Department of Pediatrics, Yale Child Health Research Center, Yale University School of Medicine, 464 Congress Avenue, Room 237, New Haven, Connecticut 06520, USA.
Endocr Rev. 2011 Dec;32(6):798-826. doi: 10.1210/er.2011-0011. Epub 2011 Aug 31.
Pediatric thyroid cancer is a rare disease with an excellent prognosis. Compared with adults, epithelial-derived differentiated thyroid cancer (DTC), which includes papillary and follicular thyroid cancer, presents at more advanced stages in children and is associated with higher rates of recurrence. Because of its uncommon occurrence, randomized trials have not been applied to test best-care options in children. Even in adults that have a 10-fold or higher incidence of thyroid cancer than children, few prospective trials have been executed to compare treatment approaches. We recognize that treatment recommendations have changed over the past few decades and will continue to do so. Respecting the aggressiveness of pediatric thyroid cancer, high recurrence rates, and the problems associated with decades of long-term follow-up, a premium should be placed on treatments that minimize risk of recurrence and the adverse effects of treatments and facilitate follow-up. We recommend that total thyroidectomy and central compartment lymph node dissection is the surgical procedure of choice for children with DTC if it can be performed by a high-volume thyroid surgeon. We recommend radioactive iodine therapy for remnant ablation or residual disease for most children with DTC. We recommend long-term follow-up because disease can recur decades after initial diagnosis and therapy. Considering the complexity of DTC management and the potential complications associated with therapy, it is essential that pediatric DTC be managed by physicians with expertise in this area.
儿童甲状腺癌是一种罕见疾病，预后良好。与成人相比，上皮来源的分化型甲状腺癌（DTC），包括乳头状和滤泡状甲状腺癌，在儿童中更晚期出现，且复发率更高。由于其罕见发生，随机试验尚未应用于测试儿童的最佳治疗方案。即使在甲状腺癌的发病率比儿童高 10 倍或更高的成年人中，也很少有前瞻性试验来比较治疗方法。我们认识到，在过去几十年中，治疗建议已经发生了变化，并且还将继续发生变化。鉴于儿童甲状腺癌的侵袭性、高复发率以及与数十年长期随访相关的问题，应该优先选择能够最大限度降低复发风险和治疗不良反应并便于随访的治疗方法。我们建议，如果能由高容量甲状腺外科医生进行，那么全甲状腺切除术和中央区淋巴结清扫术是 DTC 儿童的首选手术方法。我们建议大多数 DTC 儿童进行放射性碘治疗以进行残余消融或残留疾病治疗。我们建议进行长期随访，因为疾病在初始诊断和治疗后数十年仍可能复发。考虑到 DTC 管理的复杂性以及治疗相关的潜在并发症，由在该领域具有专业知识的医生来管理儿童 DTC 至关重要。
