916a\u6c28\u9178\u6fc0\u9176\u6291\u5236\u5242\uff08multi-target tyrosine kinase inhibitor\uff0cmTKI\uff09\u53ca\u9ad8\u9009\u62e9\u6027\u6291\u5236\u5242\uff0c\u540e\u8005\u662f\u57fa\u4e8e\u7279\u5f02\u6027\u57fa\u56e0\u7a81\u53d8\u7684\u7cbe\u51c6\u6cbb\u7597\uff0c\u5f80\u5f80\u5177\u6709\u66f4\u9ad8\u7684\u5ba2\u89c2\u53cd\u5e94\u7387\uff08objective response rate\uff0cORR\uff09\uff0c\u4ee5\u53ca\u8f83\u5c11\u7684\u4e0d\u826f\u53cd\u5e94\u3002\u5728\u9776\u5411\u6cbb\u7597\u7684\u57fa\u7840\u4e0a\u52a0\u7528\u514d\u75ab\u6cbb\u7597\uff0c\u5728\u7532\u72b6\u817a\u672a\u5206\u5316\u764c\uff08anaplastic thyroid cancer\uff0cATC\uff09\u6216\u5206\u5316\u5dee\u7684\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u4e2d\u8f83\u5e38\u91c7\u7528\u3002\u5728\u5236\u5b9a\u65b0\u8f85\u52a9\u9776\u5411\u6cbb\u7597\u7684\u65b9\u6848\u65f6\uff0c\u9700\u8981\u7efc\u5408\u8003\u8651\u836f\u7269\u7684\u6709\u6548\u6027\u3001\u53ef\u53ca\u6027\u3001\u5b89\u5168\u6027\u53ca\u6210\u672c\u6548\u76ca\uff0c\u505a\u51fa\u9002\u5408\u75c5\u4eba\u7684\u6700\u4f73\u9009\u62e9\uff08\u56fe1\uff09\u3002<\/p>\n
2.1 \u9776\u5411\u6cbb\u7597<\/p>\n
2.1.1 mTKI \u9274\u4e8e\u7532\u72b6\u817a\u764c\u4e2d\u5e7f\u6cdb\u5b58\u5728\u8840\u7ba1\u5185\u76ae\u751f\u957f\u56e0\u5b50\u53ca\u5176\u53d7\u4f53\u7684\u9ad8\u8868\u8fbe\uff0cmTKI\u5728\u4e0d\u540c\u75c5\u7406\u5b66\u5206\u578b\u7532\u72b6\u817a\u764c\u4e2d\u7684\u5e94\u7528\u5747\u6709\u62a5\u9053\u3002\u622a\u81f32023\u5e745\u6708\uff0c\u5728\u7898\u6cbb\u7597\u62b5\u6297\u7684\u5206\u5316\u578b\u7532\u72b6\u817a\u764c\uff08differentiated thyroid cancer\uff0cDTC\uff09\u4e2d\uff0c\u4ed1\u4f10\u66ff\u5c3c\u3001\u7d22\u62c9\u975e\u5c3c\u3001\u5b89\u7f57\u66ff\u5c3c\u3001\u591a\u7eb3\u975e\u5c3c\u4e3a\u56fd\u5bb6\u836f\u54c1\u76d1\u7763\u7ba1\u7406\u5c40\uff08National Medical Products Administration\uff0cNMPA\uff09\u6279\u51c6\u7684\u9776\u5411\u836f\u7269\uff1b\u5728\u7532\u72b6\u817a\u9ad3\u6837\u764c\uff08medullary thyroid cancer\uff0cMTC\uff09\u4e2d\uff0c\u4ec5\u5b89\u7f57\u66ff\u5c3c\u4e3aNMPA\u6279\u51c6\u7684\u9776\u5411\u836f\u7269\u3002\u5728\u65b0\u8f85\u52a9\u6cbb\u7597\u4e2d\uff0cmTKI\u7684\u5e94\u7528\u591a\u5c40\u9650\u4e8e\u5c0f\u6837\u672c\u7684\u4e34\u5e8a\u7814\u7a76\u53ca\u75c5\u4f8b\u62a5\u544a\u3002<\/p>\n
\u4ed1\u4f10\u66ff\u5c3c\u7528\u4e8e\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u7684\u65b0\u8f85\u52a9\u6cbb\u7597\u5df2\u6709\u4e0d\u5c11\u6848\u4f8b\u62a5\u9053\uff3b12-14\uff3d\uff0c\u63d0\u793a\u4ed1\u4f10\u66ff\u5c3c\u53ef\u5728DTC\u3001MTC\u3001\u5206\u5316\u5dee\u7684DTC\u751a\u81f3ATC\u4e2d\u6709\u6548\u7f29\u5c0f\u80bf\u7624\uff0c\u63d0\u9ad8\u624b\u672f\u5207\u9664\u7387\u3002\u4f46\u4e00\u9879\u5165\u7ec410\u4f8bATC\u75c5\u4eba\u7684\u771f\u5b9e\u4e16\u754c\u7814\u7a76\u89c2\u5bdf\u53d1\u73b0\uff0c\u4ed1\u4f10\u66ff\u5c3c\u7684\u5feb\u901f\u7f29\u5c0f\u80bf\u7624\u4f5c\u7528\u4ea7\u751f\u4e86\u81f4\u6b7b\u6027\u4e0d\u826f\u4e8b\u4ef6\uff3b13\uff3d\uff0c\u56e0\u6b64\u5bf9\u4e8e\u65b0\u8f85\u52a9\u6cbb\u7597\u4e2d\u4ed1\u4f10\u66ff\u5c3c\u7684\u7528\u6cd5\u53ca\u7528\u91cf\u5c1a\u9700\u6301\u8c28\u614e\u6001\u5ea6\u3002<\/p>\n
\u5b89\u7f57\u66ff\u5c3c\u662f\u56fd\u4ea7\u539f\u7814mTKI\u3002\u5728\u4e00\u9879\u5355\u81c2\u2161\u671f\u4e34\u5e8a\u7814\u7a76\u4e2d\u5171\u5165\u7ec413\u4f8b\u5c40\u90e8\u8fdb\u5c55\u671fDTC\u75c5\u4eba\uff0c\u5e73\u5747\u63a5\u53d73.5\u4e2a\u5468\u671f\u7684\u5b89\u7f57\u66ff\u5c3c\u65b0\u8f85\u52a9\u6cbb\u7597\uff0c\u5176ORR\u8fbe76.9%\u3002\u6700\u7ec89\u4f8b\u75c5\u4eba\u63a5\u53d7\u624b\u672f\uff0c\u6574\u4f53\u4eba\u7fa4\u7684R0\u6216R1\u5207\u9664\u7387\u4e3a61.5%\uff0c\u7b26\u5408\u65b9\u6848\u4eba\u7fa4\u7684R0\u6216R1\u5207\u9664\u7387\u4e3a72.7%\uff3b1\uff3d\u3002<\/p>\n
\u9664\u6b64\u4e4b\u5916\uff0c\u7d22\u62c9\u975e\u5c3c\uff3b15-16\uff3d\u3001\u963f\u5e15\u66ff\u5c3c\uff3b17\uff3d\u5728\u65b0\u8f85\u52a9\u6cbb\u7597\u5c40\u90e8\u8fdb\u5c55\u671fDTC\u4e2d\u5747\u6709\u4e2a\u6848\u62a5\u9053\u3002\u8212\u5c3c\u66ff\u5c3c\u5728\u65b0\u8f85\u52a9\u6cbb\u7597\u5c40\u90e8\u8fdb\u5c55\u671fMTC\u4e2d\u4e5f\u6709\u75c5\u4f8b\u62a5\u9053\uff3b18\uff3d\u3002<\/p>\n
\u63a8\u8350\u610f\u89c16\uff1a\u5bf9\u4e8e\u4e0d\u540c\u75c5\u7406\u5b66\u4e9a\u578b\u7684\u5c40\u90e8\u8fdb\u5c55\u671f\u4e0d\u53ef\u5207\u9664\u7532\u72b6\u817a\u764c\uff0cmTKI\u5747\u4e3a\u53ef\u4ee5\u9009\u7528\u7684\u65b0\u8f85\u52a9\u6cbb\u7597\u65b9\u6848\u3002\uff08\u8bc1\u636e\u7b49\u7ea7\uff1aD\uff1b\u63a8\u8350\u7b49\u7ea7\uff1aB\uff09<\/p>\n
2.1.2 BRAF\u7279\u5f02\u6027\u6291\u5236\u5242 \u5728DTC\u53caATC\u4e2d\uff0cBRAF V600E\u662f\u6700\u5e38\u89c1\u7684\u57fa\u56e0\u7a81\u53d8\u7c7b\u578b\uff3b19\uff3d\u3002\u5176\u4e2d\uff0cBRAF\u6291\u5236\u5242\u8fbe\u62c9\u975e\u5c3c\u8054\u5408MEK\u6291\u5236\u5242\u66f2\u7f8e\u66ff\u5c3c\u6cbb\u7597BRAF V600E\u7a81\u53d8\u9633\u6027\u3001\u5c40\u90e8\u8fdb\u5c55\u671f\u6216\u8f6c\u79fb\u6027ATC\u7684\u9002\u5e94\u8bc1\u5df2\u88ab\u7f8e\u56fd\u98df\u54c1\u836f\u54c1\u76d1\u7763\u7ba1\u7406\u5c40\uff08FDA\uff09\u6279\u51c6\u3002Wang\u7b49\uff3b20\uff3d\u62a5\u90536\u4f8b\u8fbe\u62c9\u975e\u5c3c\u8054\u5408\u66f2\u7f8e\u66ff\u5c3c\u65b0\u8f85\u52a9\u6cbb\u7597\u5c40\u90e8\u8fdb\u5c55\u671fBRAF\u7a81\u53d8ATC\u75c5\u4eba\uff0c\u5747\u8fbe\u5230R0\u6216R1\u5207\u9664\uff0c\u672f\u540e\u653e\u7597\u52a0\u9776\u5411\u6cbb\u7597\u7ef4\u6301\u3002\u5728\u77ed\u671f\u968f\u8bbf\u4e2d\uff0c6\u4e2a\u6708\u603b\u751f\u5b58\u7387\u4e3a 100%\uff0c12\u4e2a\u6708\u603b\u751f\u5b58\u7387\u4e3a 83%\uff0c\u65e0\u5c40\u90e8\u590d\u53d1\uff0c2\u4f8b\u8fdc\u5904\u8f6c\u79fb\u3002<\/p>\n
