青少年分化型甲状腺癌治疗及预后

Differentiated thyroid carcinoma in children and adolescence

目的探讨青少年分化型甲状腺癌(different-iated thyroid carcinoma,DTC)治疗模式的疗效和影响预后的因素。方法回顾性分析1981～2001年我科收治的年龄≤18岁DTC的随访资料74例(﹥13岁42例,≤13岁32例),均行手术加术后左旋甲状腺素治疗,13例伴肺转移患者行131I核素放射治疗。结果38例随访10年以上,6例随诊时间小于5年失访,中位随访时间(12～264)108个月;全组2例死于甲状腺癌局部复发;Kaplan-Meier法计算10年累积生存率和无瘤生存率分别为96.43%和78.90%。Cox多因素分析没有发现影响生存率的独立因素。Logistic回归分析发现原发灶累及双侧甲状腺腺叶是与复发相关的独立因素;原发灶外侵是影响并发症发生的独立因素;年龄≤13岁的青少年DTC更易发生肺转移,转移率为71.43%。结论在本组青少年DTC的治疗资料中,未发现影响生存率的独立因素。原发灶外侵和年龄≤13岁分别影响并发症发生和肺转移,此类患者应在术后行131I治疗。原发灶累及双侧甲状腺是复发的主要因素,对此类患者加强术前检查同时扩大手术范围。

OBJECTIVE To investigate the therapeutic efficacy and the prognostic factors of differentiated thyroid cancer（DTC） in young people. METHODS The clinical data of 74 patients （ 32 cases less than and 42 cases more than 13 years） with DTC less than 19 years old at the time of surgery from Jan. 1981 to Dec. 2001 in our department was retrospectively reviewed. All of the cases were received surgery and L-thyroxine therapy. Thirteen patients with distant metastasis were administered postoperative radioiodine ^131I therapy. RESULTS The median follow-up period was 108 months, with a range from 12 to 264 months. Thirty eight patients followed up more than 10 years. Two patients died of local recurrence. The 10-year survival rate and 10-year disease free survival rate for the entire group was 96.43 % and 78.90 % respectively. Logistic multivariate statistical assessment revealed the risk factor that independently influence local recurrence, complication and lung metastases was primarily focus involving bilateral lobes of thyroid gland, primarily focus extra-invasion and patient＇s age at diagnosis respectively. CONCLUSION The patients with primarily focus extra-invasion and no more than 13 years old should followed by postoperative ^131I therapy to avoid local recurrence and lung metastases. Empha