2025年甲状腺癌年度进展及展望OA

In recent years,the continuous accumulation of evidence from molecular biology,medical imaging,and evidence-based medicine has driven a systematic reshaping of diagnostic and therapeutic paradigms for thyroid cancer.Differentiated thyroid carcinoma(DTC)is generally associated with a favorable prognosis;however,marked biological and clinical heterogeneity exists across different risk populations.In contrast,poorly differentiated thyroid carcinoma(PDTC)and anaplastic thyroid carcinoma(ATC)remain characterized by high aggressiveness,rapid progression,and limited therapeutic options,accounting for the majority of thyroid cancer-related mortality.How to achieve precise risk stratification and optimize therapeutic strategies based on tumor biology and disease stage has therefore emerged as a central challenge in the field.Entering 2025,the integration of expanding evidence-based data and technological innovation has further accelerated this paradigm shift.On one hand,continuous updates to clinical practice guidelines,centered on risk stratification and dynamic assessment,have promoted a transition in early-stage DTC management toward individualized care and long-term quality-of-life-oriented strategies.On the other hand,advances in artificial intelligence(AI)-assisted diagnostics,novel molecular imaging techniques,and multi-omics analyses are redefining diagnostic pathways and risk assessment frameworks for thyroid cancer.For patients with advanced disease and radioiodine-refractory(RAIR)thyroid cancer,the therapeutic landscape continues to expand with the development of molecular targeted therapies,immunotherapy,and redifferentiation strategies.In parallel,innovative approaches such as cell-based therapies,exemplified by chimeric antigen receptor T(CAR-T)cell therapy,have begun to enter early-phase clinical exploration.Meanwhile,fundamental research paradigms are undergoing a notable shift.Research focus is moving beyond single driver mutations toward a systems-level understanding encompassing tumor metabolic reprogramming,epigenetic regulation,and complex interactions within the tumor microenvironment(TME).Integrative multi-omics and spatial transcriptomic analyses have revealed that the extreme aggressiveness of ATC is not solely determined by tumor cell-intrinsic abnormalities,but rather arises from the coordinated influence of immunosuppressive microenvironments,metabolic remodeling,and intercellular signaling networks.These insights provide a theoretical foundation for combination therapies and microenvironment-targeted interventions.Against this background,this review systematically summarizes the key advances in thyroid cancer research in 2025,including updates to clinical practice guidelines,innovations in diagnostic technologies,evolution of systemic treatment strategies,and breakthroughs in mechanistic studies,with the aim of providing a comprehensive reference framework for clinical practice and future research directions.