Clinical data of 41 patients affected by DTC in the 2000-2020 period were reviewed.
The main risk factor was autoimmune thyroiditis (39%). Cytological categories were TIR3b in 39%, TIR4 in 9.8%, TIR5 in 51.2%. After total thyroidectomy, radioiodine treatment was performed in 38 subjects (92.7%). ATA low-risk category was assigned in 11 (30.5%), intermediate-risk category in 15 (41.7%), and high-risk category in 10 patients (27.8%). Age at diagnosis was 15.1 ± 0.92 years in low-risk category, 14.7 ± 0.59 in intermediate-risk category, 11.7 ± 0.89 years in high-risk category (p = 0.01). TIR3b was manly observed in low-risk class (63.6%), while TIR5 was mainly reported in intermediate and high-risk class (60 and 80% respectively) (p = 0.04). Post-surgery stimulated thyroglobulin was increased in high-risk class (407.8 ± 307.1 ng/ml) [p = 0.04]. Tumour size was larger in high-risk category (42.6 ± 2.6 mm), than in low and intermediate-risk categories (19.4 ± 3.5 mm and 28.5 ± 3.9 mm, respectively) (p = 0.008). Patients in intermediate and high-risk categories displayed more tumour multifocality (60 and 90% respectively) (p < 0.005). Disease relapse was mainly observed in high risk category (40%, p = 0.04).
DTC in childhood is more aggressive than in adults, but the overall survival rate is excellent. The therapeutic approach is still heterogeneous, especially in low-risk category. Further studies are needed to standardise management and reduce disease persistence in childhood.
方法:回顾了2000-2020年期间41例DTC患者的临床资料。
结果:主要危险因素是自身免疫性甲状腺炎(39%)。细胞学类别为TIR3b,占39%,TIR4为9.8%,TIR5为51.2%。全甲状腺切除术后,38例(92.7%)接受放射性碘治疗.ATA低风险类别被分配在11个(30.5%),15个中等风险类别(41.7%),高危类别患者10例(27.8%)。低风险类别的诊断年龄为15.1±0.92岁,中等风险类别为14.7±0.59,高风险类别为11.7±0.89年(p=0.01)。TIR3b在低风险类别中观察到男子气概(63.6%),而TIR5主要在中危和高危类别中报告(分别为60%和80%)(p=0.04)。手术后刺激的甲状腺球蛋白在高危类别中增加(407.8±307.1ng/ml)[p=0.04]。高危类别肿瘤大小较大(42.6±2.6mm),低于低风险和中等风险类别(19.4±3.5毫米和28.5±3.9毫米,分别)(p=0.008)。中等和高风险类别的患者表现出更多的肿瘤多灶性(分别为60%和90%)(p<0.005)。疾病复发主要在高风险类别中观察到(40%,p=0.04)。
结论:儿童时期的DTC比成人更具攻击性,但总体生存率很好。治疗方法仍然是异质的,尤其是低风险类别。需要进一步的研究来标准化管理和减少儿童疾病的持久性。