Newman K D, Black T, Heller G, Azizkhan R G, Holcomb G W, Sklar C, Vlamis V, Haase G M, La Quaglia M P
Department of Pediatric Surgery, Children's National Medical Center, Washington, DC, USA.
Ann Surg. 1998 Apr;227(4):533-41. doi: 10.1097/00000658-199804000-00014.
This study was done to define the extent of disease and evaluate the effect of staging and treatment variables on progression-free survival in patients with differentiated thyroid carcinoma who were less than 21 years of age at diagnosis.
Differentiated thyroid cancer in young patients is associated with early regional lymph node involvement and distant parenchymal metastases. Despite this, the overall long-term survival rate is greater than 90%, which suggests that biologic rather than treatment factors have a greater effect on outcome.
Variables analyzed for their impact on progression-free survival in a multi-institutional cohort of 329 patients included age, antecedent thyroid irradiation, extrathyroidal tumor extension, size, nodal involvement, distant metastases, technique of thyroid surgery and lymphatic dissection, initial treatment with 131Iodine, residual cervical disease, and histopathologic subtype. Surgical complications were correlated with the specific procedures completed on the thyroid gland or cervical lymphatics.
The overall progression-free survival rate was 67% (95%, CI: 61%-73%) at 10 years with 2 disease-related deaths. Regional lymph node and distant metastases were present in 74% and 25% of patients, respectively. Progression-free survival was less in younger patients (p = 0.009) and those with residual cervical disease after thyroid surgery (p = 0.001). Permanent hypocalcemia was more frequent after total or subtotal thyroidectomy (p = 0.001) while wound complications increased after radical neck dissections (p < 0.00001).
The progression-free survival rate was better after a complete resection and in older patients. Progression-free survival rate was the same after lobectomy or more extensive thyroid procedures, but comparison was confounded by the increased use of total or subtotal thyroidectomy in patients with advanced disease. The risk of permanent hypocalcemia increased when total or subtotal thyroidectomy was done. Thyroid lobectomy alone may be appropriate for patients with small localized lesions while total or subtotal thyroidectomy should be considered for more extensive tumors.
本研究旨在明确疾病范围，并评估分期和治疗变量对诊断时年龄小于21岁的分化型甲状腺癌患者无进展生存期的影响。
年轻患者的分化型甲状腺癌与早期区域淋巴结受累及远处实质转移相关。尽管如此，总体长期生存率大于90%，这表明生物学因素而非治疗因素对预后影响更大。
在一个多机构队列的329例患者中，分析了对无进展生存期有影响的变量，包括年龄、既往甲状腺照射史、甲状腺外肿瘤侵犯、肿瘤大小、淋巴结受累情况、远处转移、甲状腺手术及淋巴结清扫技术、初始131碘治疗、颈部残留病灶以及组织病理学亚型。手术并发症与甲状腺或颈部淋巴管完成的特定手术相关。
10年时总体无进展生存率为67%（95%，CI：61%-73%），有2例与疾病相关的死亡。分别有74%和25%的患者存在区域淋巴结转移和远处转移。年轻患者（p = 0.009）及甲状腺手术后颈部残留病灶的患者（p = 0.001）的无进展生存期较短。全甲状腺切除或次全甲状腺切除术后永久性低钙血症更常见（p = 0.001），而根治性颈清扫术后伤口并发症增加（p < 0.00001）。
完全切除后及年龄较大患者的无进展生存率较好。叶切除术或更广泛的甲状腺手术术后无进展生存率相同，但在晚期疾病患者中全甲状腺切除或次全甲状腺切除的使用增加使比较变得复杂。进行全甲状腺切除或次全甲状腺切除时永久性低钙血症的风险增加。对于小的局限性病变患者，单独行甲状腺叶切除术可能合适，而对于更广泛的肿瘤应考虑行全甲状腺切除或次全甲状腺切除。
