Handkiewicz-Junak Daria, Wloch Jan, Roskosz Jozef, Krajewska Jolanta, Kropinska Aleksandra, Pomorski Lech, Kukulska Aleksandra, Prokurat Andrzej, Wygoda Zbigniew, Jarzab Barbara
Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland.
J Nucl Med. 2007 Jun;48(6):879-88. doi: 10.2967/jnumed.106.035535.
We sought to assess whether extensive surgical treatment, postsurgical radioiodine therapy, or both decrease the risk of locoregional recurrence (LR) after curative primary treatment in children and adolescents diagnosed with differentiated thyroid cancer (DTC) at age <or=18 y.
To determine the incidence of and identify predictive factors for thyroid bed recurrence (TBR) or lymph node recurrence (NR), we performed a chart review and retrospective multivariate Cox regression analysis on 235 patients with DTC diagnosed at age <or=18 y and managed with curative intent at our tertiary referral center from 1973 to 2002; 40 of these patients had distant metastases at diagnosis. We also determined overall and recurrence-free survival and generated curves for these variables using Kaplan-Meier and Cox univariate analysis.
During a median follow-up of 82 mo (range, 5-402 mo), no DTC-related deaths occurred, 203 (86%) children remained recurrence-free, and 32 (14%) children had LR, including TBR in 9 (28% of LR), NR in 20 (63% of LR), and both in 3 (9% of LR). Among patients treated with radical intent and showing no distant metastases, the most recent thyroglobulin level was <1 ng/mL in all but 4% of cases. The median time from the first surgery to LR was 37 mo (range, 9-280 mo). In multivariate analysis, significant risk factors for TBR were less than total thyroidectomy and lack of postsurgical radioiodine treatment (respective risk increases of 9.5 [P = 0.04] and 11 times [P = 0.03]). For NR, classic papillary histology, incomplete primary lymph node management (i.e., lack of modified lymphadenectomy of affected lymph nodes or lack of confirmation of disease-free nodes by intraoperative staging), and absence of adjuvant radioiodine therapy were independent significant predictive factors that increased the recurrence risk by 1.9 (P = 0.02), 3.3 (P = 0.02), and 3.2 (P = 0.02) times, respectively. Age or sex did not correlate with LR risk.
In DTC patients <or=18 y of age, extensive initial therapy-consisting of total thyroidectomy combined with modified lymphadenectomy performed in case of lymph node metastases and followed by radioiodine therapy--is associated with a substantial decrease of DTC LR risk.
我们试图评估广泛手术治疗、术后放射性碘治疗或两者联合应用是否能降低年龄≤18岁的分化型甲状腺癌（DTC）患儿和青少年在根治性初始治疗后局部区域复发（LR）的风险。
为了确定甲状腺床复发（TBR）或淋巴结复发（NR）的发生率并识别预测因素，我们对1973年至2002年在我们三级转诊中心诊断为年龄≤18岁且接受根治性治疗的235例DTC患者进行了病历回顾和回顾性多变量Cox回归分析；其中40例患者在诊断时有远处转移。我们还确定了总生存率和无复发生存率，并使用Kaplan-Meier法和Cox单变量分析生成了这些变量的曲线。
在中位随访82个月（范围5 - 402个月）期间，未发生与DTC相关的死亡，203例（86%）儿童无复发，32例（14%）儿童发生LR，包括9例（LR的28%）TBR、20例（LR的63%）NR和3例（LR的9%）两者均有。在接受根治性治疗且无远处转移的患者中，除4%的病例外，其余患者最近的甲状腺球蛋白水平均<1 ng/mL。从首次手术到LR的中位时间为37个月（范围9 - 280个月）。在多变量分析中，TBR的显著危险因素是甲状腺全切术未完成和术后未进行放射性碘治疗（风险分别增加9.5倍[P = 0.04]和11倍[P = 0.03]）。对于NR，经典乳头状组织学、原发性淋巴结处理不彻底（即未对受影响淋巴结进行改良淋巴结清扫或术中分期未确认无病淋巴结）以及未进行辅助放射性碘治疗是独立的显著预测因素，分别使复发风险增加1.9倍（P = 0.02）、3.3倍（P = 0.02）和3.2倍（P = 0.02）。年龄或性别与LR风险无关。
在年龄≤18岁的DTC患者中，初始广泛治疗——包括甲状腺全切术，若有淋巴结转移则联合改良淋巴结清扫，随后进行放射性碘治疗——与DTC的LR风险大幅降低相关。
