Cherella Christine E, Wassner Ari J
Thyroid Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Thyroid Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Best Pract Res Clin Endocrinol Metab. 2023 Jan;37(1):101715. doi: 10.1016/j.beem.2022.101715. Epub 2022 Nov 7.
Thyroid cancer is rare in children but its incidence is increasing. Recent data have clarified important similarities and differences between thyroid cancers originating in childhood and in adulthood. The genetic drivers of pediatric thyroid cancers are similar to those in adult tumors but comprise more gene fusions and fewer point mutations. Clinically, despite frequent metastatic spread, pediatric thyroid cancer has an excellent prognosis and mortality is rare. Therefore, treatment approaches must weigh carefully the morbidity of thyroid cancer treatments against their benefits. Current key questions include which children require total thyroidectomy rather than more limited-and safer-lobectomy, and in which children does the benefit of radioactive iodine therapy outweigh its risk of inducing a secondary malignancy. Finally, molecular therapies targeting genetic drivers of thyroid cancer now provide effective treatment for children with progressive, radioiodine-refractory disease, as well as opportunities to explore novel neoadjuvant uses that facilitate therapeutic surgery or radioactive iodine.
甲状腺癌在儿童中较为罕见，但发病率正在上升。最近的数据已经明确了儿童期和成人期起源的甲状腺癌之间重要的异同点。儿童甲状腺癌的遗传驱动因素与成人肿瘤相似，但包含更多的基因融合和更少的点突变。临床上，尽管常有转移扩散，但儿童甲状腺癌预后良好，死亡率很低。因此，治疗方法必须仔细权衡甲状腺癌治疗的发病率及其益处。当前的关键问题包括哪些儿童需要进行全甲状腺切除术而非更有限且更安全的甲状腺叶切除术，以及放射性碘治疗对哪些儿童的益处超过其诱发继发性恶性肿瘤的风险。最后，针对甲状腺癌遗传驱动因素的分子疗法现在为患有进展性、放射性碘难治性疾病的儿童提供了有效的治疗方法，同时也为探索有助于治疗性手术或放射性碘治疗的新型新辅助用途提供了机会。
