Brink J S, van Heerden J A, McIver B, Salomao D R, Farley D R, Grant C S, Thompson G B, Zimmerman D, Hay I D
Division of General and Gastroenterologic Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Surgery. 2000 Dec;128(6):881-6; discussion 886-7. doi: 10.1067/msy.2000.109728.
Papillary thyroid cancer (PTC) in young patients may rarely be encountered with pulmonary metastases. Previous studies have suggested that, in the pediatric population, this may not portend a lethal outcome. Our present study, children with pulmonary metastases, was designed to clarify this issue.
Fourteen children and young adolescents (mean age, 13.5 years; range, 9.8-17 years) with PTC and pulmonary metastases were treated at our institution between 1937 and 1998. Surgical treatment consisted of total thyroidectomy (n = 10 patients), subtotal thyroidectomy (n = 3 patients), and a biopsy only procedure (n = 1 patient). All patients who underwent thyroidectomy also underwent a variety of cervical lymph node dissections, and all patients proved to have regional nodal disease. After the operation, 12 patients were treated with ablative doses of (131)I, 1 patient was treated with external beam irradiation, and all patients were placed on suppressive thyroid hormone therapy. The mean length of follow-up was 19.3 years (range, 1-45 years).
Regional recurrent disease developed in 2 patients (15%). No patient experienced the development of worsening pulmonary disease or extra-pulmonary metastases. All patients with recurrent disease underwent selective nodal resections. No patient died of metastatic PTC. Seven patients (50%) remain completely free of disease and are probably cured; 7 patients (50%) are asymptomatic with residual pulmonary disease.
A stepwise treatment approach allows long-term survival and frequent cure for young patients with PTC and concomitant pulmonary metastases.
年轻患者的甲状腺乳头状癌（PTC）很少出现肺转移。先前的研究表明，在儿科人群中，这可能并不预示着致命的结局。我们目前针对患有肺转移的儿童开展的这项研究旨在阐明这一问题。
1937年至1998年间，我们机构收治了14例患有PTC并伴有肺转移的儿童和青少年（平均年龄13.5岁；范围9.8 - 17岁）。手术治疗包括全甲状腺切除术（10例患者）、次全甲状腺切除术（3例患者）以及仅行活检手术（1例患者）。所有接受甲状腺切除术的患者还进行了各种颈部淋巴结清扫术，且所有患者均证实有区域淋巴结疾病。术后，12例患者接受了大剂量（131）I治疗，1例患者接受了外照射放疗，所有患者均接受甲状腺激素抑制治疗。平均随访时间为19.3年（范围1 - 45年）。
2例患者（15%）出现区域复发疾病。没有患者出现肺部疾病恶化或肺外转移。所有复发疾病患者均接受了选择性淋巴结切除术。没有患者死于转移性PTC。7例患者（50%）仍完全无疾病，可能已治愈；7例患者（50%）无症状，有残留肺部疾病。
逐步治疗方法可使患有PTC并伴有肺转移的年轻患者获得长期生存且常能治愈。