BRAF\u6291\u5236\u5242\u5728DTC\u65b0\u8f85\u52a9\u6cbb\u7597\u4e2d\u5e94\u7528\u5c1a\u65e0\u6587\u732e\u62a5\u9053\u3002\u5728\u8fdb\u5c55\u671f\u7898\u6cbb\u7597\u62b5\u6297DTC\u4e2d\uff0c\u8fbe\u62c9\u975e\u5c3c\u5355\u836f\u3001\u8fbe\u62c9\u975e\u5c3c\u8054\u5408\u66f2\u7f8e\u66ff\u5c3c\u7684ORR\u5206\u522b\u4e3a35%\u53ca30%\uff3b21\uff3d\uff0c\u6709\u6548\u7387\u4f4e\u4e8e\u4ed1\u4f10\u66ff\u5c3c\u3001\u5b89\u7f57\u66ff\u5c3c\uff0c\u6545\u4e00\u822c\u4e0d\u4f5c\u4e3a\u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u9996\u9009\u65b9\u6848\u3002<\/p>\n
\u63a8\u8350\u610f\u89c17\uff1a\u63a8\u8350\u5bf9\u5177\u6709BRAF\u7a81\u53d8\u7684\u5c40\u90e8\u8fdb\u5c55\u671f\u4e0d\u53ef\u5207\u9664ATC\u75c5\u4eba\u4f7f\u7528\u8fbe\u62c9\u975e\u5c3c\u4e0e\u66f2\u7f8e\u66ff\u5c3c\u8054\u5408\u8fdb\u884c\u65b0\u8f85\u52a9\u6cbb\u7597\u3002\uff08\u8bc1\u636e\u7b49\u7ea7\uff1aB\uff1b\u63a8\u8350\u7b49\u7ea7\uff1aA\uff09<\/p>\n
2.1.3 RET\u7279\u5f02\u6027\u6291\u5236\u5242 RET\u57fa\u56e0\u53d8\u5f02\u4e5f\u662f\u7532\u72b6\u817a\u764c\u4e2d\u5e38\u89c1\u53d8\u5f02\u4f4d\u70b9\uff0c\u7ea6\u670910%\uff5e20%\u7684\u4e73\u5934\u72b6\u764c\u5b58\u5728RET\u57fa\u56e0\u878d\u5408\u3001\u91cd\u6392\uff0c\u7ea6\u670950%\uff5e70%\u7684MTC\u5b58\u5728RET\u57fa\u56e0\u7a81\u53d8\uff3b22\uff3d\u3002\u585e\u666e\u66ff\u5c3c\u53ca\u666e\u62c9\u66ff\u5c3c\u5747\u4e3aRET\u7279\u5f02\u6027\u6291\u5236\u5242\uff0cNMPA\u6279\u51c6\u7528\u4e8e\u6cbb\u7597\u8fdb\u5c55\u671fRET\u57fa\u56e0\u7a81\u53d8\u7684MTC\u53caRET\u878d\u5408\u7a81\u53d8\u7684\u7898\u6cbb\u7597\u62b5\u6297DTC\uff0c\u5176\u4e00\u7ebfORR\u53ef\u8fbe71.6%\uff5e92.0%\uff0c\u4e14\u5bf9\u4e00\u7ebfmTKI\u6cbb\u7597\u540e\u7684\u75c5\u4eba\u540c\u6837\u6709\u6548\uff3b23-24\uff3d\u3002\u76ee\u524d\u4e5f\u6709\u585e\u666e\u66ff\u5c3c\u65b0\u8f85\u52a9\u6cbb\u7597\u5c40\u90e8\u8fdb\u5c55\u671fMTC\u7684\u75c5\u4f8b\u62a5\u9053\uff0c\u75c5\u4eba\u83b7\u5f97\u4e86\u6839\u6cbb\u6027\u5207\u9664\uff0c\u751f\u5316\u68c0\u67e5\u53ca\u5f71\u50cf\u5b66\u68c0\u67e5\u5747\u65e0\u590d\u53d1\uff3b25\uff3d\u3002<\/p>\n
\u63a8\u8350\u610f\u89c18\uff1a\u5bf9\u5177\u6709RET\u53d8\u5f02\u7684\u5c40\u90e8\u8fdb\u5c55\u671f\u4e0d\u53ef\u5207\u9664MTC\u53caDTC\u75c5\u4eba\u53ef\u8003\u8651\u4f7f\u7528\u585e\u666e\u66ff\u5c3c\u6216\u666e\u62c9\u66ff\u5c3c\u8fdb\u884c\u65b0\u8f85\u52a9\u6cbb\u7597\u3002\uff08\u8bc1\u636e\u7b49\u7ea7\uff1aC\uff1b\u63a8\u8350\u7b49\u7ea7\uff1aB\uff09<\/p>\n
2.1.4 \u5176\u4ed6\u9776\u5411\u836f\u7269 NTRK\u878d\u5408\u7a81\u53d8\u662f\u7532\u72b6\u817a\u764c\u4e2d\u53e6\u4e00\u4e2a\u7cbe\u51c6\u6cbb\u7597\u7684\u9776\u70b9\uff0c\u5176\u9ad8\u9009\u62e9\u6027\u6291\u5236\u5242\u62c9\u7f57\u66ff\u5c3c\u548c\u6069\u66f2\u66ff\u5c3c\u5df2\u88ab\u7f8e\u56fdFDA\u6279\u51c6\u6cbb\u7597NTRK\u878d\u5408\u7a81\u53d8\u665a\u671f\u5b9e\u4f53\u7624\uff0c\u5176\u6cbb\u7597\u7532\u72b6\u817a\u764c\u7684ORR\u9ad8\u8fbe71%\uff3b26\uff3d\uff0c\u4f46\u76ee\u524d\u5728\u65b0\u8f85\u52a9\u6cbb\u7597\u4e2d\u672a\u89c1\u62a5\u9053\u3002\u5176\u4ed6\u9776\u5411\u836f\u7269\u5982MEK\u6291\u5236\u5242\u8003\u6bd4\u66ff\u5c3c\u3001\u6bd4\u7f8e\u66ff\u5c3c\u548c\u53f8\u7f8e\u66ff\u5c3c\uff0c\u4ecd\u5728\u4e34\u5e8a\u7814\u7a76\u9636\u6bb5\uff3b27\uff3d\u3002<\/p>\n
\u63a8\u8350\u610f\u89c19\uff1a\u63a8\u8350\u5bf9\u5177\u6709NTRK\u878d\u5408\u7a81\u53d8\u7684\u5c40\u90e8\u8fdb\u5c55\u671f\u4e0d\u53ef\u5207\u9664\u7532\u72b6\u817a\u764c\u4f7f\u7528\u62c9\u7f57\u66ff\u5c3c\u6216\u6069\u66f2\u66ff\u5c3c\u8fdb\u884c\u65b0\u8f85\u52a9\u6cbb\u7597\u3002\uff08\u8bc1\u636e\u7b49\u7ea7\uff1aC\uff1b\u63a8\u8350\u7b49\u7ea7\uff1aB\uff09<\/p>\n
2.2 \u5316\u7597\u6216\u653e\u5316\u7597<\/p>\n
2.2.1 DTC\u53caMTC DTC\u53caMTC\u5bf9\u653e\u3001\u5316\u7597\u4e0d\u654f\u611f\uff0c\u65b0\u8f85\u52a9\u653e\u5316\u7597\u5728\u5c40\u90e8\u8fdb\u5c55\u671fDTC\u53caMTC\u4e2d\u7684\u7597\u6548\u5c1a\u672a\u5f97\u5230\u80af\u5b9a\u7ed3\u8bba\uff3b28\uff3d\u3002Besic\u7b49\uff3b3, 29\uff3d\u62a5\u9053\u5728\u5c40\u90e8\u8fdb\u5c55\u671fDTC\u4e2d\uff0c\u4ee5\u957f\u6625\u65b0\u78b1\u3001\u963f\u9709\u7d20\u4e3a\u4e3b\u7684\u65b0\u8f85\u52a9\u5316\u7597\u53ef\u4ee5\u4f7f\uff1e40%\u7684\u75c5\u4eba\u80bf\u7624\u6709\u6548\u9000\u7f29\u3002\u5316\u7597\u65b9\u6848\u4e00\u822c\u4f7f\u7528\u542b\u7d2b\u6749\u7c7b\u836f\u7269\uff0c\u8fd8\u53ef\u8054\u5408\u84bd\u73af\u7c7b\u836f\u7269\u6216\u94c2\u7c7b\u8fdb\u884c\u5316\u7597\uff3b19\uff3d\u3002\u4f46\u968f\u7740\u9776\u5411\u6cbb\u7597\u7684\u53d1\u5c55\uff0c\u65b0\u8f85\u52a9\u653e\u5316\u7597\u5728DTC\u53caMTC\u4e2d\u7684\u5e94\u7528\u5df2\u65e0\u540e\u7eed\u62a5\u9053\u3002<\/p>\n
2.2.2 ATC \u5bf9\u4e8e\u5c40\u90e8\u8fdb\u5c55\u671fATC\uff0c\u672f\u524d\u65b0\u8f85\u52a9\u653e\u3001\u5316\u7597\u6216\u53ef\u80fd\u6709\u6548\u51cf\u8f7b\u80bf\u7624\u8d1f\u8377\uff0c\u5e76\u4e3a\u66f4\u5927\u8303\u56f4\u7684\u6839\u6cbb\u6027\u624b\u672f\u63d0\u4f9b\u53ef\u80fd\u3002\u5e38\u7528\u7684\u65b0\u8f85\u52a9\u5316\u7597\u836f\u7269\u5305\u62ec\u7d2b\u886b\u7c7b\u3001\u84bd\u73af\u7c7b\u548c\u94c2\u7c7b\uff3b30-31\uff3d\u3002Higashiyama\u7b49\uff3b32\uff3d\u62a5\u9053\uff0c\u7d2b\u6749\u9187\u5355\u5468\u65b9\u6848\u65b0\u8f85\u52a9\u6cbb\u7597\u2163B\u671fATC\uff0c\u53ef\u4f7f33%\u7684\u75c5\u4eba\u8fbe\u5230\u90e8\u5206\u6216\u5b8c\u5168\u7f13\u89e3\u5e76\u63a5\u53d7\u6839\u6cbb\u6027\u624b\u672f\uff0c\u603b\u751f\u5b58\u65f6\u95f4\u660e\u663e\u957f\u4e8e\u5bf9\u7167\u7ec4\u3002\u5168\u5242\u91cf\u6216\u90e8\u5206\u5242\u91cf\u65b0\u8f85\u52a9\u653e\u7597\u53ef\u63d0\u9ad8\u90e8\u5206\u5c40\u90e8\u8fdb\u5c55\u671fATC\u75c5\u4eba\u6839\u6cbb\u6027\u624b\u672f\u6210\u529f\u7387\u6216\u8fbe\u5230\u521d\u59cb\u624b\u672f\u76f8\u540c\u6cbb\u7597\u6548\u679c\uff0c\u4ece\u800c\u53ef\u4ee5\u5141\u8bb8\u5ef6\u8fdf\u63a5\u53d7\u521d\u6b21\u624b\u672f\u7684\u65f6\u95f4\uff3b19, 