不同年龄儿童及青少年分化型甲状腺癌患者的临床病理学特征与131I治疗分析

背景与目的： 既往研究已发现18岁以下的儿童及青少年分化型甲状腺癌（differentiated thyroid carcinoma,DTC）与成人DTC在临床病理学特征、远期预后等方面存在差异,但对其内部不同年龄段之间,特别是青春期前、围青春期和青春期之间的特征研究较少,因此本研究旨在探讨不同年龄组儿童及青少年DTC的临床病理学特征及首次¹³¹I治疗效果的差异。方法： 回顾性分析四川大学华西医院2006年7月—2022年1月收治的156例儿童及青少年DTC患者。根据年龄分为青春期前（0岁<年龄≤10岁）、围青春期（10岁<年龄≤14岁）及青春期（14岁<年龄≤18岁）3组,比较3组的临床病理学特征、初始复发危险度分层、首次¹³¹I治疗后动态风险评估及刺激性甲状腺球蛋白（stimulated thyroglobulin,sTg）水平在首次¹³¹I治疗后的变化。结果： 3组患者的性别、原发肿瘤最大直径、包膜侵犯、T分期、N分期及切除淋巴结阳性转移比例差异无统计学意义（P>0.05）。3组患者的远处转移率分别为63.2%、42.1%和20.2%（χ²=16.839,P=0.000）,高危患者分别占88.9%、60.5%和46.4%（χ²=12.447,P=0.009）。3组患者首次¹³¹I治疗后动态风险评估的差异有统计学意义（χ²=21.744,P=0.001）,其中3组患者的疗效满意（excellent response,ER）比例分别为10.5%、25.0%和38.1%;结构性疗效不佳（structural incomplete response,SIR）比例分别为68.4%、52.8%和25.8%;生化疗效不佳（biochemical incomplete response,BIR）比例分别为21.1%、13.9%和14.4%。63例患者接受了第2次¹³¹I治疗且TgAb低于40 U/mL,首次¹³¹I治疗后3组的中位sTg降幅分别为41.31%、38.02%和60.38%（H=4.642,P=0.098）。结论： 儿童及青少年DTC中0~10岁组患者的远处转移率和高危复发风险最高,首次¹³¹I治疗后ER的结局最少,青春期前儿童DTC的发生、发展机制和治疗值得进一步研究。

Clinicopathological characteristics and 131I treatment of differentiated thyroid carcinoma in children and adolescents of different age groups

Background and purpose: Previous studies have found different clinicopathological characteristics and prognosis between differentiated thyroid carcinoma (DTC) in children and adolescents who are ≤18 years old and in adult. However, there are few studies comparing the characteristics within DTC in children and adolescents itself. In this study, the clinicopathological characteristics of DTC in children and adolescents and the response to the initial ¹³¹I treatment were investigated in different age groups. Methods: One hundred and fifty-six cases of DTC in children and adolescents admitted to West China Hospital, Sichuan University from July 2006 to January 2022 were retrospectively analyzed. The cohorts were segregated into three age categories: prepubertal (0 year131I treatment and the percentage change of stimulated thyroglobulin (sTg) were compared among three age groups. Results: There was no statistically significant difference among three age groups in gender, maximum diameter of primary tumor, extrathyroidal invasion, T stage, N stage and positive metastasis proportion of dissected lymph node (P>0.05). The proportion of distant metastasis in 0-10 years, 10-14 years and 14-18 years were 63.2%, 42.1% and 20.2%, respectively (χ²=16.839, P=0.000). High-risk recurrence patients accounted for 88.9%, 60.5%, 46.4% in three age groups, respectively (χ²=12.447, P=0.009). Dynamic risk assessment after initial ¹³¹I treatment was obviously different among three age groups (χ²=21.744, P=0.001). The excellent response (ER) rate in three groups was 10.5%, 25.0% and 38.1%, respectively. The structural incomplete response (SIR) rate was 68.4%, 52.8% and 25.8%, respectively. The biochemical incomplete response (BIR) rate was 21.1%, 13.9% and 14.4%, respectively. Sixty-three patients with TgAb less than 40 U/mL received the second ¹³¹I treatment, and the median ΔsTg% in three group was 41.31%, 38.02% and 60.38% (H=4.642, P=0.098), respectively. Conclusion: Patients aged 0-10 years had the highest proportion of distant metastasis and high-risk recurrence and lowest ER rate after initial ¹³¹I treatment among DTC in children and adolescents. More effort is needed to study the carcinogenesis mechanism and treatment strategies of DTC in prepubertal children with DTC.