Schlumberger M, De Vathaire F, Travagli J P, Vassal G, Lemerle J, Parmentier C, Tubiana M
Institut Gustave-Roussy, Villejuif, France.
J Clin Endocrinol Metab. 1987 Dec;65(6):1088-94. doi: 10.1210/jcem-65-6-1088.
Seventy-two children with differentiated thyroid cancer who were 16 years old or younger at the time of initial treatment were followed for a median time of 13 yr. Initially, 18% had lung metastases, and 74% had palpable lymph nodes. Capsular invasion was found in 67%, and histological lymph node involvement in 90%. The recurrent laryngeal nerve chain and the jugulo-carotid chain were involved with the same frequency (greater than 80%). The anterior superior mediastinum was involved only in patients with involvement of the recurrent laryngeal nerve chain. Forty-three patients had a complete remission after initial treatment. In patients without distant metastases for whom surgery was macroscopically incomplete, relapses occurred 5 times more frequently than in patients whose surgery was complete. Six patients died from thyroid carcinoma at ages ranging from 19-44 yr, 12-33 yr after initial treatment, and 1 died from intercurrent disease. Despite favorable long term survival (90.3% at 20 yr), the standardized mortality ratio was equal to 8.1. This study underlines the need for complete surgical treatment and compulsive follow-up, which should be continued throughout the patient's life, in order to detect and effectively treat relapses of thyroid cancer.
对72例初次治疗时年龄在16岁及以下的分化型甲状腺癌患儿进行了中位时间为13年的随访。最初，18%有肺转移，74%可触及淋巴结。67%发现有包膜侵犯，90%有组织学上的淋巴结受累。喉返神经链和颈静脉-颈动脉链受累频率相同（超过80%）。只有喉返神经链受累的患者前上纵隔才会受累。43例患者初次治疗后完全缓解。在无远处转移且手术肉眼观察不完全的患者中，复发频率比手术完全的患者高5倍。6例患者死于甲状腺癌，年龄在19至44岁之间，初次治疗后12至33年，1例死于并发疾病。尽管长期生存率良好（20年时为90.3%），但标准化死亡比为8.1。本研究强调需要进行完整的手术治疗和强制性随访，且应贯穿患者一生，以便检测并有效治疗甲状腺癌复发。
