61例14岁以下儿童分化型甲状腺癌的临床病理特点

Clinicopathological characteristics of differentiated thyroid carcinoma in 61 patients under 14 years old

目的探讨14岁以下儿童分化型甲状腺癌的临床及病理特征。方法回顾性分析2005年1月至2014年12月61例就诊于天津医科大学肿瘤医院14岁以下分化型甲状腺癌患者的临床病理资料。结果61例患者中男26例，女35例，男女性别比1：1．35；61例患者中行一侧腺叶＋峡叶切除者11例，行全／近全甲状腺切除者50例；56例患者合并中央区淋巴结转移；47例患者伴有侧颈淋巴结转移，其中33例患者出现双侧侧颈淋巴结转移；肺转移者9例：61例患者病理类型均为甲状腺乳头状癌，其中高侵袭亚型35例；中位随访时间3年6个月（30～116个月），总生存率为100％，复发4例。结论与成人分化型甲状腺癌相比，〈14岁的儿童分化型甲状腺癌双侧或多灶性甲状腺癌多见；中央区淋巴结转移率及侧颈淋巴结转移率高；病理亚型中高侵袭亚型比例偏高。

Objective To explore the clinico-pathological characteristics and treatment of thyroid carcinoma in patients under 14 years old. Method The clinical and pathological data of 61 children 14 years old or younger treated for differentiated thyroid carcinoma （DTC） from Jan 2005 to Dec 2014 were retrospectively analyzed. Results There were 26 males and 35 females with the sex ratio of 1： 1.35. All the 61 patients underwent surgery including lobectomy for ipsilateral foci in 11 cases and total or near total thyroidectomy for bilateral or multi-foci in 50 cases. 5 patients had not lymph node metastasis. 56 patients had central compartment metastasis and 47 patients had lateral cervical lymph node metastasis. 9 patients had distant metastasis and the affected organ was lung. Pathology for all the 61 patients was thyroid papillary carcinoma, 35 patients were of highly invasive subtype. The median follow-up time was 3 years and 6 months （30 -116 months） with a total survival rate of 100% while 4 patients suffered from recurrence. Conclusions For below 14 years old DTC patients, the prognosis is better than in adults. The rate of bilateral lesions or multiple foci in ipsilateral lobe and central compartment lymph node or lateral neck lymph node metastasis was higher than in adults. Furthermore, highly invasively pathological subtype is more common in younger patients.