年轻成人与儿童的分化型甲状腺癌：临床特征与 10 年随访结局。

Differentiated Thyroid Cancers in Young Adults Versus Children: Clinical Characteristics and 10-year Follow-up Outcomes.

机构信息

Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.

出版信息

J Clin Endocrinol Metab. 2023 Nov 17;108(12):e1670-e1677. doi: 10.1210/clinem/dgad343.

DOI:10.1210/clinem/dgad343

PMID:37285485

Abstract

BACKGROUND

Differentiated thyroid cancer (DTC) in young adults has been steadily rising in incidence over the decades. However, data on long-term outcomes in this specific cohort remain limited. In this study, we intended to evaluate young adults with DTC with regard to their clinical characteristics and treatment outcomes and compare the same vis-à-vis pediatric patients with DTC.

METHODS

Data of pediatric (≤18 years) and young adult (19-39 years) patients with DTC, from 1971 to 2016, were sequentially extracted and analyzed for clinical characteristics, treatment responses, rates of recurrent/persistent disease, and disease-free survival (DFS).

RESULTS

A total of 1803 patients with DTC were included (pediatric cohort: n = 176; young adult cohort: n = 1627). Pediatric patients with DTC had more frequent adverse baseline features including extrathyroidal extension (P = .040), nodal and distant metastases, and American Thyroid Association high-risk disease (P < .001 each). At 2 years posttreatment, young adult patients with DTC had significantly lower incomplete responses compared with pediatric patients with DTC (223/1627; 13.7% vs 94/176, 53.4%, respectively; P < .001). Over a median follow-up of 10.7 years, 120/1627 (7.4%) young adult patients with DTC had recurrent/persistent disease vs 23/176 (13.1%) pediatric patients with DTC (P = .012). The 10-year DFS probability was 93.6% for the young adult patients with DTC vs 88.7% for the pediatric patients with DTC (P = .007). American Thyroid Association high-risk disease and incomplete response at 2 years were independent predictors of significantly worse DFS in the young adult cohort (P < .001 each).

CONCLUSIONS

Young adult DTCs behave less aggressively compared with their pediatric counterparts with excellent long-term outcomes. Appropriate initial and dynamic risk stratification can help optimize treatment decisions and follow-up strategies.

摘要

背景

几十年来，年轻成年人分化型甲状腺癌（DTC）的发病率一直在稳步上升。然而，关于这一特定人群的长期预后数据仍然有限。在这项研究中，我们旨在评估年轻成年人 DTC 的临床特征和治疗结果，并将其与儿科 DTC 患者进行比较。

方法

从 1971 年至 2016 年，连续提取并分析了儿科（≤18 岁）和年轻成年人（19-39 岁）DTC 患者的临床特征、治疗反应、复发性/持续性疾病发生率和无疾病生存率（DFS）。

结果

共纳入 1803 例 DTC 患者（儿科组：n=176；年轻成年人组：n=1627）。儿科 DTC 患者具有更多的不良基线特征，包括甲状腺外延伸（P=0.040）、淋巴结和远处转移，以及美国甲状腺协会高危疾病（均 P＜0.001）。治疗后 2 年，年轻成年人 DTC 患者的不完全反应明显低于儿科患者（223/1627；13.7%比 94/176，53.4%；P＜0.001）。在中位随访 10.7 年后，1627 例年轻成年人 DTC 患者中有 120 例（7.4%）发生了复发性/持续性疾病，而 176 例儿科患者中有 23 例（13.1%）（P=0.012）。年轻成年人 DTC 患者的 10 年 DFS 概率为 93.6%，而儿科患者为 88.7%（P=0.007）。美国甲状腺协会高危疾病和 2 年时的不完全反应是年轻成年人组 DFS 显著恶化的独立预测因素（均 P＜0.001）。