Wang Xing, Wang Xiao-Lei
Department of Head and Neck surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang 310022, China.
Institute of Cancer and Basic Medical (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China.
Chin Med J (Engl). 2020 Oct 5;133(19):2281-2286. doi: 10.1097/CM9.0000000000000910.
The standard treatment for pediatric differentiated thyroid carcinoma (DTC) still requires consideration because of a lack of clinical evidence. The purpose of this study was to summarize the clinical experiences and explore the risk factors for post-operative recurrence through a retrospective analysis to develop better clinical strategies for pediatric DTC.
This study retrospectively analyzed children and adolescents with DTC who were treated between January 1999 and December 2014 at the Cancer Hospital, Chinese Academy of Medical Sciences. Clinicopathological results and outcomes were collected. A log-rank test of Kaplan-Meier curves and the Cox regression model were used to determine the factors associated with recurrence.
Data of 150 patients were collected in this study. During the follow-up, there was only one disease-related death. The recurrence rates at 3, 5, and 10 years were 13.6%, 18.7%, and 28.6%, respectively. There was a significant difference in the rate of recurrence according to age (P < 0.001), extrathyroidal extension (P < 0.001), lymph node metastasis (P = 0.023), and invasion of the trachea and esophageal wall (P = 0.004). Cox regression analysis demonstrated that age (P = 0.006) and extrathyroidal extension (P = 0.013) were significant dependent factors of post-operative recurrence.
The prognosis of DTC in children and adolescents is favorable. A close follow-up is recommended because of the high recurrence rate. A comparatively higher recurrence rate was observed in the younger age group, and new age-based divisions may be needed to conveniently evaluate the possibility of recurrence.
由于缺乏临床证据，小儿分化型甲状腺癌（DTC）的标准治疗仍需进一步考量。本研究旨在通过回顾性分析总结临床经验，探索术后复发的危险因素，从而为小儿DTC制定更好的临床策略。
本研究回顾性分析了1999年1月至2014年12月在中国医学科学院肿瘤医院接受治疗的DTC患儿及青少年患者。收集临床病理结果及预后情况。采用Kaplan-Meier曲线对数秩检验和Cox回归模型确定与复发相关的因素。
本研究共收集了150例患者的数据。随访期间，仅1例与疾病相关的死亡病例。3年、5年和10年的复发率分别为13.6%、18.7%和28.6%。根据年龄（P<0.001）、甲状腺外侵犯（P<0.001）、淋巴结转移（P=0.023）以及气管和食管壁侵犯情况（P=0.004），复发率存在显著差异。Cox回归分析表明，年龄（P=0.006）和甲状腺外侵犯（P=0.013）是术后复发的显著相关因素。
儿童及青少年DTC的预后良好。鉴于复发率较高，建议密切随访。较年轻年龄组的复发率相对较高，可能需要基于年龄的新分类方法以便于评估复发可能性。
