Royal Marsden NHS Foundation Trust Thyroid Unit, London, UK.
Department of Primary Care & Public Health, School of Public Health, Imperial College London, London, UK.
Clin Oncol (R Coll Radiol). 2019 Jun;31(6):385-390. doi: 10.1016/j.clon.2019.02.005. Epub 2019 Mar 14.
To obtain an overview of the management and outcomes of children aged 18 years or younger diagnosed with differentiated thyroid carcinoma of follicular cell origin across the UK, by collecting and analysing data from the limited number of centres treating these patients. This multicentre data might provide a more realistic perspective than single-institution series.
Six centres submitted data extracted from historical records on patients aged 18 years or younger, diagnosed between 1964 and 2017. The univariate and multivariable Cox proportional hazard model was used to identify potential predictors of progression-free survival, using national data as a control.
Data on 166 patients were available for analysis. Females (74%) were predominant, and the age ranged from 3 to 19 years at diagnosis, mean 14.1 years. Nodal metastases were present in 51%; 12% had distant metastases. After surgery, 95% received radioactive iodine (39% on more than one occasion) and 4% received external beam radiotherapy. With a median follow-up duration of 5 years, 69% are alive with no evidence of disease; 20% are alive with a raised thyroglobulin level as the only evidence of residual disease; 6% have residual structural disease detectable on imaging; 2% have died, from cerebral metastases.
Despite most patients having advanced disease at presentation, outcomes are very good. A national prospective registry should allow systematic collection of good-quality data and may facilitate research to further improve outcomes.
通过收集和分析治疗这些患者的少数中心的数据，了解英国年龄在 18 岁或以下的滤泡细胞来源分化型甲状腺癌患者的治疗方法和结果。这种多中心数据可能比单机构系列提供更现实的观点。
6 个中心从 1964 年至 2017 年间诊断的年龄在 18 岁或以下的患者的历史记录中提取数据并提交。使用单变量和多变量 Cox 比例风险模型，使用国家数据作为对照，确定无进展生存的潜在预测因素。
共有 166 名患者的数据可用于分析。女性（74%）占优势，诊断时年龄为 3 至 19 岁，平均年龄为 14.1 岁。51%存在淋巴结转移，12%有远处转移。手术后，95%的患者接受放射性碘治疗（39%不止一次），4%的患者接受外部束放射治疗。中位随访时间为 5 年，69%的患者无疾病存活；20%的患者存活，唯一残留疾病的证据是升高的甲状腺球蛋白水平；6%的患者在影像学上检测到残留结构性疾病；2%的患者因脑转移而死亡。
尽管大多数患者在就诊时已处于晚期疾病，但预后非常好。国家前瞻性登记册应允许系统地收集高质量的数据，并可能有助于研究，以进一步提高预后。