33\uff3d\u3002\u76ee\u524d\u7f8e\u56fd\u56fd\u5bb6\u7efc\u5408\u764c\u75c7\u7f51\u7edc\uff08NCCN\uff09\u6307\u5357\u63a8\u8350\uff0c\u5bf9\u5c40\u90e8\u8fdb\u5c55\u671f\u2163A\u3001\u2163B\u671fATC\u75c5\u4eba\u53ef\u8003\u8651\u884c\u65b0\u8f85\u52a9\u653e\u5316\u7597\uff0c\u6839\u636e\u7597\u6548\u8003\u8651\u624b\u672f\u65f6\u673a\uff3b34\uff3d\u3002\u90e8\u5206\u5c40\u90e8\u8fdb\u5c55\u671fATC\u75c5\u4eba\u53ef\u4ee5\u8fbe\u5230\u90e8\u5206\u7f13\u89e3\u751a\u81f3\u5b8c\u5168\u7f13\u89e3\u7684\u7597\u6548\uff0c\u4ece\u800c\u6210\u529f\u63a5\u53d7\u6839\u6cbb\u6027\u624b\u672f\uff0c\u603b\u751f\u5b58\u65f6\u95f4\u4ea6\u6709\u6240\u5ef6\u957f\uff3b20\uff0c33\uff0c35\uff3d\u3002\u4f46\u8fc4\u4eca\u5c1a\u65e0\u65b0\u8f85\u52a9\u653e\u5316\u7597\u4e0e\u65b0\u8f85\u52a9\u9776\u5411\u6cbb\u7597\u5728\u5c40\u8fdb\u5c55ATC\u4e2d\u7597\u6548\u6bd4\u8f83\u7684\u7814\u7a76\u3002<\/p>\n
\u63a8\u8350\u610f\u89c110\uff1a\u5bf9\u4e8e\u90e8\u5206\u5c40\u90e8\u8fdb\u5c55\u671fATC\uff0c\u5c24\u5176\u662f\u4e0d\u9002\u5408\u65b0\u8f85\u52a9\u9776\u5411\u6cbb\u7597\u7684\u75c5\u4eba\u53ef\u8003\u8651\u884c\u65b0\u8f85\u52a9\u5316\u7597\u6216\u653e\u5316\u7597\u4ee5\u63d0\u9ad8\u624b\u672f\u5207\u9664\u7387\u3002\uff08\u8bc1\u636e\u7b49\u7ea7\uff1aC\uff1b\u63a8\u8350\u7b49\u7ea7\uff1aB\uff09<\/p>\n
2.3 \u514d\u75ab\u6cbb\u7597 \u514d\u75ab\u6cbb\u7597\u5728\u65b0\u8f85\u52a9\u6cbb\u7597\u4e2d\u7684\u4f5c\u7528\u4ecd\u5904\u4e8e\u63a2\u7d22\u9636\u6bb5\uff0c\u591a\u4e0e\u9776\u5411\u6cbb\u7597\u8054\u5408\u5e94\u7528\uff0c\u4f46\u76f8\u5173\u4e34\u5e8a\u8bd5\u9a8c\u62a5\u9053\u8f83\u5c11\uff0c\u5728\u5176\u9002\u5e94\u8bc1\u3001\u6cbb\u7597\u6d41\u7a0b\u3001\u672f\u540e\u6cbb\u7597\u3001\u751f\u5b58\u83b7\u76ca\u7b49\u65b9\u9762\u4ecd\u7f3a\u4e4f\u8db3\u591f\u5faa\u8bc1\u533b\u5b66\u4f9d\u636e\u3002\u5bf9\u4e8e\u7a0b\u5e8f\u6027\u6b7b\u4ea1\u914d\u4f531\uff08PD-L1\uff09\u8868\u8fbe\u9633\u6027\u7684\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\uff0c\u5c24\u5176\u662fATC\u53ca\u5206\u5316\u5dee\u7684\u764c\uff0c\u53ef\u8003\u8651\u884c\u7a0b\u5e8f\u6027\u6b7b\u4ea1\u56e0\u5b50-1\uff08PD-1\uff09\u6216\u7a0b\u5e8f\u6027\u6b7b\u4ea1\u914d\u4f53-1\uff08PD-L1\uff09\u6291\u5236\u5242\u7684\u6cbb\u7597\uff3b19\uff3d\u3002<\/p>\n
\u8fbe\u62c9\u975e\u5c3c\u8054\u5408\u66f2\u7f8e\u66ff\u5c3c\u65b0\u8f85\u52a9\u6cbb\u7597\u5c40\u90e8\u8fdb\u5c55\u671fBRAF\u7a81\u53d8ATC\u76846\u4f8b\u75c5\u4eba\u4e2d\uff0c\u67092\u4f8b\u540c\u65f6\u884c\u65b0\u8f85\u52a9PD-1\u6291\u5236\u5242\u7684\u6cbb\u7597\u3002\u5176\u4e2d1\u4f8b\u5728\u8fbe\u62c9\u975e\u5c3c\u8054\u5408\u66f2\u7f8e\u66ff\u5c3c\u6cbb\u7597\u540e\u539f\u53d1\u7076\u90e8\u5206\u7f13\u89e3\uff0c\u4f46\u9501\u9aa8\u4e0a\u8f6c\u79fb\u6dcb\u5df4\u7ed3\u589e\u5927\uff0c\u6545\u5728\u539f\u65b9\u6848\u57fa\u7840\u4e0a\u52a0\u7528PD-1\u6291\u5236\u5242\u6cbb\u7597\uff0c3\u4e2a\u7597\u7a0b\u540e\u624b\u672f\u5b8c\u6574\u5207\u9664\u80bf\u7624\uff3b20\uff3d\u3002<\/p>\n
\u4e00\u9879\u5355\u81c2\u2161\u671f\u7814\u7a76\u63a2\u7d22\u4e86\u7d22\u51e1\u66ff\u5c3c\u8054\u5408PD-1\u6291\u5236\u5242\u65b0\u8f85\u52a9\u6cbb\u7597\u5c40\u90e8\u8fdb\u5c55\u671fDTC\u7684\u7597\u6548\u3002\u8be5\u7814\u7a76\u5165\u7ec4\u4e8610\u4f8b\u5c40\u90e8\u8fdb\u5c55\u671fDTC\u75c5\u4eba\uff0cORR\u4e3a60%\uff0c\u5176\u4e2d9\u4f8b\u75c5\u4eba\u63a5\u53d7\u4e86\u624b\u672f\u5207\u9664\uff0c\u5747\u8fbe\u5230R0\u6216R1\u5207\u9664\uff08R0\u6216R1\u5207\u9664\u7387\u4e3a90%\uff09\uff3b36\uff3d\u3002\u4f46\u5c1a\u65e0\u5934\u5bf9\u5934\u7684\u4e34\u5e8a\u8bc1\u636e\u8868\u660e\u9776\u5411\u6cbb\u7597\u8054\u5408\u514d\u75ab\u6cbb\u7597\u5728\u65b0\u8f85\u52a9\u6cbb\u7597\u4e2d\u7684\u7597\u6548\u4f18\u4e8e\u5355\u7eaf\u9776\u5411\u6cbb\u7597\u3002<\/p>\n
3 \u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u8bc4\u4f30<\/p>\n
3.1 \u65b0\u8f85\u52a9\u6cbb\u7597\u524d\u7684\u5168\u8eab\u8bc4\u4f30 \u5728\u5f00\u59cb\u65b0\u8f85\u52a9\u6cbb\u7597\u524d\uff0c\u9700\u8981\u5bf9\u75c5\u4eba\u7684\u5168\u8eab\u60c5\u51b5\u8fdb\u884c\u8bc4\u4f30\uff0c\u5305\u62ec\u65e2\u5f80\u7532\u72b6\u817a\u764c\u7684\u6cbb\u7597\u53f2\u3001\u836f\u7269\u8fc7\u654f\u53ca\u9ad8\u8840\u538b\u7b49\u75c5\u53f2\u3001\u5408\u5e76\u75c7\u4ee5\u53ca\u8f85\u52a9\u68c0\u67e5\u3002\u8f85\u52a9\u68c0\u67e5\u5efa\u8bae\u5305\u542b\u8840\u5e38\u89c4\u3001\u809d\u80be\u529f\u80fd\u3001\u7535\u89e3\u8d28\u3001\u7532\u72b6\u817a\u529f\u80fd\u3001\u5c3f\u5e38\u89c4\u3001\u51fa\u51dd\u8840\u529f\u80fd\u3001\u5fc3\u7535\u56fe\u7b49\uff0c\u4ee5\u8bc4\u4f30\u75c5\u4eba\u5bf9\u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u8010\u53d7\u6027\uff0c\u5e76\u4f5c\u4e3a\u57fa\u7ebf\u6570\u636e\u4e0e\u6cbb\u7597\u8fc7\u7a0b\u4e2d\u7684\u68c0\u67e5\u8fdb\u884c\u5bf9\u6bd4\u3002<\/p>\n
3.2 \u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u7597\u6548\u8bc4\u4f30<\/p>\n
