儿童及青少年甲状腺癌复发危险因素的Meta分析

Meta-analysis of risk factors associated with recurrence of thyroid carcinoma in children and adolescents

目的探讨儿童及青少年甲状腺癌(thyroid carcinoma in children and adolescents,caTC)手术后复发的危险因素,以早期发现caTC术后复发的高危人群。方法按照循证医学方法,在PubMed、Web of Science、中国知网、万方数据库、中国生物医学文献数据库中检索自建库至2022年5月公开发表的caTC术后复发危险因素研究,依据纳入及排除标准,由2位研究员独立对检索后的文献进行筛选并提取研究指标(年龄、性别、甲状腺外侵犯、肿瘤直径、手术方式、颈部淋巴结转移、双侧受累、多灶性、I^(131)治疗等),利用RevMan 5.3对上述研究指标进行Meta分析。结果最终共纳入7篇文献(341例患儿)。Meta分析结果显示:年龄≤10岁(OR=4.03,95%CI:1.04~15.63,P=0.04)、存在甲状腺外侵犯(OR=0.10,95%CI:0.02~0.43,P=0.002)、肿瘤呈多灶性(OR=0.14,95%CI:0.06~0.32,P<0.001)是caTC复发的危险因素,而性别、肿瘤直径、双侧受累、T分期、颈淋巴结转移、手术方式、术后是否行I131治疗对患者的复发没有影响。结论年龄≤10岁、肿瘤呈多灶性、具有甲状腺外侵犯特征的儿童及青少年甲状腺癌患者,手术后复发的概率更高。

Objective To explore the risk factors of postoperative recurrence of thyroid carcinoma in children and adolescents(caTC)to identify the high-risk population of postoperative recurrence of caTC early.Methods According to the evidence-based medicine methodology,PubMed,Web of Science,China Wanfang and Chinese Biomedical Literature Database were searched for the risk factors of postoperative recurrence of caTC published since May 2022.According to the inclusion and exclusion criteria,two researchers independently screened the retrieved literatures and extracted the research indicators of age,gender,extraglandular invasion,tumor diameter,surgical approach,cervical lymph node metastasis,bilateral involvement,multifocality&I^(131) radiotherapy.RevMan 5.3 was utilized for Meta-analysis.Results A total of 7 articles(341 children)were finally retrieved.Meta-analysis indicated that age≤10 year(OR=4.03,95%CI:1.0-15.63,P=0.04),extraglandular involvement(OR=0.10,95%CI:0.02-0.43,P=0.002)and multifocality(OR=0.14,95%CI:0.06-0.32,P<0.001)were risk factors for recurrent caTC.Gender,tumor diameter,bilateral involvement,T stage,cervical lymph node metastasis,surgical approach and I131 therapy had no effect on recurrent caTC.Conclusion Children and adolescents with thyroid carcinoma≤10 years of age,multifocal tumors and extraglandular invasion have a higher risk of postoperative recurrence.