Division of Endocrinology and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
World J Surg. 2010 Jun;34(6):1192-202. doi: 10.1007/s00268-009-0364-0.
Controversy exists regarding the aggressiveness of initial therapy in childhood papillary thyroid cancer (PTC). Few studies with long-term outcome exist and second primary malignancies have rarely been analyzed.
We studied 215 PTC patients younger than 21 years old managed during 1940 through 2008. The patients were aged 3-20 year old (median age = 16 years); the median follow-up was 29 years. Recurrence and mortality details were taken from a computerized database.
Median primary tumor size was 2.2 cm. Six percent had distant metastases at presentation, 5% had incomplete tumor resection, 86% had nodes removed at initial surgery, and 78% had nodal metastases. After complete surgical resection, PTC recurred in 32% by 40 years. At 20 years, the recurrence rates at local, regional, and distant sites were 7, 21, and 5%, respectively. During 1940-1969, local and regional recurrence rates after unilateral lobectomy (UL) were significantly (P < 0.001) higher than after bilateral lobar resection (BLR). During 1950-2008 radioiodine remnant ablation (RRA) was administered within 18 months to 32%; it did not diminish the 25-year regional recurrence rate of 16% seen after BLR alone (P = 0.86). Only two fatal events from PTC occurred at 28 and 30 years, for a cause-specific mortality at 40 years of only 2%. All-causes mortality rates did not exceed expectation through 20 years, but from 30 through 50 years, the number of deaths was significantly (P < 0.001) higher than predicted. Fifteen of 22 deaths (68%) resulted from nonthyroid malignancy.
Survival from childhood PTC should be expected, but later death from nonthyroid malignancy is disconcerting. Seventy-three percent of those who died from nonthyroid malignancy had received postoperative therapeutic irradiation.
在儿童甲状腺乳头状癌（PTC）的初始治疗中存在争议。很少有长期预后的研究，很少分析第二原发恶性肿瘤。
我们研究了 1940 年至 2008 年期间治疗的 215 名年龄小于 21 岁的 PTC 患者。患者年龄为 3-20 岁（中位年龄= 16 岁）；中位随访时间为 29 年。复发和死亡率细节来自计算机数据库。
中位原发肿瘤大小为 2.2cm。6%的患者在初诊时存在远处转移，5%的患者肿瘤不完全切除，86%的患者在初始手术时切除淋巴结，78%的患者淋巴结转移。完全手术后，32%的 PTC 在 40 年内复发。20 年时，局部、区域和远处复发率分别为 7%、21%和 5%。在 1940-1969 年，单侧叶切除术（UL）后的局部和区域复发率明显（P <0.001）高于双侧叶切除术（BLR）。在 1950-2008 年，18 个月至 32%的患者接受了放射性碘残留消融（RRA）；它并没有降低单独 BLR 后 16%的 25 年区域复发率（P=0.86）。仅在 28 岁和 30 岁时发生了 2 例 PTC 致死事件，因此在 40 岁时的特异性死亡率仅为 2%。通过 20 年，所有原因的死亡率均未超过预期，但从 30 年到 50 年，死亡人数明显（P <0.001）高于预期。22 例死亡中的 15 例（68%）归因于非甲状腺恶性肿瘤。
应预期儿童 PTC 的生存，但后来死于非甲状腺恶性肿瘤令人不安。73%死于非甲状腺恶性肿瘤的患者接受了术后治疗性放疗。