3.2.1 \u5f71\u50cf\u5b66\u8bc4\u4f30\u65b9\u6cd5 \u53c2\u7167\u5b9e\u4f53\u80bf\u7624\u7597\u6548\u8bc4\u4f30\u6807\u51c61.1\uff08Response Evaluation Criteria in Solid Tumors1.1\uff0cRECIST 1.1\uff09\u6765\u8bc4\u4f30\u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u7597\u6548\uff0c\u5373\u6839\u636e\u5f71\u50cf\u5b66\u80bf\u7624\u9776\u75c5\u7076\u7684\u603b\u548c\u4e0e\u65b0\u8f85\u52a9\u6cbb\u7597\u524d\u57fa\u7ebf\u7684\u53d8\u5316\u60c5\u51b5\uff0c\u5224\u5b9a\u6cbb\u7597\u53cd\u5e94\uff0c\u5305\u62ec\u5b8c\u5168\u7f13\u89e3\uff08complete response\uff0cCR\uff09\u3001\u90e8\u5206\u7f13\u89e3\uff08partial response\uff0cPR\uff09\u3001\u75be\u75c5\u8fdb\u5c55\uff08progressive disease\uff0cPD\uff09\u548c\u75be\u75c5\u7a33\u5b9a\uff08stable disease\uff0cSD\uff09\uff3b37\uff3d\u3002\u4e00\u822c\u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u8bc4\u4f30\u95f4\u9694\u4e3a2\u4e2a\u5468\u671f\uff0c\u4ee5\u53ca\u65f6\u8bc4\u4ef7\u80bf\u7624\u7684\u9000\u7f29\u7a0b\u5ea6\uff0c\u628a\u63e1\u624b\u672f\u6cbb\u7597\u7684\u65f6\u673a\uff0c\u82e5\u6709\u7597\u6548\u4e0d\u4f73\u6216PD\u7684\u60c5\u51b5\u53ef\u53ca\u65f6\u8c03\u6574\u6cbb\u7597\u65b9\u6848\u3002<\/p>\n
\u5bf9\u4e8e\u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u7597\u7a0b\u5c1a\u65e0\u5171\u8bc6\u3002\u6587\u732e\u62a5\u9053\u7532\u72b6\u817a\u764c\u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u4e2d\u4f4d\u6301\u7eed\u65f6\u95f4\u4e3a4.3\u4e2a\u6708\uff3b38\uff3d\uff0c\u5177\u4f53\u5230\u4e0d\u540c\u836f\u7269\uff0c\u53ef\u53c2\u8003\u665a\u671f\u75c5\u4eba\u4e2d\u836f\u7269\u81f3\u7f13\u89e3\u65f6\u95f4\u8fdb\u884c\u8bc4\u4f30\u3002\u7531\u4e8e\u80bf\u7624\u7684\u53ef\u5207\u9664\u6027\u548c\u5f71\u50cf\u5b66\u4e0a\u80bf\u7624\u7684\u9000\u7f29\u60c5\u51b5\u6ca1\u6709\u76f4\u63a5\u5173\u8054\uff0c\u56e0\u6b64\u5e76\u4e0d\u80fd\u7528\u662f\u5426\u8fbe\u5230PR\u6216CR\u4f5c\u4e3a\u53ef\u624b\u672f\u7684\u6807\u51c6\uff0c\u80fd\u5426\u8f6c\u5316\u4e3a\u53ef\u624b\u672f\u7684\u7532\u72b6\u817a\u764c\u4ecd\u9700\u8981MDT\u8ba8\u8bba\u51b3\u5b9a\u3002<\/p>\n
\u63a8\u8350\u610f\u89c111\uff1a\u91c7\u7528\u5f71\u50cf\u5b66RECIST 1.1\u6807\u51c6\u5bf9\u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u7597\u6548\u8fdb\u884c\u8bc4\u4f30\u3002\uff08\u8bc1\u636e\u7ea7\u522b\uff1aB\uff1b\u63a8\u8350\u7ea7\u522b\uff1aA\uff09<\/p>\n
3.2.2 \u75c5\u7406\u5b66\u8bc4\u4f30 \u76ee\u524d\uff0c\u5bf9\u4e8e\u65b0\u8f85\u52a9\u6cbb\u7597\u540e\u7532\u72b6\u817a\u764c\u7684\u75c5\u7406\u5b66\u8bc4\u4f30\u53ca\u62a5\u544a\u6807\u51c6\u5c1a\u65e0\u5171\u8bc6\uff0c\u53c2\u8003\u5176\u4ed6\u764c\u79cd\u65b0\u8f85\u52a9\u6cbb\u7597\u540e\u7684\u75c5\u7406\u5b66\u8bc4\u4f30\uff0c\u5e94\u5c3d\u53ef\u80fd\u8fbe\u5230\u5168\u9762\u7684\u80bf\u7624\u5927\u4f53\u53ca\u7ec4\u7ec7\u5b66\u8bc4\u4f30\uff0c\u4ee5\u5224\u65ad\u75c5\u7406\u7f13\u89e3\u60c5\u51b5\uff3b39\uff3d\u3002\u5176\u4e2d\uff0c\u4e3b\u8981\u75c5\u7406\u5b66\u7f13\u89e3\uff08major pathology response\uff0cMPR\uff09\u6307\u6d3b\u6027\u7684\u80bf\u7624\u6210\u5206\u51cf\u5c11\u5230\u67d0\u4e00\u4e34\u754c\u503c\u4ee5\u4e0b\uff0c\u5982\u5728\u80ba\u764c\u4e2d\uff0cMPR\u5b9a\u4e49\u4e3a\u6b8b\u5b58\u6d3b\u80bf\u7624\u7ec6\u80de\u7684\u767e\u5206\u6bd4 \u226410%\uff1b\u5b8c\u5168\u75c5\u7406\u5b66\u7f13\u89e3\uff08complete pathology response\uff0cCPR\uff09\u6307\u6ca1\u6709\u4efb\u4f55\u6d3b\u6027\u7684\u80bf\u7624\u7ec6\u80de\u3002MPR\u53caCPR\u90fd\u662f\u5224\u65ad\u65b0\u8f85\u52a9\u6cbb\u7597\u540e\u7597\u6548\u7684\u91cd\u8981\u6307\u6807\u3002\u9664\u6b64\u4e4b\u5916\uff0c\u8fd8\u5e94\u8be6\u7ec6\u62a5\u544a\u80bf\u7624\u7684\u75c5\u7406\u5b66\u7c7b\u578b\u53ca\u4e9a\u578b\uff0c\u5468\u56f4\u7ed3\u6784\u7684\u6d78\u6da6\u7d2f\u53ca\u60c5\u51b5\uff0c\u4ee5\u53ca\u6dcb\u5df4\u7ed3\u8f6c\u79fb\u60c5\u51b5\uff0c\u5fc5\u8981\u65f6\u7ed3\u5408\u514d\u75ab\u7ec4\u5316\u53ca\u57fa\u56e0\u68c0\u6d4b\u3002<\/p>\n
\u63a8\u8350\u610f\u89c112\uff1a\u5bf9\u65b0\u8f85\u52a9\u6cbb\u7597\u540e\u7684\u624b\u672f\u6807\u672c\u8fdb\u884c\u75c5\u7406\u5b66\u5206\u578b\uff0c\u5e76\u5bf9\u75c5\u7406\u5b66\u7f13\u89e3\u60c5\u51b5\u8fdb\u884c\u5145\u5206\u8bc4\u4f30\u3002\uff08\u8bc1\u636e\u7ea7\u522b\uff1aD\uff1b\u63a8\u8350\u7ea7\u522b\uff1aB\uff09<\/p>\n
3.2.3 \u624b\u672f\u5207\u7f18\u8bc4\u4f30 \u5728\u624b\u672f\u8fc7\u7a0b\u4e2d\uff0c\u5e94\u8bc4\u4f30\u80bf\u7624\u5207\u7f18\uff0c\u4ee5\u8bc4\u4ef7\u80bf\u7624\u662f\u5426\u5b8c\u6574\u5207\u9664\uff0c\u4e3a\u540e\u7eed\u6cbb\u7597\u63d0\u4f9b\u4f9d\u636e\u3002R0\u5207\u9664\u6307\u5728\u663e\u5fae\u955c\u4e0b\u65e0\u80bf\u7624\u6b8b\u7559\uff1bR1\u5207\u9664\u6307\u80bf\u7624\u65e0\u8089\u773c\u6b8b\u7559\uff0c\u4f46\u6709\u955c\u4e0b\u6b8b\u7559\uff1bR2\u5207\u9664\u6307\u80bf\u7624\u6709\u8089\u773c\u6b8b\u7559\u3002\u65e2\u5f80\u6587\u732e\u62a5\u9053\uff0c\u8fbe\u5230R0\u6216R1\u5207\u9664\u7684\u7532\u72b6\u817a\u764c\u8f83R2\u5207\u9664\u7684\u7532\u72b6\u817a\u764c\u5c40\u90e8\u590d\u53d1\u7387\u663e\u8457\u964d\u4f4e\uff0c\u751f\u5b58\u671f\u663e\u8457\u5ef6\u957f\uff3b40\uff3d\u3002\u56e0\u6b64\uff0c\u662f\u5426\u80fd\u5c06\u65e0\u6cd5\u624b\u672f\u6216\u9884\u8ba1\u624b\u672f\u6709\u6b8b\u7559\u7684\u75c5\u4f8b\u7ecf\u8fc7\u65b0\u8f85\u52a9\u6cbb\u7597\u540e\u8f6c\u5316\u4e3aR0\u6216R1\u5207\u9664\uff0c\u4e5f\u662f\u65b0\u8f85\u52a9\u6cbb\u7597\u6709\u6548\u6027\u7684\u91cd\u8981\u8003\u91cf\u3002<\/p>\n
\u63a8\u8350\u610f\u89c113\uff1a\u5bf9\u65b0\u8f85\u52a9\u6cbb\u7597\u540e\u624b\u672f\u7684\u624b\u672f\u5207\u7f18\u8fdb\u884c\u75c5\u7406\u5b66\u8bc4\u4f30\u3002\uff08\u8bc1\u636e\u7ea7\u522b\uff1aD\uff1b\u63a8\u8350\u7ea7\u522b\uff1aB\uff09<\/p>\n
