Welch Dinauer C A, Tuttle R M, Robie D K, McClellan D R, Svec R L, Adair C, Francis G L
Department of Pediatrics, Walter Reed Army Medical Center, Washington, D.C. 20307, USA.
Clin Endocrinol (Oxf). 1998 Nov;49(5):619-28. doi: 10.1046/j.1365-2265.1998.00584.x.
Differentiated thyroid cancer (DTC), including papillary (PTC) and follicular (FTC) variants, is unusual in children and accounts for only 10% of all cases. For that reason, knowledge of the clinical features which predict recurrence is limited. We reviewed 170 cases of childhood DTC to determine if specific clinical or pathological findings were associated with increased risk of recurrence.
This was a retrospective study of children and adolescents with DTC registered in the Department of Defense Automated Centralized Tumor Registry.
We reviewed 137 cases of PTC and 33 cases of FTC diagnosed between 1953 and 1996 at < or = 21 years of age.
In the PTC group (median follow-up 6.6 years, range 2 month-39.5 years), only one patient died, but 21 developed local and 6 developed distant recurrence. By univariate analysis, recurrence was more common in patients with multifocal (odds ratio 7.5) or large tumours (odds ratio 4.1), and in those with palpable cervical lymphadenopathy (odds ratio 3.0) or metastasis at diagnosis (odds ratio 2.8). By multivariate analysis focality was the best predictor of recurrence (P = 0.0019). In the FTC group (median follow-up 5 years, range 6 month-38.1 years), no patient died of disease, but 5 developed recurrence. As with PTC, recurrence was more likely in patients with multifocal tumours (odds ratio 22.0).
Differentiated thyroid cancer in children and adolescents has low mortality, but a high risk of recurrence. Young patients with large, multifocal tumours that are already metastatic at diagnosis have the greatest risk of recurrence.
分化型甲状腺癌（DTC），包括乳头状（PTC）和滤泡状（FTC）亚型，在儿童中较为罕见，仅占所有病例的10%。因此，关于预测复发的临床特征的知识有限。我们回顾了170例儿童DTC病例，以确定是否有特定的临床或病理发现与复发风险增加相关。
这是一项对在国防部自动化中央肿瘤登记处登记的患有DTC的儿童和青少年的回顾性研究。
我们回顾了1953年至1996年间诊断的137例PTC和33例FTC病例，患者年龄≤21岁。
在PTC组（中位随访6.6年，范围2个月至39.5年），仅1例患者死亡，但21例出现局部复发，6例出现远处复发。单因素分析显示，多灶性（优势比7.5）或大肿瘤（优势比4.1）患者、有可触及的颈部淋巴结病（优势比3.0）或诊断时有转移（优势比2.8）的患者复发更常见。多因素分析显示，灶性是复发的最佳预测因素（P = 0.0019）。在FTC组（中位随访5年，范围6个月至38.1年），无患者死于该病，但5例出现复发。与PTC一样，多灶性肿瘤患者复发的可能性更大（优势比22.0）。
儿童和青少年分化型甲状腺癌死亡率低，但复发风险高。诊断时已发生转移的大的多灶性肿瘤的年轻患者复发风险最高。
