儿童甲状腺乳头状癌临床分析及肺转移风险因素讨论

Clinical analysis of thyroid papillary carcinoma and risk factors of pulmonary metastasis in children

目的探讨分析儿童甲状腺乳头状癌临床特征及肺转移风险因素以指导临床工作。方法收集2005-2016年郑州大学第一附属医院甲状腺外科收治的14岁以下首次行手术治疗并经过术后常规病理证实为甲状腺乳头状癌患者资料40例，将有关头颈部恶性肿瘤或淋巴瘤病史、继发性甲状腺癌、甲状腺功能亢进合并甲状腺乳头状癌，病例资料不完整的病例排除。40例患儿年龄3-14岁，其中男12例，女28例。最大肿瘤直径7.5 cm，最小肿瘤直径0.3 cm。肿瘤病灶单发22例，多发18例。肿瘤合并颈部淋巴结转移33例，无颈部淋巴结转移7例。肿瘤合并肺转移10例，无肺转移30例。采用χ2检验和Logistic回归分析儿童甲状腺乳头状癌患者年龄、性别、肿瘤直径、病灶数、手术方式、颈部淋巴结转移等临床特征及肺转移相关风险因素。结果儿童甲状腺乳头状癌肺转移的阳性率为25.0%（10/40）,统计分析发现：肿瘤合并肺转移患儿阳性率在多发病灶数（χ^2=8.620,P=0.003）、肿瘤直径2cm（χ^2=5.763,P=0.016）中较高且差异有统计学意义，经Logistic回归分析示：多病灶数是儿童甲状腺乳头状癌肺转移的危险因素（OR：13.058，P=0.028）。结论较高的肺转移率为儿童甲状腺乳头状癌的临床特征，对于多病灶的甲状腺乳头状癌患儿，肺转移风险明显增高。

Objective Investigated the clinical features and risk factors of pulmonary metastasis in children with papillary thyroid carcinoma aiming to provide guide for clinical work. Methods Collected the informations of 40 patients with under the age of 14, who underwent surgery in the Thyroid surgery of the First Affiliated Hospital of ZhengZhou University and confirmed for the papillary thyroid carcinoma by the postoperative pathology. At the same time, excluded studies with history of head and neck malignancy or lyphoma or secondary thyroid cancer, papillary thyroid carcinoma with hyperthyroidism and cases of imcomplete informations. The age of the 40 patients was 3 to 14 years old, 12 were boy and 28 were girl. The largest tumor diameter was 7.5 cm, and the smallest was 0.3 cm. Tumor lesions were solitary in 22 cases and multiple lesions were in 18 cases. There were 33 cases of cervical lymph node metastases and 7 cases of no cervical lymph nodes. There were 10 cases of pulmonary metastasis and 30 cases of non-pulmonary metastasis. This research adopted chi-square test and Logistic regression statistical analysis of related risk factors and clinical features, including patients′ age, gender, tumor diameter, number of lesions, surgical methods, neck lymph node metastasis, and pulmonary metastasis. Results The positive rate of plumonary metastsis in children with papillary thyroid carcinoma was 25% （10/40）, statistical analysis found that the positive rate of children with lung metastasis （χ^2=8.620, P=0.003）, tumor diameter over 2 cm （χ^2=5.763, P=5.763） and the difference was statistically significant higher. Logistic regression analysis showed that the number of risk factors was multifocal papillary thyroid carcinoma in children lung metastasis（OR=13.058, P=0.028）. Conclusions Higher lung metastasis is a clinical feature of thyroid papillary carcinoma in children. The risk of lung metastasis was significantly higher for children with thyroid papillary carcinoma who had multiple lessions.