3.3 \u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u672f\u524d\u505c\u836f\u65f6\u95f4 \u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u672f\u524d\u505c\u836f\u65f6\u95f4\u76ee\u524d\u6ca1\u6709\u7edf\u4e00\u6807\u51c6\uff0c\u6587\u732e\u62a5\u9053\u57281\uff5e42 d\uff0c\u5e73\u5747\u4e3a2\u5468\u5de6\u53f3\uff3b38\uff3d\u3002\u9700\u8981\u7efc\u5408\u8003\u8651\u836f\u7269\u4e0d\u826f\u53cd\u5e94\u7684\u6062\u590d\u60c5\u51b5\u3001\u80bf\u7624\u7684\u51fa\u8840\u98ce\u9669\u3001\u505c\u836f\u540e\u80bf\u7624\u751f\u957f\u7684\u53ef\u80fd\u4ee5\u53ca\u672f\u524d\u51c6\u5907\u7684\u60c5\u51b5\u3002\u636e\u4e00\u9879\u2161\u671f\u4e34\u5e8a\u7814\u7a76\u62a5\u9053\uff0c\u5e94\u7528mTKI\u8fdb\u884c\u65b0\u8f85\u52a9\u6cbb\u7597\uff0c\u6ca1\u6709\u589e\u52a0\u540e\u7eed\u75c5\u4eba\u624b\u672f\u4e2d\u7684\u51fa\u8840\u98ce\u9669\uff3b1\uff3d\u3002<\/p>\n
3.4 \u4e0d\u826f\u53cd\u5e94\u7684\u8bc4\u4f30\u53ca\u7ba1\u7406 \u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u4e0d\u826f\u53cd\u5e94\u9700\u53c2\u8003\u5404\u836f\u7269\u76f8\u5173\u62a5\u9053\uff0c\u8bc4\u4f30\u591a\u91c7\u75285.0 \u7248\u5e38\u89c1\u4e0d\u826f\u4e8b\u4ef6\u8bc4\u4ef7\u6807\u51c6\uff08CTC AE 5.0\uff09\uff0c\u5c06\u4e0d\u826f\u4e8b\u4ef6\u7531\u8f7b\u5230\u91cd\u5206\u4e3a1\uff5e5\u7ea7\u3002\u603b\u4f53\u800c\u8a00\uff0c\u53d1\u751f 1\uff5e2 \u7ea7\u4e0d\u826f\u4e8b\u4ef6\u65f6\uff0c\u8fdb\u884c\u89c2\u5bdf\u6216\u5bf9\u75c7\u5904\u7406\uff0c\u7ee7\u7eed\u8fdb\u884c\u65b0\u8f85\u52a9\u6cbb\u7597\uff0c\u5982\u9488\u5bf9\u9ad8\u8840\u538b\uff0c\u53ef\u4ee5\u542f\u52a8\u6216\u4f18\u5316\u964d\u538b\u6cbb\u7597\uff1b\u9488\u5bf9\u76ae\u75b9\u548c\u624b\u8db3\u76ae\u80a4\u53cd\u5e94\uff0c\u53ef\u91c7\u7528\u52a0\u5f3a\u76ae\u80a4\u62a4\u7406\u3001\u6da6\u80a4\u4e73\u4fdd\u6301\u6e7f\u6da6\u3001\u4f7f\u7528\u5c3f\u7d20\u8f6f\u818f\u7b49\u5bf9\u75c7\u6cbb\u7597\uff1b\u5bf9\u4e8e\u7532\u72b6\u817a\u529f\u80fd\u51cf\u9000\uff0c\u8fdb\u884c\u6fc0\u7d20\u66ff\u4ee3\u6cbb\u7597\u3002\u51fa\u73b0 3 \u7ea7\u4e0d\u826f\u4e8b\u4ef6\uff0c\u9700\u6682\u505c\u7528\u836f\uff0c\u5bf9\u75c7\u5904\u7406\u6216\u89c2\u5bdf\u76f4\u81f3\u4e0d\u826f\u53cd\u5e94\u7f13\u89e3\u81f3 0\uff5e1 \u7ea7\u540e\uff0c\u518d\u8003\u8651\u7ee7\u7eed\u5e76\u964d\u4f4e\u9776\u5411\u836f\u7269\u5242\u91cf\u3002\u4e00\u65e6\u53d1\u751f 4 \u7ea7\u4e0d\u826f\u4e8b\u4ef6\uff0c\u5219\u9700\u6c38\u4e45\u505c\u7528\u5bfc\u81f4\u4e0d\u826f\u53cd\u5e94\u7684\u9776\u5411\u836f\u7269\uff3b27\uff3d\u3002\u5728\u6b64\u8fc7\u7a0b\u4e2d\uff0c\u4e5f\u5e94\u5f53\u8861\u91cf\u75c5\u4eba\u8fdb\u884c\u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u98ce\u9669\u548c\u83b7\u76ca\uff0c\u51b3\u5b9a\u662f\u5426\u7ee7\u7eed\u65b0\u8f85\u52a9\u6cbb\u7597\u3002<\/p>\n
\u63a8\u8350\u610f\u89c114\uff1a\u65b0\u8f85\u52a9\u6cbb\u7597\u8fc7\u7a0b\u4e2d\u5e94\u6ce8\u610f\u76d1\u6d4b\u53ca\u8bc4\u4f30\u836f\u7269\u76f8\u5173\u4e0d\u826f\u53cd\u5e94\uff0c\u5e76\u79ef\u6781\u5904\u7406\u3002\uff08\u8bc1\u636e\u7ea7\u522b\uff1aB\uff1b\u63a8\u8350\u7ea7\u522b\uff1aA\uff09<\/p>\n
4 \u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u65b0\u8f85\u52a9\u6cbb\u7597\u540e\u7eed\u6cbb\u7597\u5728\u65b0\u8f85\u52a9\u6cbb\u7597\u540e\uff0c\u5168\u9762\u8bc4\u4f30\u75c5\u4eba\u75c5\u60c5\u53ca\u7597\u6548\uff0c\u7ecfMDT\u8ba8\u8bba\u53ca\u4e0e\u75c5\u4eba\u6c9f\u901a\u540e\u51b3\u5b9a\u624b\u672f\u6cbb\u7597\uff0c\u540c\u65f6\u9700\u8ba1\u5212\u540e\u7eed\u6cbb\u7597\uff0c\u4fdd\u969c\u5305\u62ecATC\u5728\u5185\u9ad8\u5371\u75c5\u4eba\u5404\u6cbb\u7597\u73af\u8282\u7684\u7d27\u5bc6\u8854\u63a5\uff0c\u63d0\u9ad8\u6cbb\u7597\u6548\u7387\u3002<\/p>\n
4.1 \u65b0\u8f85\u52a9\u6cbb\u7597\u540e\u7684\u624b\u672f \u4e00\u7ecf\u51b3\u5b9a\u884c\u624b\u672f\u6cbb\u7597\uff0c\u9700\u5b8c\u6210\u4e13\u79d1\u75c5\u53f2\u91c7\u96c6\u3001\u5168\u8eab\u8bc4\u4f30\u3001\u5b8c\u5584\u5fc5\u8981\u7684\u672f\u524d\u68c0\u67fb\uff08\u65b0\u8f85\u52a9\u6cbb\u7597\u524d\u540e\u9700\u5bf9\u6bd4\uff09\u3002\u5728\u672f\u524d\u68c0\u67e5\u65b9\u9762\uff0c\u5bf9\u6000\u7591\u75c5\u7076\u5916\u4fb5\u5589\u3001\u6c14\u7ba1\u3001\u98df\u7ba1\u6216\u5927\u8840\u7ba1\u65f6\uff0c\u9700\u672f\u524d\u590d\u67e5\u9888\u90e8\u589e\u5f3aCT\u3001MRI\u3001\u6c14\u7ba1\u955c\u3001\u98df\u7ba1\u955c\u3001\u5589\u955c\u3001CT\u8840\u7ba1\u9020\u5f71\uff08CTA\uff09\u3001MRI\u8840\u7ba1\u9020\u5f71\uff08MRA\uff09\u7b49\u3002\u505a\u597d\u5145\u5206\u7684\u672f\u524d\u51c6\u5907\uff0c\u5982\u6709\u9888\u5185\u9759\u8109\u764c\u6813\u4e14\u672f\u4e2d\u8131\u843d\u98ce\u9669\u8f83\u5927\u8005\u9700\u9884\u7f6e\u4e0a\u8154\u9759\u8109\u6ee4\u7f51\u5e76\u4e88\u5145\u5206\u6297\u51dd\u6cbb\u7597\u3002\u603b\u4f53\u672f\u524d\u8bc4\u4f30\u80bf\u7624\u53ef\u5207\u9664\u6027\u3001\u624b\u672f\u7b56\u7565\u3001\u62df\u884c\u624b\u672f\u65b9\u5f0f\u3001\u624b\u672f\u5b89\u5168\u6027\u3001\u624b\u672f\u83b7\u76ca\u548c\u98ce\u9669\u3001\u624b\u672f\u5173\u952e\u6b65\u9aa4\u3001\u672f\u4e2d\u5e94\u6025\u65b9\u6848\u3001\u672f\u540e\u5e76\u53d1\u75c7\u5904\u7406\u3001\u672f\u540e\u8f85\u52a9\u6cbb\u7597\u548c\u989d\u5916\u62a4\u7406\u3001\u624b\u672f\u548c\u5eb7\u590d\u8d39\u7528\u7b49\uff3b41\uff3d\u3002<\/p>\n
\u63a8\u8350\u610f\u89c115\uff1a\u65b0\u8f85\u52a9\u6cbb\u7597\u540e\u7684\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\uff0c\u5e94\u5168\u9762\u8fdb\u884c\u7597\u6548\u53ca\u53ef\u5207\u9664\u6027\u8bc4\u4f30\uff0c\u7ecfMDT\u8ba8\u8bba\u53ca\u4e0e\u75c5\u4eba\u6c9f\u901a\u540e\u51b3\u5b9a\u624b\u672f\u6cbb\u7597\u65b9\u6848\u3002<\/p>\n
4.2 \u672f\u540e\u8f85\u52a9\u6cbb\u7597<\/p>\n
