儿童及青少年分化型甲状腺癌诊治策略若干进展

The trends in clinical diagnosis and treatment strategies of differentiated thyroid cancer in pediatrics and adolescents

儿童及青少年DTC发病率较低,预后相对较好,但与成人相比,其侵袭性更强,复发率相对较高.DTC患儿在手术切除后辅以131I治疗可以有效减少复发的风险.对于大多数DTC患儿,全或近全甲状腺切除加中央区淋巴结清扫可作为推荐术式.DTC患儿术后应行131I治疗以清除残留甲状腺组织,降低肿瘤复发的风险.大剂量131I治疗可能增加患者罹患其他实体第二原发恶性肿瘤的风险.笔者推荐对已接受手术及131I治疗后的DTC患儿长期密切随访,以及时发现肿瘤复发;同时采取多学科合作及个体化治疗方案,尽可能减少不良反应.

DTC in pediatric and adolescent patients has lower incidence and is generally reported to have better prognosis.However,compared with DTC in adults,it is more aggressive and the recurrence rate is higher.Surgery and adjuvant radioiodine therapy can minimize the risk of recurrence.Total or near total thyroidectomy combined with central compartment lymph node dissection is the preferred surgical procedure for most of these patients.Radioiodine therapy for ablation of thyroidal remnant or residual disease is recommended in order to reduce the risk of tumor recurrence,but there is slight chance of increased risk of a sec ond primary malignancy （SPM）.Long-term follow-up is therefore recommended for the pediatrics and adolescents with DTC after treatment.Multi-disciplinary collaborative management is needed to optimize treatment efficacy and to minimize adverse effects.