86例青少年甲状腺癌的临床分析

目的 探讨青少年甲状腺癌的临床病理特点、最佳治疗方法及预后。方法 86例患者均以手术治疗为主,辅以内分泌治疗,少数患者加^131Ⅰ内照射治疗。结果 全组乳头状癌73例(84．9％),滤泡状癌6例(7．0％),乳头滤泡状癌4例(4、7％),髓样癌3例(3．5％)。颈部淋巴结转移59例(68．6％),其中双侧甲状腺癌并双颈部淋巴结转移者16例,占27.1％。肺转移11例。术后复发6例。本组颈部淋巴结转移率、双侧甲状腺受侵犯伴双颈淋巴结转移率、肺转移率均明显高于成年人。84例获5年以上随访,5年生存率95．3％(82／86)。41例获10年以上随访,10年生存率87．8％(36／41)。结论 青少年甲状腺癌颈部肿块临床表现大多数无特异性,难以与其他颈部肿块鉴别,易误诊,应引起临床高度重视。治疗手段以手术为主,预后良好。既使已有肺转移,手术加^131Ⅰ内照射的综合治疗仍能获得较满意疗效。

Childhood and adolescent thyroid carcinoma: a clinical analysis of 86 cases

OBJECTIVE: To investigate the clinico-pathologic characteristics, treatment and prognosis of thyroid carcinoma in childhood and adolescents. METHODS: From 1984 to 1997, 86 cases with thyroid carcinoma in childhood and adolescent treated were summarized. RESULTS: All cases underwent operation with adjuvant therapy. Pathologically, papillary carcinoma was diagnosed in 73 (84.9%), follicular carcinoma in 6 (7%), papillary-follicular carcinoma in 4 (4.7%) and medullary carcinoma in 3 (3.5%). Cervical lymph node metastasis was found in 59 cases (68.6%), 16 of which with both thyroid carcinoma and bilateral cervical lymph node metastasis (27.1%). Lung metastasis was found in 11 cases. Recurrence occurred in 6 cases after operation. Compared with the thyroid carcinoma in adult patients, cervical lymph node metastasis, bilateral involvement of the thyroid gland with bilateral cervical nodes and lung metastasis rate were more commonly seen in childhood and adolescence. All but 2 patients had been followed up for more than 5 years, 41 patients for more than 10 years. The 5-year and 10-year survival rate was 95.3% (82/86) and 87.8% (36/41), respectively. CONCLUSION: The clinical manifestations of childhood and adolescent thyroid cancer are generally not pathognostic which may lead to misdiagnosis. Surgery is the main method in the comprehensive treatment with a good prognosis. The therapy with (131)I after operation was beneficial for some patients accompanied with lung metastasis.