4.2.1 131I\u6cbb\u7597\u53ca\u4fc3\u7532\u72b6\u817a\u6fc0\u7d20\u6291\u5236\u6cbb\u7597 131I\u6cbb\u7597\u53ca\u4fc3\u7532\u72b6\u817a\u6fc0\u7d20\uff08TSH\uff09\u6291\u5236\u6cbb\u7597\u5747\u4e3aDTC\u672f\u540e\u7efc\u5408\u6cbb\u7597\u7684\u4e3b\u8981\u63aa\u65bd\u3002\u65b0\u8f85\u52a9\u6cbb\u7597\u540e\u7684\u5c40\u90e8\u8fdb\u5c55\u671fDTC\u5c5e\u4e8e\u7f8e\u56fd\u7532\u72b6\u817a\u5b66\u4f1a\uff08ATA\uff09\u590d\u53d1\u98ce\u9669\u8bc4\u5206\u7cfb\u7edf\u4e2d\u7684\u9ad8\u5371\u75c5\u4eba\uff0c\u5982\u884c\u7532\u72b6\u817a\u5168\u90e8\u5207\u9664\uff0c\u5219\u5e94\u5728\u672f\u540e\u5e38\u89c4\u884c131I\u6cbb\u7597\uff0c\u5176\u6cbb\u7597\u539f\u5219\u548c\u65b9\u6cd5\u4e0e\u5176\u4ed6DTC\u75c5\u4eba\u76f8\u540c\uff3b28\uff3d\u3002\u540c\u7406\uff0c \u6839\u636e\u75c5\u4eba\u590d\u53d1\u98ce\u9669\u53caTSH\u6291\u5236\u6cbb\u7597\u4e0d\u826f\u4e8b\u4ef6\u7684\u53d1\u751f\u98ce\u9669\uff0c\u4e2a\u4f53\u5316\u8c03\u6574TSH\u6291\u5236\u6cbb\u7597\u7684\u76ee\u6807\uff3b8, 28\uff3d\u3002<\/p>\n
\u63a8\u8350\u610f\u89c116\uff1a\u63a8\u8350\u63a5\u53d7\u7532\u72b6\u817a\u5168\u5207\u9664\u672f\u7684\u65b0\u8f85\u52a9\u6cbb\u7597\u540eDTC\u75c5\u4eba\uff0c\u53c2\u7167ATA\u590d\u53d1\u98ce\u9669\u8bc4\u5206\u7cfb\u7edf\u4e2d\u7684\u9ad8\u5371\u75c5\u4eba\u8fdb\u884c131I\u6cbb\u7597\u548cTSH\u6291\u5236\u6cbb\u7597\u3002<\/p>\n
4.2.2 \u8f85\u52a9\u653e\u7597 \u5bf9\u4e8e\u624b\u672f\u540e\u4ecd\u6709\u8089\u773c\u80bf\u7624\u6b8b\u7559\u7684DTC\u53caMTC\u75c5\u4eba\uff0c\u672f\u540e\u8f85\u52a9\u653e\u7597\u662f\u589e\u52a0\u5c40\u90e8\u80bf\u7624\u63a7\u5236\u7684\u91cd\u8981\u624b\u6bb5\uff0c\u4f46\u5bf9\u4e8eR0\u6216R1\u5207\u9664\u7684\u75c5\u4eba\uff0c\u8f85\u52a9\u653e\u7597\u5c1a\u65e0\u83b7\u76ca\u7684\u8bc1\u636e\u3002<\/p>\n
\u5bf9\u4e8eATC\u800c\u8a00\uff0c\u65e0\u6cd5\u901a\u8fc7\u624b\u672f\u8fbe\u5230R0\u6216R1\u5207\u9664\u7684\u75c5\u4eba\uff0c\u653e\u7597\u53ef\u4ee5\u7f29\u5c0f\u80bf\u7624\u4f53\u79ef\u3001\u964d\u4f4e\u5c40\u90e8\u5e76\u53d1\u75c7\u53d1\u751f\u7387\u3001\u589e\u52a0\u518d\u6b21\u624b\u672f\u673a\u4f1a\uff0c\u6709\u6548\u964d\u5730ATC\u7684\u8f6c\u79fb\u548c\u590d\u53d1\u98ce\u9669\uff0c\u4ece\u800c\u63d0\u9ad8\u751f\u5b58\u7387\uff3b42-43\uff3d\u3002\u867d\u7136\u76ee\u524d\u5e76\u6ca1\u660e\u786e\u6570\u636e\u663e\u793a\u65b0\u8f85\u52a9\u6cbb\u7597\u624b\u672f\u540e\u7684\u75c5\u4eba\u53ef\u4ece\u653e\u7597\u4e2d\u83b7\u76ca\uff0c\u4f46\u9274\u4e8eATC\u7684\u751f\u7269\u5b66\u884c\u4e3a\uff0c\u5efa\u8bae\u5373\u4f7fR0\u6216R1\u5207\u9664\u540e\uff0c\u4e5f\u5b9c\u5c3d\u65e9\u5f00\u59cb\u8f85\u52a9\u653e\u7597\u3002<\/p>\n
\u63a8\u8350\u610f\u89c117\uff1a\u5bf9\u4e8e\u624b\u672f\u540e\u4ecd\u6709\u8089\u773c\u80bf\u7624\u6b8b\u7559\u7684DTC\u53caMTC\u75c5\u4eba\uff0c\u63a8\u8350\u8fdb\u884c\u8f85\u52a9\u653e\u7597\u3002\uff08\u8bc1\u636e\u7b49\u7ea7\uff1aC\uff1b\u63a8\u8350\u7b49\u7ea7\uff1aB\uff09<\/p>\n
\u63a8\u8350\u610f\u89c118\uff1a\u5bf9\u4e8e\u65b0\u8f85\u52a9\u6cbb\u7597\u540e\u7684ATC\u75c5\u4eba\uff0c\u65e0\u8bba\u662f\u5426\u5b8c\u6574\u5207\u9664\uff0c\u5747\u63a8\u8350\u8fdb\u884c\u672f\u540e\u8f85\u52a9\u653e\u7597\uff0c\u8f85\u52a9\u5316\u7597\u4ef7\u503c\u76ee\u524d\u5c1a\u4e0d\u660e\u786e\uff0c\u5b9c\u914c\u60c5\u8003\u8651\u4f7f\u7528\u3002\uff08\u8bc1\u636e\u7ea7\u522b\uff1aB\uff1b\u63a8\u8350\u7b49\u7ea7\uff1aA\uff09<\/p>\n
4.2.3 \u9776\u5411\u53ca\u514d\u75ab\u7ef4\u6301\u6cbb\u7597 \u5bf9\u4e8e\u65b0\u8f85\u52a9\u6cbb\u7597\u540e\u63a5\u53d7\u624b\u672f\u6cbb\u7597\u7684\u75c5\u4eba\u672f\u540e\u662f\u5426\u9700\u8981\u8fdb\u884c\u9776\u5411\u6216\u514d\u75ab\u7684\u7ef4\u6301\u6cbb\u7597\uff0c\u76ee\u524d\u5c1a\u65e0\u5faa\u8bc1\u533b\u5b66\u8bc1\u636e\u3002\u5728\u585e\u666e\u66ff\u5c3c\u65b0\u8f85\u52a9\u6cbb\u7597RET\u7a81\u53d8MTC\u7684\u75c5\u4f8b\u4e2d\uff0c\u7531\u4e8e\u75c5\u4eba\u540c\u65f6\u5408\u5e76\u80ba\u3001\u9aa8\u53ca\u809d\u8f6c\u79fb\uff0c\u5728\u624b\u672f\u5207\u9664\u5c40\u90e8\u533a\u57df\u75c5\u7076\u540e\u7ee7\u7eed\u8fdb\u884c\u585e\u666e\u66ff\u5c3c\u7ef4\u6301\u6cbb\u7597\uff3b25\uff3d\u3002\u5728\u65b0\u8f85\u52a9\u6cbb\u7597ATC\u7684\u75c5\u4f8b\u4e2d\uff0c\u63a5\u53d7\u9776\u5411\u7ef4\u6301\u6cbb\u7597\u7684\u6bd4\u4f8b\u8f83\u9ad8\uff0c\u5927\u591a\u6570\u75c5\u4eba\u5728\u672f\u540e\u7ef4\u6301\u4e86\u4ed1\u4f10\u66ff\u5c3c\u6216\u8fbe\u62c9\u975e\u5c3c\u8054\u5408\u66f2\u7f8e\u66ff\u5c3c\u7684\u9776\u5411\u6cbb\u7597\uff0c\u90e8\u5206\u75c5\u4eba\u540c\u65f6\u7ef4\u6301\u4e86PD-1\u6291\u5236\u5242\u6cbb\u7597\u3002\u4f46\u76ee\u524d\u7ef4\u6301\u6cbb\u7597\u7684\u6307\u5f81\u53ca\u6301\u7eed\u65f6\u95f4\u5c1a\u4e0d\u660e\u786e\uff0c\u9700\u8981\u66f4\u591a\u4e34\u5e8a\u7814\u7a76\u8bc1\u5b9e\u5176\u751f\u5b58\u83b7\u76ca\u3002<\/p>\n
\u63a8\u8350\u610f\u89c119\uff1a\u5bf9\u4e8e\u65b0\u8f85\u52a9\u6cbb\u7597\u540e\u63a5\u53d7\u624b\u672f\u6cbb\u7597\u7684DTC\u53caMTC\uff0c\u672f\u540e\u9776\u5411\u7ef4\u6301\u6cbb\u7597\u7684\u83b7\u76ca\u5c1a\u4e0d\u660e\u786e\uff0c\u9700\u8981\u7ed3\u5408\u5c40\u90e8\u533a\u57df\u80bf\u7624\u6b8b\u7559\u3001\u8fdc\u5904\u8f6c\u79fb\u3001\u80bf\u7624\u6807\u8bb0\u7269\u53d8\u5316\u8d8b\u52bf\u3001\u80bf\u7624\u5f02\u8d28\u6027\u4ee5\u53ca\u4e0d\u826f\u53cd\u5e94\u7b49\u60c5\u51b5\u7efc\u5408\u8003\u8651\u3002\uff08\u8bc1\u636e\u7ea7\u522b\uff1aD\uff1b\u63a8\u8350\u7b49\u7ea7\uff1aD\uff09<\/p>\n
\u63a8\u8350\u610f\u89c120\uff1a\u5bf9\u4e8e\u65b0\u8f85\u52a9\u6cbb\u7597\u540e\u63a5\u53d7\u624b\u672f\u6cbb\u7597\u7684ATC\uff0c\u672f\u540e\u53ef\u8003\u8651\u8fdb\u884c\u9776\u5411\u53ca\u514d\u75ab\u7ef4\u6301\u6cbb\u7597\u3002\uff08\u8bc1\u636e\u7ea7\u522b\uff1aD\uff1b\u63a8\u8350\u7b49\u7ea7\uff1aC\uff09<\/p>\n
