儿童分化型甲状腺癌的临床特征及危险因素分析

Clinical characteristics and risk factors for differentiated thyroid carcinoma in children

目的近年来,儿童甲状腺癌发病率不断上升,因此探讨儿童分化型甲状腺癌(children differentiated thyroid cancer,DTC)的临床特征并分析复发病例情况。方法回顾性分析1998年1月~2018年5月在上海交通大学医学院附属新华医院就诊的年龄≤13岁的50例儿童分化型甲状腺癌的临床资料。以7岁为界分为学龄前期组(≤7周岁)和学龄期组(>7周岁至13周岁),比较学龄前期与学龄期的临床特征情况。根据儿童DTC复发与否进行分组,比较复发组与无复发组的临床特征数据。比较临床特征、TNM分期及AJCC推荐的风险水平、复发及转移情况。采用Kaplan-Meier评价各年龄组无复发生存率。结果50例中,学龄前期与学龄期在局部侵犯情况有显著统计学差异(P=0.008),学龄前期组的局部侵犯比例(6例,42.6%)高于学龄期组(3例,8.1%)。两组肿瘤T分期存在明显差异(χ^2=12.584,P=0.028),学龄期组T2比例较高(19例,51.4%),而学龄前期组T4a比例较高(5例,38.5%)。手术并发症比例,学龄前期组显著多与学龄期儿童(χ^2=9.632,P=0.008)。无发复组双侧甲状腺全切比例明显高于复发组(85.7%,53.3%)(χ^2=11.227,P=0.004),甲状腺全切可以降低儿童DTC复发风险。复发组与无复发组TNM与风险水平无统计学差异。复发组T1a、T1b和T2的总百分比超过50%,低风险水平为37.5%,中风险水平25%。约半数的复发病例在最初诊断时是TNM分期较低的且为低风险水平的。儿童DTC术后复发率差异无统计学意义(P>0.05)。结论学龄前期DTC病例的局部浸润,肿瘤分期以及手术并发症比例高于学龄期,年龄是儿童DTC的重要危险因素。将近一半的复发病例在最初诊断时是低风险的,因此应进一步研究儿童DTC复发风险评估策略。应提高对儿童DTC病例临床特征了解并采取适当的治疗策略。

Objective The prevalence of differentiated thyroid cancer(DTC)has been increasing in children in recent years.Here,we have discussed the clinical characteristics of differentiated thyroid cancer(DTC)in children,and analyzed cases with recurrence.Methods We retrospectively investigated 50 children diagnosed with DTC at our hospital between January 1998 and July 2014.The clinical characteristics were compared for different age groups based on their age at initial diagnosis:pre-school group(≤7 years old)and school-age group(7-13 years old),and the clinical data of the recurrence and non-recurrence groups were also reviewed.The clinical features observed in this study included the TNM stage,and the AJCC recommended risk,recurrence,and metastasis.The Kaplan Meier method was used to evaluate the recurrence-free survival rate of all age groups.Results There was a significant difference between the pre-school and school-age groups in terms of local invasion(P=0.008).The proportion of local invasion in the pre-school group(6 cases,42.6%)was higher than that in the school-age group(3 cases,8.1%).There was a significant difference in the T stage between the two groups(χ^2=12.584,P=0.028).The proportion of T2 in the school-age group was higher(19 cases,51.4%)than that in the pre-school age group.Whereas the proportion of T4 A in the pre-school age group was higher(5 cases,38.5%)than that in the school-age group.The proportion of surgical complications in the pre-school group was significantly higher than that in the school-age group(χ^2=9.632,P=0.008).The proportion of total thyroidectomy in the non-recurrence group was significantly higher than that in the recurrence group(85.7%,53.3%)(χ^2=11.227,P=0.004).Total thyroidectomy was found to reduce the recurrence risk of DTC in children.There was no significant difference in TNM and risk level between the recurrence group and the non-recurrence group.The total percentage of T1 a,T1 b and T2 was more than 50%,and the low-risk and medium-risk levels were 37.5%and 25%,respectively.More than half of the recurrence cases had a low TNM stage and low-risk level at the time of initial diagnosis.There was no significant difference in the postoperative recurrence rate of DTC in children(P>0.05).Discussion The proportion of local invasion,tumor stage,and surgical complications in patients with DTC in the pre-school group was higher than that in the school-age group.Age was found to be an important risk factor for children with DTC.More than half of the recurrence cases were low-risk at the time of initial diagnosis.Therefore,further study should be conducted regarding the risk assessment strategy of DTC recurrence in children.Understanding of the clinical characteristics of children with DTC should be improved so that appropriate treatment strategies can be implemented.