Li S C, Li Z D, Liu H W, Dong H L, Xu Y
Department of Head and Neck Surgery,China Medical University Cancer Hospital,Liaoning Cancer Hospital and Institute,Shenyang,110042,China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Mar 20;31(6):431-437. doi: 10.13201/j.issn.1001-1781.2017.06.006.
To study the clinical characteristics and treatment strategies of differentiated thyroid carcinoma in adolescents and children.From 1983 to 2014, total 2936 patients with the thyroid cancer were collected in our hospital, among which there were 85 patients of adolescents and children with 61 female and 24 male. The age was from 9 to 21 years old (median 18.3 years). There were 12 cases less than 14 years.The pathologic diagnoses were papillary carcinoma 76 cases and follicular carcinoma 9 cases. The clinical material, history of disease, clinical presentation, TNM classification, histopathological features, treatment method, and the final follow-up results were analyzed and studied. Overall survival rate was 100%, follow-up from 0.5 to 31 years(medium 10.9 years), 10 year progression free survival rate was 87.1%. There was no mortality and 8(9.4%)cases occurred recurrence,who followed by surgery and resumed finally. There were 20 cases found extrathyroid extention, including 8 cases less than 14 years and 12 cases older than 15 years. The extrathyroid extention rate was significantly higher in cases of lower years(66.7%)than other group(16.4%)(<0.01). Forty-nine(57.6%) cases were found lymphanods metastases, among them ≤14 years metastases rate 92.0%（11/12）significantly more than ≥15 years metastases rate 52.1%(38/73) (<0.05). Three patients suffered with pulmonary metastases and all of them were ≤14 years patients. All of 85 patients were received surgery treatment included total, subtotal and oneside thyroidectomy. The neck lymph nodes were underwent modefied, radical or no neck dissection. Fifteen patients were received 131I therapy postoperatively, the dosage was 50～170 mCi. All of 85 patients were received TSH suppression therapy. 13 cases(15.3%) occurred complications,such as laryngeal recurrent nerve paralysis and hypoparathyroidism commonly. Majority of thyroid cancer for adolescents and children are papillary and follicular carcinoma. The histopathologic feature has significant invasion beyond thyroid capsula, and metastasis to the lymphanods and distante area,especially ≤14 years patients significant more than ≥15 years. The prognosis is favorable, it is few death from thyroid cancer. The treatment means is surgery to resect all of the disease, sometimes should perform total or neartotal thyroidectomy if there are distant metastasis and extensive invasion. It should pay attention to preserve the function of recurrent laryngeal nerve and parathyroid gland. Most of them can be performed unilateral lobectomy if the tumor located oneside thyroid gland. The lymphanode metastasis should be undertaken modified neck dissection, make effort to avoid radical neck dissection. It should be carful to use 131I internal radiation therapy and avoid the excessive treatment.
研究青少年及儿童分化型甲状腺癌的临床特征及治疗策略。1983年至2014年，我院共收集甲状腺癌患者2936例，其中青少年及儿童患者85例，女性61例，男性24例。年龄9至21岁（中位年龄18.3岁），14岁以下12例。病理诊断为乳头状癌76例，滤泡状癌9例。对临床资料、疾病史、临床表现、TNM分类、组织病理学特征、治疗方法及最终随访结果进行分析研究。总生存率为100%，随访时间0.5至31年（中位10.9年），10年无进展生存率为87.1%。无死亡病例，8例（9.4%）复发，经再次手术最终恢复。发现20例有甲状腺外侵犯，其中14岁以下8例，15岁以上12例。低年龄组甲状腺外侵犯率（66.7%）显著高于其他组（16.4%）（P<0.01）。49例（57.6%）有淋巴结转移，其中≤14岁转移率92.0%（11/12）显著高于≥15岁转移率52.1%（38/73）（P<0.05）。3例有肺转移，均为≤14岁患者。85例均接受手术治疗，包括甲状腺全切、次全切及单侧甲状腺切除。颈部淋巴结行改良、根治或未行颈部清扫。15例术后接受131I治疗，剂量为50～170mCi。85例均接受促甲状腺激素抑制治疗。13例（15.3%）发生并发症，如喉返神经麻痹和甲状旁腺功能减退较为常见。青少年及儿童甲状腺癌多数为乳头状和滤泡状癌。组织病理学特征有明显的甲状腺包膜外侵犯，以及淋巴结和远处转移，尤其是≤14岁患者显著多于≥15岁患者。预后良好，死于甲状腺癌者少见。治疗方法为手术切除所有病灶，如有远处转移和广泛侵犯有时应行甲状腺全切或近全切。应注意保留喉返神经和甲状旁腺功能。肿瘤位于单侧甲状腺者多数可行单侧叶切除。有淋巴结转移应行改良颈部清扫，尽量避免根治性颈部清扫。应谨慎使用131I内放射治疗，避免过度治疗。