4.3 \u672f\u540e\u968f\u8bbf \u624b\u672f\u662f\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u7684\u6cbb\u7597\u6838\u5fc3\u548c\u57fa\u7840\uff0c\u672f\u540e\u5e94\u6ce8\u610f\u5bf9\u75c5\u4eba\u8fdb\u884c\u957f\u671f\u968f\u8bbf\u3002\u6709\u7814\u7a76\u62a5\u9053\uff0c\u9488\u5bf9\u6301\u7eed\u6216\u590d\u53d1\u5c40\u90e8\u8fdb\u5c55\u671fDTC\u75c5\u4eba\uff0c\u53ca\u65f6\u6709\u6548\u5730\u8fdb\u884c\u672f\u540e\u968f\u8bbf\u53ef\u4ee5\u6539\u5584\u5176\u9884\u540e\u3002\u968f\u8bbf\u8fc7\u7a0b\u4e2d\u9700\u8981\u52a8\u6001\u3001\u5b9a\u671f\u8bc4\u4f30\u75c5\u4eba\u9888\u90e8\u5c40\u90e8\u60c5\u51b5\u3001\u7532\u72b6\u817a\u6fc0\u7d20\u6c34\u5e73\u3001\u80bf\u7624\u76f8\u5173\u6807\u8bb0\u7269\u6c34\u5e73\u3001\u5168\u8eab\u8fdc\u5904\u8f6c\u79fb\u98ce\u9669\u7b49\u3002\u5728MTC\u75c5\u4eba\u4e2d\uff0c\u76d1\u6d4b\u751f\u5316\u6307\u6807\u8840\u6e05\u964d\u9499\u7d20\u548c\u764c\u80da\u6297\u539f\u7684\u52a8\u6001\u53d8\u5316\uff0c\u53ef\u4f5c\u4e3a\u7597\u6548\u8bc4\u4f30\u7684\u8f85\u52a9\u624b\u6bb5\u3002\u5bf9\u4e8e\u665a\u671fDTC\u75c5\u4eba\u4f7f\u7528\u9776\u5411\u836f\u7269\u6cbb\u7597\uff0c\u8840\u6e05\u7532\u72b6\u817a\u7403\u86cb\u767d\uff08Tg\uff09\u53ca\u6297\u7532\u72b6\u817a\u7403\u86cb\u767d\u6297\u4f53\uff08TgAb\uff09\u7684\u52a8\u6001\u53d8\u5316\u4e5f\u53ef\u4f5c\u4e3a\u8f85\u52a9\u8bc4\u4f30\u7597\u6548\u7684\u53c2\u8003\u3002\u540c\u6837\uff0c\u4e34\u5e8a\u8fd8\u8981\u5173\u6ce8DTC\u53bb\u5206\u5316\u540e\u53caTgAb\u5347\u9ad8\u53ef\u80fd\u5bfc\u81f4Tg\u7684\u4e34\u5e8a\u53c2\u8003\u4ef7\u503c\u964d\u4f4e\u3002<\/p>\n
4.4 \u8f6c\u79fb\u6216\u590d\u53d1\u75c5\u4eba\u7684\u6cbb\u7597 \u5bf9\u4e8e\u5c40\u90e8\u518d\u6b21\u590d\u53d1\u7684\u75c5\u4eba\u9700\u8981\u518d\u6b21\u8bc4\u4f30\u590d\u53d1\u75c5\u7076\u662f\u5426\u53ef\u4ee5\u5207\u9664\uff0c\u53ef\u624b\u672f\u8005\u9996\u9009\u624b\u672f\u6cbb\u7597\uff0c\u65e0\u6cd5\u5207\u9664\u8005\u53ef\u9009\u62e9\u6838\u7d20\u6cbb\u7597\u3001\u7c92\u5b50\u690d\u5165\u6cbb\u7597\u3001\u9776\u5411\u6cbb\u7597\u3001\u653e\u7597\u7b49\u3002\u9776\u5411\u836f\u7269\u7684\u9009\u62e9\u53ef\u4ee5\u53c2\u8003\u65b0\u8f85\u52a9\u6cbb\u7597\u4e2d\u9776\u5411\u836f\u7269\u7684\u7597\u6548\uff0c\u82e5\u65b0\u8f85\u52a9\u6cbb\u7597\u4e2d\u8fbe\u5230PR\u548cCR\uff0c\u5219\u53ef\u4ee5\u518d\u6b21\u9009\u7528\u8be5\u9776\u5411\u836f\u7269\u8fdb\u884c\u6cbb\u7597\u3002<\/p>\n
\u5bf9\u4e8e\u51fa\u73b0\u8fdc\u5904\u8f6c\u79fb\u7684\u75c5\u4eba\uff0c\u8fdc\u5904\u5927\u7684\u5355\u4e2a\u8f6c\u79fb\u75c5\u7076\u80fd\u591f\u624b\u672f\u5207\u9664\u8005\uff0c\u9996\u9009\u624b\u672f\u6cbb\u7597\u3002\u5982\u65e0\u6cd5\u5207\u9664\uff0c\u5c1a\u53ef\u8003\u8651\u9aa8\u6c34\u6ce5\u3001\u653e\u7597\u3001\u4ecb\u4eba\u3001\u5c04\u9891\u3001\u7c92\u5b50\u690d\u5165\u7b49\u3002\u5bf9\u4e8e\u51fa\u73b0\u80ba\u8f6c\u79fb\uff08\u8f6c\u79fb\u7076\u6570\u91cf\u57281\uff5e5\u4e2a\u4ee5\u5185\u7684\u5be1\u8f6c\u79fb\uff09\u3001\u9aa8\u8f6c\u79fb\uff08\u6709\u75c7\u72b6\u3001\u627f\u91cd\u9aa8\uff09\u6216\u8111\u8f6c\u79fb\uff08\u5be1\u8f6c\u79fb\uff09\u7684\u75c5\u4eba\u53ef\u4e88\u884c\u5c40\u90e8\u653e\u7597\uff3b44-49\uff3d\u3002<\/p>\n
\u63a8\u8350\u610f\u89c121\uff1a\u65b0\u8f85\u52a9\u6cbb\u7597\u540e\u63a5\u53d7\u624b\u672f\u6cbb\u7597\u75c5\u4eba\u672f\u540e\u80bf\u7624\u590d\u53d1\u65f6\uff0c\u82e5\u9700\u8981\u5e94\u7528\u9776\u5411\u836f\u7269\uff0c\u53ef\u4ee5\u53c2\u8003\u65b0\u8f85\u52a9\u6cbb\u7597\u4e2d\u9776\u5411\u836f\u7269\u7684\u7597\u6548\u3002\uff08\u8bc1\u636e\u7ea7\u522b\uff1aD\uff1b\u63a8\u8350\u7b49\u7ea7\uff1aC\uff09<\/p>\n
\u603b\u4e4b\uff0c\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u662f\u7532\u72b6\u817a\u764c\u4e2d\u7684\u6cbb\u7597\u96be\u70b9\uff0c\u4e5f\u662f\u63d0\u9ad8\u6211\u56fd\u7532\u72b6\u817a\u764c\u75c5\u4eba\u6574\u4f53\u751f\u5b58\u7387\u7684\u91cd\u8981\u7814\u7a76\u65b9\u5411\u3002\u968f\u7740\u9776\u5411\u8bc1\u636e\u7684\u4e0d\u65ad\u79ef\u7d2f\uff0c\u65b0\u8f85\u52a9\u6cbb\u7597\u5c24\u5176\u662f\u65b0\u8f85\u52a9\u9776\u5411\u6cbb\u7597\u6210\u4e3a\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u764c\u6cbb\u7597\u7684\u65b0\u6a21\u5f0f\uff0c\u4e5f\u662f\u76ee\u524d\u7814\u7a76\u7684\u70ed\u70b9\u3002\u7531\u4e8e\u76ee\u524d\u4e34\u5e8a\u8bc1\u636e\u8f83\u5c11\uff0c\u672c\u5171\u8bc6\u6709\u4e00\u5b9a\u5c40\u9650\u6027\uff0c\u5bf9\u4e8e\u65b0\u8f85\u52a9\u6cbb\u7597\u6307\u5f81\u7684\u628a\u63e1\u3001\u5206\u5b50\u68c0\u6d4b\u6307\u5bfc\u7684\u836f\u7269\u4e2a\u4f53\u5316\u9009\u62e9\u3001\u65b0\u8f85\u52a9\u6cbb\u7597\u540e\u7684\u624b\u672f\u65f6\u673a\u53ca\u8303\u56f4\u7684\u9009\u62e9\u3001\u540e\u7eed\u6cbb\u7597\u65b9\u5f0f\u53ca\u5f3a\u5ea6\uff0c\u4ecd\u6709\u5f85\u8fdb\u4e00\u6b65\u7684\u4e34\u5e8a\u63a2\u7d22\u3002\u540c\u65f6\uff0c\u503c\u5f97\u6ce8\u610f\u7684\u662f\uff0c\u5c40\u90e8\u8fdb\u5c55\u671f\u7532\u72b6\u817a\u7684\u65b0\u8f85\u52a9\u6cbb\u7597\u5e94\u7531\u5177\u6709\u4e30\u5bcc\u4e34\u5e8a\u7ecf\u9a8c\u7684\u7532\u72b6\u817a\u764cMDT\u8fdb\u884c\uff0c\u4ee5\u4fdd\u969c\u6cbb\u7597\u7684\u89c4\u8303\u6027\uff0c\u51cf\u5c11\u836f\u7269\u6ee5\u7528\u3002\u5e0c\u671b\u672c\u5171\u8bc6\u80fd\u4e3a\u56fd\u5185\u540c\u9053\u63d0\u4f9b\u65b0\u8f85\u52a9\u6cbb\u7597\u7684\u53c2\u8003\uff0c\u5e76\u63a8\u52a8\u7532\u72b6\u817a\u764c\u7cbe\u51c6\u7efc\u5408\u6cbb\u7597\u7684\u53d1\u5c55\u3002<\/p>\n<\/p>\n
\u53c2\u8003\u6587\u732e<\/p>\n
\uff08\u5728\u6846\u5185\u6ed1\u52a8\u624b\u6307\u5373\u53ef\u6d4f\u89c8\uff09<\/p>\n
