18岁及以下甲状腺乳头状癌患者治疗后远处转移的预测分析

Predictive analysis of distant metastasis after primary treatment of papillary thyroid cancer in patients under 18 years old

目的探讨18岁及以下甲状腺乳头状癌患者初次治疗后远处转移的特点及治疗方案。方法回顾性分析2001年1月1日至2014年12月31日初次就诊于中国医学科学院北京协和医学院肿瘤医院和浙江省肿瘤医院2所医疗机构诊断为甲状腺乳头状癌的180例儿童及青少年患者,其中男54例,女126例;年龄6~18岁,收集临床病例资料并随访,随访期远处转移率计算采用Kaplan-Meier法,单因素分析比较采用Log-Rank检验。多因素分析比较建立Cox回归模型。结果 24例(13.3%)患者治疗后出现远处转移,Log-Rank检验表明患者年龄≤15岁(χ^2=11.803,P=0.001)、肿瘤直径>20 mm(χ^2=5.776,P=0.016)、肿瘤多灶(χ^2=11.205,P=0.001)、癌灶双侧分布(χ^2=19.804,P=0.001)、甲状腺被膜侵犯(χ^2=10.808,P=0.001)、双侧颈淋巴结转移(χ^2=6.278,P=0.012)是初次治疗后远处转移的危险因素。Cox回归模型结果显示,患者年龄≤15岁(HR=4.08,95%CI为1.504~11.111,P=0.006)、肿瘤双侧分布(HR=4.77,95%CI为1.903~11.966,P=0.001)是治疗后远处转移的独立危险因素。局部区域复发与远处转移的危险因素相似,但未见局部区域复发对远处转移的预测意义(χ^2=0.695,P=0.404)。双侧多灶癌患者中甲状腺全切组远处转移率低于非甲状腺全切组,差异有统计学意义(χ^2=5.891,P=0.015)。结论年龄、肿瘤直径、肿瘤多灶、癌灶双侧分布、甲状腺被膜侵犯、双侧颈淋巴结转移是儿童和青少年甲状腺乳头状癌患者治疗后远处转移的危险因素。对于≤18岁的双侧多灶甲状腺乳头状癌患者推荐施行甲状腺全切术。

Objective To investigate the distant metastasis after primary treatment of papillary thyroid cancer(PTC)in children and adolescents.Methods A retrospective analysis of 180 cases(54 boys and 126 girls,with an age range of 6-18 years)with PTC treated at the Chinese Medical Academy Cancer Hospital and Zhejiang Cancer Hospital from January 1,2001 to December 31,2014 was performed.Patients’clinical and pathological data were collected.The follow-up results were statistically analyzed.The distant metastasis rate during the follow-up period was analyzed by the Kaplan-Meier method.Log-Rank test was used for univariate analysis and Cox regression model was established in multivariate analysis.Results Twenty-four cases(13.3%)had distant metastases during following-up with a median of 92 months.The Log-Rank test showed that the younger age≤15 years old(χ^2=11.803,P=0.001),the larger tumor diameter>20 mm(χ^2=5.776,P=0.016),multifocal(χ^2=11.205,P=0.001),bilateral tumor distribution(χ^2=19.804,P=0.001),invaded capsule(χ^2=10.808,P=0.001),and bilateral lymph nodes metastasis(χ^2=6.278,P=0.012)were risk factors for distant metastasis after initial treatment.The Cox regression analysis showed that age≤15 years(hazard ratio[95%confidence interval]:4.08[1.504-11.111],P=0.006)and bilateral tumor distribution(hazard ratio[95%confidence interval]:4.77[1.903-11.966],P=0.001)were independent risk factors for distant metastasis after initial treatment.The risk factors for local recurrence and distant metastasis were similar,but the local recurrence could not be a significant predictor for distant metastasis.It was indicated that distant metastasis rate was lower in patients with total thyroidectomy in multifocal lesions groups(χ^2=5.891,P=0.015).Conclusions Age,tumor size,invaded capsule,bilateral lymph nodes metastasis,multifocal and bilateral lesions are factors for predicting distant metastasis after primary treatment of PTC in children and adolescents.Total thyroidectomy is recommended for patients with multifocal and bilateral lesions.