Dinauer Catherine, Francis Gary L
Department of Pediatrics, Yale School of Medicine, P.O. Box 208081, 464 Congress Avenue, New Haven, CT 06520-8081, USA.
Endocrinol Metab Clin North Am. 2007 Sep;36(3):779-806, vii. doi: 10.1016/j.ecl.2007.04.002.
In 1996, the authors were asked to review the subject of thyroid cancer in children. Over the subsequent decade, much has been learned about the treatment and outcome of these uncommon tumors. We now recognize quantitative and perhaps qualitative differences in genetic mutations and growth factor expression patterns in childhood thyroid cancers compared with those of adults. We also know that thyroid cancers induce a robust immune response in children that might contribute to their longevity. Patients under 10 years of age probably represent a unique subset of children at particularly high risk for persistent or recurrent disease; the management of these patients is under evaluation. We remain limited in our knowledge of how to stratify children into low- and high-risk categories for appropriate long-term follow-up and in our knowledge of how to treat children who have detectable serum thyroglobulin but negative imaging studies. In this article, the authors update our understanding of thyroid cancers in children with special emphasis on how these data relate to the current guidelines for management of thyroid cancer developed by the American Thyroid Association Taskforce. The limited data regarding management of children who have detectable serum thyroglobulin but negative whole-body scans are also reviewed.
1996年，作者受邀对儿童甲状腺癌这一主题进行综述。在随后的十年里，我们对这些罕见肿瘤的治疗方法和预后有了更多了解。现在我们认识到，与成人甲状腺癌相比，儿童甲状腺癌在基因突变和生长因子表达模式上存在数量上甚至可能是质量上的差异。我们还知道，甲状腺癌在儿童中会引发强烈的免疫反应，这可能有助于他们的长期生存。10岁以下的患者可能是儿童中一个独特的亚组，面临持续或复发疾病的特别高风险；这些患者的管理正在评估中。我们在如何将儿童分层为低风险和高风险类别以进行适当的长期随访方面，以及在如何治疗血清甲状腺球蛋白可检测但影像学检查阴性的儿童方面，知识仍然有限。在本文中，作者更新了我们对儿童甲状腺癌的理解，特别强调这些数据与美国甲状腺协会特别工作组制定的当前甲状腺癌管理指南的关系。关于血清甲状腺球蛋白可检测但全身扫描阴性的儿童管理的有限数据也进行了综述。
