Liu Yuwei, Wang Shengcai, Li Yanzhen, Zhang Xuexi, Liu Zhiyong, Liu Qiaoyin, Sun Nian, Zhang Jie, Ge Wentong, Guo Yongli, Liu Yuanhu, Fang Xiaolian, Ji Tingting, Tai Jun, Ni Xin
Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China.
Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, China.
Eur Thyroid J. 2021 Jul;10(5):364-371. doi: 10.1159/000516830. Epub 2021 Jun 17.
The objectives of this study were to explore the clinical heterogeneity of differentiated thyroid cancer (DTC) between prepubertal children and adolescents and guide clinical treatment.
A retrospective study included patients with DTC aged ≤19 years in Beijing Children's Hospital from June 2014 to June 2019. All patients were enrolled and divided into 2 subgroups based on the threshold age of 10 years, namely the childhood group (CG) (≤10 years old); and the adolescent group (AG) (between 10 and 19 years old). The χ test and Fisher's exact test were used to estimate the effect of risk factors in the 2 age groups. Multivariate binary logistic regression models were conducted to assess the recurrent risk factors.
Seventy cases of DTC were included with an average age of 9.94 ± 2.88 years, including 35 in CG and 35 in AG. The most common clinical manifestation was a painless mass in the neck, accounting for 77.1% (54/70) of patients. Compared with the AG, the CG was more likely to have lymph node metastasis ( = 0.022) and distant metastasis ( = 0.041). The CG was more likely to have extrathyroidal extension ( = 0.012) and had a significantly higher recurrence rate than the AG ( = 0.040). Age was an independent variable predictive of recurrence ( = 0.0347).
Regional invasiveness, cervical lymph node metastasis, and distant metastasis of DTC were more likely to occur in children ≤10 years old. Meanwhile, children ≤10 years old with DTC were more likely to have recurrence than adolescent's postsurgical treatment. Thus, children younger than 10 years of age with DTC should be treated more aggressively.
本研究旨在探讨青春期前儿童与青少年分化型甲状腺癌（DTC）的临床异质性，并指导临床治疗。
一项回顾性研究纳入了2014年6月至2019年6月在北京儿童医院就诊的年龄≤19岁的DTC患者。所有患者均被纳入研究，并根据10岁的年龄阈值分为2个亚组，即儿童组（CG）（≤10岁）和青少年组（AG）（10至19岁）。采用χ检验和Fisher精确检验评估2个年龄组中危险因素的作用。进行多变量二元逻辑回归模型以评估复发危险因素。
共纳入70例DTC患者，平均年龄为9.94±2.88岁，其中CG组35例，AG组35例。最常见的临床表现是颈部无痛性肿块，占患者的77.1%（54/70）。与AG组相比，CG组更易发生淋巴结转移（P = 0.022）和远处转移（P = 0.041）。CG组更易发生甲状腺外侵犯（P = 0.012），且复发率显著高于AG组（P = 0.040）。年龄是复发的独立预测变量（P = 0.0347）。
10岁及以下儿童的DTC更易发生局部侵袭、颈部淋巴结转移和远处转移。同时，10岁及以下的DTC儿童术后复发的可能性高于青少年。因此，对10岁以下的DTC儿童应采取更积极的治疗措施。
