Gui Yan, Huang Dongmei, Hou Yun, Wei Xudong, Zhang Jinming, Wang Junyi
The First Hospital of Lanzhou University, Department of Otorhinolaryngology Head and Neck Surgery, Lanzhou City, China.
The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.
Front Oncol. 2022 Feb 24;12:833775. doi: 10.3389/fonc.2022.833775. eCollection 2022.
The incidence of papillary thyroid carcinoma (PTC) in children and adolescents has increased, but the data on long-term outcomes are limited. There are few literatures on the clinicopathological characteristics and prognosis of PTC in children and adolescents in China. Therefore, it is necessary to identify clinicopathological features to precisely predict clinical prognosis and to help choose the optimal method and perform the best therapeutic regimen.
This study was a retrospective analysis of patients undergoing thyroidectomy at Tianjin Medical University Cancer Institute and Hospital. We analyzed the factors related to the clinicopathological features and prognosis of PTC in children and adolescents.
A total of 95 juvenile PTC patients who underwent thyroidectomy were enrolled. Our research found that patients with younger age (<14 years) were predominantly multifocal and have positive preoperative thyroglobulin (Tg) and higher recurrence rate, and their number of lymph node metastases (LNMs) was more than that of the older group (14-18 years). Maximal tumor size >2 cm, T stage, and multifocality were the risk factors for LNM and the number of LNM (p < 0.05). Multivariate analysis displayed the number of central LNM as the independent risk factor for lateral LNM, and multifocality was the independent risk factor for the number of central and lateral LNM. Younger age at diagnosis, positive preoperative thyroid-stimulating hormone (TSH), maximal tumor size >2 cm, lateral LNM, number of LNM, N staging, and American Thyroid Association (ATA) pediatric risk were related to poor prognosis in PTC patients (p < 0.05). Cox regression analysis found that younger age at diagnosis and positive preoperative TSH were independent risk factors for recurrence of PTC in children and adolescents.
Our study showed that the clinicopathological characteristics of younger age compared with older age were as follows: highly aggressive, prone to metastases, and higher recurrence rate. In our opinion, patients with characteristics such as younger age at diagnosis, positive preoperative TSH, maximal tumor size >2 cm, lateral LNM, and number of LNM >5 may be considered for prophylactic or therapeutic dissection of additional metastatic LNs by high-volume surgeons to prevent and reduce the recurrence rate of patients during long-term follow-up.
儿童和青少年甲状腺乳头状癌（PTC）的发病率有所上升，但长期预后的数据有限。中国关于儿童和青少年PTC临床病理特征及预后的文献较少。因此，有必要明确临床病理特征，以精确预测临床预后，并有助于选择最佳方法和实施最佳治疗方案。
本研究是对天津医科大学肿瘤医院接受甲状腺切除术的患者进行的回顾性分析。我们分析了与儿童和青少年PTC临床病理特征及预后相关的因素。
共纳入95例接受甲状腺切除术的青少年PTC患者。我们的研究发现，年龄较小（<14岁）的患者多为多灶性，术前甲状腺球蛋白（Tg）呈阳性，复发率较高，且其淋巴结转移（LNM）数量多于年龄较大组（14 - 18岁）。最大肿瘤直径>2 cm、T分期和多灶性是LNM及LNM数量的危险因素（p < 0.05）。多因素分析显示中央区LNM数量是侧方LNM的独立危险因素，多灶性是中央区和侧方LNM数量的独立危险因素。诊断时年龄较小、术前促甲状腺激素（TSH）阳性、最大肿瘤直径>2 cm、侧方LNM、LNM数量、N分期以及美国甲状腺协会（ATA）儿科风险与PTC患者预后不良相关（p < 0.05）。Cox回归分析发现，诊断时年龄较小和术前TSH阳性是儿童和青少年PTC复发的独立危险因素。
我们的研究表明，与年龄较大者相比，年龄较小者的临床病理特征如下：侵袭性强、易发生转移且复发率较高。我们认为，对于诊断时年龄较小、术前TSH阳性、最大肿瘤直径>2 cm、侧方LNM以及LNM数量>5等特征的患者，高年资外科医生可考虑对额外的转移淋巴结进行预防性或治疗性清扫，以预防和降低患者长期随访期间的复发率。