\uff3b1\uff3d Huang NS, Wei WJ, Xiang J, et al. The efficacy and safety of anlotinib in neoadjuvant treatment of locally advanced thyroid cancer: a single-arm phase ii clinical trial\uff3bJ\uff3d. Thyroid, 2021, 31(12): 1808-1813. <\/p>\n
\uff3b2\uff3d Lamartina L, Godbert Y, Nascimento C, et al. Locally unresectable differentiated thyroid cancer: outcomes and perspectives \uff3bJ\uff3d. Endocrine, 2020, 69(1): 133-141. <\/p>\n
\uff3b3\uff3d Besic N, Auersperg M, Gazic B, et al. Neoadjuvant chemotherapy in 29 patients with locally advanced follicular or Hurthle cell thyroid carcinoma: a phase 2 study \uff3bJ\uff3d. Thyroid, 2012, 22(2): 131-137. <\/p>\n
\uff3b4\uff3d Metere A, Aceti V, Giacomelli L. The surgical management of locally advanced well-differentiated thyroid carcinoma: changes over the years according to the AJCC 8th edition Cancer Staging Manual \uff3bJ\uff3d. Thyroid Res, 2019, 12:10. <\/p>\n
\uff3b5\uff3d Wang LY, Nixon IJ, Patel SG, et al. Operative management of locally advanced, differentiated thyroid cancer \uff3bJ\uff3d. Surgery, 2016, 160(3): 738-746. <\/p>\n
\uff3b6\uff3d Nixon IJ, Simo R, Newbold K, et al. Management of invasive differentiated thyroid cancer \uff3bJ\uff3d. Thyroid, 2016, 26(9): 1156-1166. <\/p>\n
\uff3b7\uff3d Shindo ML, Caruana SM, Kandil E, et al. Management of invasive well-differentiated thyroid cancer: an American Head and Neck Society consensus statement. AHNS consensus statement \uff3bJ\uff3d. Head Neck, 2014, 36(10): 1379-1390. <\/p>\n
\uff3b8\uff3d Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer \uff3bJ\uff3d. Thyroid, 2016, 26(1): 1-133. <\/p>\n
\uff3b9\uff3d Wang J, Takashima S, Matsushita T, et al. Esophageal invasion by thyroid carcinomas: prediction using magnetic resonance imaging \uff3bJ\uff3d. J Comput Assist Tomogr, 2003, 27(1): 18-25. <\/p>\n
\uff3b10\uff3d Huang NS, Li Q, Gao XY, et al. Using a CT- based scale to evaluate disease extension and the resectability of locally advanced thyroid cancer\uff3bJ\uff3d. Eur Radiol,2023. Doi: 10.1007\/s00330-023-09799-3.\uff3bOnline ahead of print\uff3d.<\/p>\n
\uff3b11\uff3d \u5f90\u6960, \u8521\u6c38\u806a, \u5b59\u8363\u660a\uff0c\u7b49. \u6301\u7eed\/\u590d\u53d1\u7532\u72b6\u817a\u4e73\u5934\u72b6\u764c\u518d\u624b\u672f\u4e34\u5e8a\u7279\u5f81\u53ca\u9884\u540e\u5206\u6790\uff3bJ\uff3d. \u4e2d\u534e\u8033\u9f3b\u54bd\u5589\u5934\u9888\u5916\u79d1\u6742\u5fd7, 2022, 57(9): 1052-1058. <\/p>\n
\uff3b12\uff3d Maurer E, Eilsberger F, Wachter S, et al. Mutation-based, short-term ‘neoadjuvant’ treatment allows resectability in stage IVB and C anaplastic thyroid cancer \uff3bJ\uff3d. Eur Arch Otorhinolaryngol, 2023, 280(3): 1509-1518. <\/p>\n
\uff3b13\uff3d Kim M, Ahn J, Song DE, et al. Real-world experience of lenvatinib in patients with advanced anaplastic thyroid cancer \uff3bJ\uff3d. Endocrine, 2021, 71(2): 427-433. <\/p>\n
\uff3b14\uff3d Gay S, Monti E, Trambaiolo Antonelli C, et al. Case report: lenvatinib in neoadjuvant setting in a patient affected by invasive poorly differentiated thyroid carcinoma \uff3bJ\uff3d. Future Oncol, 2019, 15(24): 13-19. <\/p>\n
\uff3b15\uff3d Nava CF, Scheffel RS, Cristo AP, et al. Neoadjuvant multikinase inhibitor in patients with locally advanced unresectable thyroid carcinoma \uff3bJ\uff3d. Front Endocrinol (Lausanne), 2019, 10:712. <\/p>\n
\uff3b16\uff3d Danilovic DLS, Castro G Jr., Roitberg FSR, et al. Potential role of sorafenib as neoadjuvant therapy in unresectable papillary thyroid cancer \uff3bJ\uff3d. Arch Endocrinol Metab, 2018, 62(3): 370-375. <\/p>\n
\uff3b17\uff3d Zhang Y, Deng X, Ding Z, et al. Preoperative neoadjuvant targeted therapy with apatinib for inoperable differentiated thyroid cancer: A case report \uff3bJ\uff3d. Medicine (Baltimore), 2021, 100(12): e25191. <\/p>\n
\uff3b18\uff3d Cleary JM, Sadow PM, Randolph GW, et al. Neoadjuvant treatment of unresectable medullary thyroid cancer with sunitinib \uff3bJ\uff3d. J Clin Oncol, 2010, 28(23): e390-392. <\/p>\n
\uff3b19\uff3d Bible KC, Kebebew E, Brierley J, et al. 2021 American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer \uff3bJ\uff3d. Thyroid, 2021, 31(3): 337-386. <\/p>\n
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\uff3b22\uff3d \u4e2d\u56fd\u533b\u5e08\u534f\u4f1a\u5916\u79d1\u533b\u5e08\u5206\u4f1a\u7532\u72b6\u817a\u5916\u79d1\u533b\u5e08\u59d4\u5458\u4f1a, \u4e2d\u56fd\u6297\u764c\u534f\u4f1a\u7532\u72b6\u817a\u764c\u4e13\u4e1a\u59d4\u5458\u4f1a, \u4e2d\u56fd\u7814\u7a76\u578b\u533b\u9662\u5b66\u4f1a\u7532\u72b6\u817a\u75be\u75c5\u4e13\u4e1a\u59d4\u5458\u4f1a. \u7532\u72b6\u817a\u9ad3\u6837\u764c\u8bca\u65ad\u4e0e\u6cbb\u7597\u4e2d\u56fd\u4e13\u5bb6\u5171\u8bc6\uff082020 \u7248\uff09 \uff3bJ\uff3d. \u4e2d\u56fd\u5b9e\u7528\u5916\u79d1\u6742\u5fd7, 2020, 40(9):1012-1020. <\/p>\n
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\uff3b27\uff3d \u4e2d\u56fd\u6297\u764c\u534f\u4f1a\u7532\u72b6\u817a\u764c\u4e13\u4e1a\u59d4\u5458\u4f1a, \u4e2d\u56fd\u6297\u764c\u534f\u4f1a\u5934\u9888\u80bf\u7624\u4e13\u4e1a\u59d4\u5458\u4f1a, \u4e2d\u534e\u533b\u5b66\u4f1a\u80bf\u7624\u5b66\u5206\u4f1a\u7532\u72b6\u817a\u80bf\u7624\u4e13\u4e1a\u59d4\u5458\u4f1a. \u665a\u671f\u7532\u72b6\u817a\u764c\u9776\u5411\u836f\u7269\u5e94\u7528\u4e2d\u56fd\u4e13\u5bb6\u5171\u8bc6(2022 \u5e74\u7248) \uff3bJ\uff3d. \u4e2d\u534e\u666e\u901a\u5916\u79d1\u6742\u5fd7, 2022, 37(12):881-889.<\/p>\n
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\uff082023-07-03\u6536\u7a3f\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"
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