儿童及青少年分化型甲状腺癌远处转移的临床病理学危险因素分析

doi:10.19401/j.cnki.1007-3639.2019.06.004

中国癌症杂志 ›› 2019, Vol. 29 ›› Issue (6): 423-428.doi: 10.19401/j.cnki.1007-3639.2019.06.004

儿童及青少年分化型甲状腺癌远处转移的临床病理学危险因素分析

眭慧敏，刘杰蕊，王瞳，朱朝晖，林岩松

中国医学科学院北京协和医学院北京协和医院核医学科，北京100730

出版日期:2019-06-30 发布日期:2019-07-12
通信作者: 林岩松 E-mail: linyansong68@yahoo.com.cn

Clinicopathological risk factors for distant metastasis of differentiated thyroid carcinoma in children and adolescents

SUI Huimin, LIU Jierui, WANG Tong, ZHU Zhaohui, LIN Yansong

Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China

Published:2019-06-30 Online:2019-07-12
Contact: LIN Yansong E-mail: linyansong68@yahoo.com.cn

摘要/Abstract

摘要： 背景与目的：近年来，儿童及青少年甲状腺癌发病率不断上升。探讨儿童及青少年分化型甲状腺癌（children and adolescents differentiated thyroid cancer, caDTC）远处转移的临床病理学危险因素。方法：回顾性分析2007年2月—2018年10月在北京协和医院核医学科就诊的年龄<21岁的69例DTC患者，合并远处转移的40例患者归入A组，无远处转移的29例患者归入B组，用t检验对比两组年龄，用χ²检验对比两组性别、甲状腺外侵犯、多灶及BRAF^V600E，用Mann-Whitney U检验对比两组肿瘤直径、T分期、N分期、术后¹³¹I治疗前刺激性甲状腺球蛋白（preablation-stimulated thyroglobulin，ps-Tg）及甲状腺球蛋白抗体（thyroglobulin antibody，TgAb）。通过受试者工作特征（receiver operating characteristic，ROC）曲线评估ps-Tg对远处转移的预测价值。应用多因素logistic回归分析确定远处转移的预测因子。结果：A组患者表现出更小的年龄、更易呈多灶性、更高的病理分期及更高的ps-Tg水平，而两组性别、甲状腺外侵犯、肿瘤直径及TgAb方面差异无统计学意义。ps-Tg与远处转移关系的ROC曲线的曲线下面积为0.900。ps-Tg最佳临界点为102.35 ng/mL，对应的灵敏度、特异度和阴性预测值分别为70.0%、100.0%和70.7%。进一步多因素logistic回归分析中，年龄和ps-Tg被证实是远处转移的预测因子。结论：低龄、高ps-Tg水平及多灶性等局部侵袭特征与caDTC的远处转移相关，以102.35 ng/mL作为ps-Tg的界值点对caDTC的远处转移具有预测价值。

关键词: 分化型甲状腺癌, 远处转移, 儿童, 青少年

Abstract: Background and purpose: In recent years, the incidence of the thyroid carcinoma in children and adolescents has increased significantly. This study aimed to explore the clinicopathological risk factors for children and adolescents with distant metastasis of differentiated thyroid carcinoma (caDTC). Methods: Totally, 69 patients with DTC (<21 years) treated in Department of Nuclear Medicine, Peking Union Medical College Hospital from Feb. 2007 to Oct. 2018 were retrospectively analyzed in this study. Patients were divided into two groups as per the presence of distant metastases or not: group A (n=40) and group B (n=29). For comparison between the two groups, t-test was used to compare the ages, χ² test was used to compare the gender, extrathyroidal invasion, multifocality and BRAF^V600E, while the Mann-Whitney U test was used to compare the tumor size, T stage, N stage, preablation-stimulated thyroglobulin (ps-Tg) and thyroglobulin antibody (TgAb). The receiver operating characteristic (ROC) curve was analyzed to evaluate the predictive value of ps-Tg for distant metastasis. Multivariate logistic regression analysis was used to identify predictors of distant metastasis. Results: Group A showed younger age at diagnosis, more likelihood of multifocality, higher pathological stage and higher ps-Tg level, while the two groups did not differ in gender, extrathyroidal invasion, tumor size and TgAb. Area under the ROC curve was 0.900. The cut-off point of ps-Tg was 102.35 ng/mL, with a sensitivity of 70.0%, specificity of 100%, and negative predictive value of 70.7%. In further multivariate logistic regression analysis, age and ps-Tg were confirmed to be predictors of distant metastasis. Conclusion: Young age, high ps-Tg level, and advanced local invasion characteristics such as multifocality and higher tumor stage are associated with the distant metastasis of caDTC. With a cut-off of 102.35 ng/mL, ps-Tg holds the predictive value in identifying distant metastasis of caDTC.

Key words: Differentiated thyroid carcinoma, Distant metastasis, Children, Adolescents

眭慧敏，刘杰蕊，王瞳，朱朝晖，林岩松. 儿童及青少年分化型甲状腺癌远处转移的临床病理学危险因素分析[J]. 中国癌症杂志, 2019, 29(6): 423-428.

SUI Huimin, LIU Jierui, WANG Tong, ZHU Zhaohui, LIN Yansong. Clinicopathological risk factors for distant metastasis of differentiated thyroid carcinoma in children and adolescents[J]. China Oncology, 2019, 29(6): 423-428.

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儿童及青少年分化型甲状腺癌远处转移的临床病理学危险因素分析

Clinicopathological risk factors for distant metastasis of differentiated thyroid carcinoma in children and adolescents

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