Kumar Ajay, Bal C S
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
Indian J Pediatr. 2003 Sep;70(9):707-13. doi: 10.1007/BF02724312.
The retrospective analysis of the case files of children with differentiated thyroid carcinoma (DTC) was performed to define the disease by its presentation, clinical course and outcome of radioiodine therapy.
Between 1967 to October 2002, 1754 patients with thyroid cancer were treated in the Dept of Neuclear Medicine, AIIMS, out of which 122 (7%) were < or = 20 years of age (71 girls and 51 boys). The mean age was 15.8 +/- 3.6 years and the mean duration of follow-up was 90 +/- 59.3 months. Mean tumor size was 4.4 cm. Histologically, 85% of the patients had papillary and rest follicular carcinoma. Cervical lymph node involvement was seen in 64%, and distant metastases, mainly pulmonary, in 23% of the patients. The presentation of the disease was very aggressive in the first decade of life with male preponderance. All but one patient in this age group had nodal and/or distant metastases; in 83.3% the disease had spread to the lymph nodes and 67% had metastases to the lungs. The post-surgery 48-hour mean radioiodine neck uptake was 10.5 +/- 7.6%.
94% of the residual thyroid, 88% of nodal metastases and 71% of pulmonary metastases were ablated requiring mean cumulative doses of 2.8 +/- 2.7 GBq, 4.5 +/- 2.7 GBq and 10.4 +/- 7.9 GBq of 131I, respectively. Average number of doses required for remnant, nodal and pulmonary metastases ablation were 1.3, 2.2 and 3.3, respectively. 80% of the patients with only remnant thyroid tissue and 50% with cervical lymph node metastases got ablated with a single dose of 131I. Overall, 87% patients were currently free of disease. While, nine patients had nodal recurrence between surgery and radioiodine treatment, no recurrence was observed thereafter and 3 disease related deaths producing overall mortality of 2.5% (all in children < or =10 years of age) were seen in the mean follow-up of 7.5 years.
Differentiated thyroid cancer in children and adolescents is rare but aggressive. The biological behavior differs from that in adults and is related to the age. Younger the age (< or =10 years), more aggressive and widespread is the disease with male preponderance and high mortality. The post-surgical radioiodine ablation/therapy is an important and effective adjuvant in the management of DTC in children and adolescents and even though they present with advance disease, long-term survival and overall prognosis is good.
对分化型甲状腺癌（DTC）患儿的病历进行回顾性分析，以通过其临床表现、临床病程及放射性碘治疗结果来明确该疾病。
1967年至2002年10月期间，全印医学科学研究所核医学科共治疗了1754例甲状腺癌患者，其中122例（7%）年龄小于或等于20岁（71例女孩，51例男孩）。平均年龄为15.8±3.6岁，平均随访时间为90±59.3个月。平均肿瘤大小为4.4厘米。组织学检查显示，85%的患者为乳头状癌，其余为滤泡状癌。64%的患者有颈部淋巴结受累，23%的患者有远处转移，主要为肺部转移。该疾病在生命的第一个十年表现出非常侵袭性的特点，男性居多。这个年龄组除1例患者外，所有患者均有淋巴结和/或远处转移；83.3%的疾病已扩散至淋巴结，67%的患者有肺部转移。术后48小时放射性碘颈部平均摄取率为10.5±7.6%。
94%的残留甲状腺、88%的淋巴结转移灶和71%的肺部转移灶被清除，清除这些病灶分别需要平均累积剂量为2.8±2.7GBq、4.5±2.7GBq和10.4±7.9GBq的131I。清除残留甲状腺组织、淋巴结转移灶和肺部转移灶所需的平均剂量分别为1.3、2.2和3.3次。80%仅残留甲状腺组织的患者和50%有颈部淋巴结转移的患者通过单次剂量的131I即可清除病灶。总体而言，87%的患者目前无疾病。虽然有9例患者在手术和放射性碘治疗之间出现淋巴结复发，但此后未观察到复发情况，在平均7.5年的随访中，有3例与疾病相关的死亡，总死亡率为2.5%（均为年龄小于或等于10岁的儿童）。
儿童和青少年分化型甲状腺癌罕见但具有侵袭性。其生物学行为与成人不同，且与年龄有关。年龄越小（小于或等于10岁），疾病越具侵袭性且扩散范围越广，男性居多且死亡率高。术后放射性碘清除/治疗是儿童和青少年DTC管理中的重要且有效的辅助手段，尽管他们表现为晚期疾病，但长期生存率和总体预后良好。
