儿童及青少年分化型甲状腺癌75例临床分析

Clinical analysis of differentiated thyroid carcinoma in children and adolescent: 75 cases

目的探讨儿童及青少年分化型甲状腺癌的临床特点及治疗策略。方法回顾性分析中国医科大学附属第一医院2004年1月至2017年3月收治的75例儿童及青少年(≤18岁)分化型甲状腺癌的临床资料。根据诸福棠实用儿科学第八版对学龄期及青春期的定义,以13岁为界分为A组(<13岁)和B组(≥13岁),比较2组的临床病理特征及预后情况。结果75例中,乳头状癌74例,滤泡状癌1例;与B组相比,A组更易发生双叶癌(55.6%vs18.2%,x^2=6.311/=0.037)及侧颈部淋巴结转移(100%vs54.5%,x^2=6.818,P=0.025);两组在中央区淋巴结转移(88.9%vs69.7%,x^2=1.758,上0.420)、性别构成比(22.2%vs31.8%,x^2=0.343,P=0.841)、腺外侵袭(33.3%vs18.2%,x^2=1136,40.534)、远处转移(11.1%vs1.5%,x^2=2.810,P=0.566)及复发(25%vs7.8%,x^2=1.141,P=0.183)方面无明显差异。结论儿童及青少年分化型甲状腺癌以乳头状癌为主,<13岁的患者更易发生双叶癌及侧颈部淋巴结转移。

Objective To investigate the clinical characters and treatment strategies of differentiated thyroid carcinoma in children and adolescent. Methods The clinical data of 75 cases of thyroid carcinoma in children and adolescents(≤ 18 years old )from Jan. 2004 to Mar. 2017 in the First Hospital of China Medical University were retrospectively analyzed. Clinical pathology characters and prognosis between patients <13 years old (group A) and those ≥13 years old (group B) were compared. Results There were 74 cases with papillary carcinoma and 1 with follicular carcinoma. The rate of lateral neck lymph node metastasis (100% vs 54.5%, x^2=6.818,P=0.025) and bilateral location (55.6% vs 18.2%, x^2=6.311, P=0.037) in group A were higher than in group B. There were no significant differences in central lymph nodes metastasis (88.9% vs 69.7%,x^2=1.758,P=0.420), gender composition ratio (22.2% vs 31.8%,x^2=0.343, P=0.841), extra-thyroid extension (33.3% vs 18.2%, x2= 1.136, P=0.534), distant metastasis (11.1% vs 1.5%, x^2=2.810, P=0.566) and recurrent disease (25% vs 7.8%, x^2=1.141, P=0.183) between the two groups. Conclusions Papillary carcinoma is the most common pathology type in children and adolescent thyroid carcinoma. Patients<13 years old are more likely to present lateral neck lymph node metastasis and bilateral location.