目的:本研究旨在探讨18岁以下儿童和青少年分化型甲状腺癌(DTC)的临床特征,并评估手术联合甲状腺激素和放射性碘(RAI)对其预后的影响。
方法:进行了一项回顾性观察研究,涉及1998年1月至2018年12月在天津医科大学肿瘤研究所和医院头颈科接受手术的DTC儿童/青少年。
结果:在198名患者中,130名(65.7%)为女性。根据美国甲状腺协会的指南,病例被归类为低(106,53.5%),中间(54,27.3%),和高风险(38,19.2%)。随访时间3~23年。局部复发和远处转移分别为21例(10.6%)和14例(7.1%),分别。所有患者都接受了左甲状腺素,而RAI治疗是对中危和高危患者进行的。两组的局部复发率和远处转移率分别为33.3%和39.5%,分别,低危组无复发或转移。在随访结束时,没有结构性疾病证据的持续性为0.9%,3.7%和26.3%,中介-,和高危人群,分别。三组的总生存率均为100%,而低收入人群的无病生存率分别为99.1%、63.0%和34.2%,中介-,和高危人群,分别。
结论:即使没有RAI,患有低危DTC的儿童/青少年也表现出良好的预后。然而,中危和高危DTC患者,尽管RAI和左甲状腺素治疗,显示出持续性疾病的发生率升高,局部复发,和远处转移。
OBJECTIVE: This study aims to investigate the clinical features of differentiated thyroid carcinoma (DTC) in children and adolescents under 18 years and assess the impact of surgery combined with thyroid hormone and radioactive iodine (RAI) on their prognosis.
METHODS: A retrospective observational study was conducted, involving children/adolescents with DTC who underwent surgery at the Head and Neck Department of Tianjin Medical University Cancer Institute and Hospital from January 1998 to December 2018.
RESULTS: Among 198 patients, 130 (65.7 %) were female. According to the American Thyroid Association guidelines, cases were categorized as low (106, 53.5 %), intermediate (54, 27.3 %), and high (38, 19.2 %) risk. The follow-up duration ranged from 3 to 23 years. Local recurrence and distant metastasis were identified in 21 (10.6 %) and 14 (7.1 %) cases, respectively. All patients received levothyroxine, while RAI therapy was administered to intermediate- and high-risk patients. The local recurrence and distant metastasis rates in these two groups were 33.3 and 39.5 %, respectively, with no recurrence or metastasis in the low-risk group. Persistent without structural evidence of disease were 0.9, 3.7, and 26.3 % at end of follow-up for the low-, intermediate-, and high-risk groups, respectively. The overall survival rates for all three groups were 100 %, while disease-free survival rates were 99.1, 63.0, and 34.2 % for the low-, intermediate-, and high-risk groups, respectively.
CONCLUSIONS: Children/adolescents with low-risk DTC exhibited a favorable prognosis even without RAI. However, intermediate- and high-risk DTC patients, despite RAI and levothyroxine treatment, showed elevated rates of persistent disease, local recurrence, and distant metastasis.