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

doi:10.19401/j.cnki.1007-3639.2022.05.005

中国癌症杂志 ›› 2022, Vol. 32 ›› Issue (5): 404-409.doi: 10.19401/j.cnki.1007-3639.2022.05.005

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

齐萌芳()(), 田甜, 黄蕤()()

四川大学华西医院核医学科,四川成都 610041

收稿日期:2022-04-06 修回日期:2022-05-03 出版日期:2022-05-30 发布日期:2022-06-09
通信作者: 黄蕤 E-mail:2955529532@qq.com;huang_rui@scu.edu.cn
作者简介:齐萌芳（ORCID: 0000-0002-4733-7693）,硕士在读 E-mail: 2955529532@qq.com
黄蕤,四川大学华西医院核医学科主任医师,博士研究生导师,放射性核素治疗组组长。中华医学会核医学分会第十届委员会青年委员会委员,四川省医学会核医学专业委员会第九届委员会副主任委员,中国临床肿瘤学会甲状腺癌专家委员会常务委员兼秘书长,四川省医师协会核医学科医师分会第三届委员会常委,四川省肿瘤学会甲状腺癌专业委员会副主任委员,《中华核医学与分子影像杂志》《医学装备杂志》通讯编委,国家自然科学基金项目同行评议专家。主持国家自然科学基金面上项目一项,国家自然科学基金青年项目一项,四川省科技局支撑项目一项及GCP项目六项。参与中华医学会核医学分会《¹³¹I治疗格雷夫斯甲亢指南（2021版）》《氯化锶[⁸⁹Sr]治疗转移性骨肿瘤专家共识（2017年版）》撰写,参与中国临床肿瘤学会《2021 CSCO分化型甲状腺癌诊疗指南》撰写。担任专著《¹³¹I治疗分化型甲状腺癌》和教材《核医学（第2版）》副主编,参编由Springer出版社出版的Nuclear Medicine全英文专著、《临床核医学》和《临床医学影像学》专著。研究方向主要包括放射性核素诊疗一体化开发及甲状腺癌的分子机制。

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

QI Mengfang()(), TIAN Tian, HUANG Rui()()

Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China

Received:2022-04-06 Revised:2022-05-03 Published:2022-05-30 Online:2022-06-09
Contact: HUANG Rui E-mail:2955529532@qq.com;huang_rui@scu.edu.cn

摘要/Abstract

摘要：

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。

关键词: 分化型甲状腺癌, 儿童, 青少年, 临床病理学特征, ¹³¹I

Abstract:

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 year<age≤10 years), peri-pubertal (10 years<age≤14 years) and pubertal (14 years<age≤18 years). Clinicopathological characteristics, initial recurrence risk, dynamic risk assessment after initial ¹³¹I 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.

Key words: Differentiated thyroid carcinoma, Children, Adolescent, Clinicopathological characteristics, ¹³¹I

中图分类号:

R736.1

齐萌芳, 田甜, 黄蕤. 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[J]. 中国癌症杂志, 2022, 32(5): 404-409.

QI Mengfang, TIAN Tian, HUANG Rui. Clinicopathological characteristics and ¹³¹I treatment of differentiated thyroid carcinoma in children and adolescents of different age groups[J]. China Oncology, 2022, 32(5): 404-409.

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参考文献 16

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Clinicopathological characteristic	0-10 (N=19)	10-14 (N=38)	14-18 (N=99)	Statistical value	P value
Gender				χ²=4.255	0.119
Male	8 (42.1)	10 (26.3)	20 (20.2)
Female	11 (57.9)	28 (73.7)	79 (79.8)
Tumor diameter D/cm median (range) (N=123)	2.5 (1.0-5.0)	3.0 (0.0-6.0)	2.9 (0.0-8.0)	H=0.801	0.670
Extrathyroidal invasion (N=129)				χ²=1.998	0.368
No	5 (33.3)	17 (51.5)	43 (53.1)
Yes	10 (66.7)	16 (48.5)	38 (46.9)
T stage (N=129)				χ²=4.683	0.096
T_0-3	8 (53.3)	18 (54.5)	59 (72.8)
T₄	7 (46.7)	15 (45.5)	22 (27.2)
N stage				χ²=7.509	0.088^*
N₀	2 (11.1)	0 (0.0)	7 (7.2)
N_1a	2 (11.1)	5 (13.5)	25 (25.8)
N_1b	14 (77.8)	32 (86.5)	65 (67.0)
Percentage of lymph node metastasis (N=127)				χ²=4.265	0.119
≤50%	12 (92.3)	21 (65.6)	52 (63.4)
>50%	1 (7.7)	11 (34.4)	30 (36.6)
Pathologic types				χ²=14.128	0.006^*
CPTC	15 (78.9)	36 (94.8)	97 (98)
FVPTC	1 (5.3)	1 (2.6)	0 (0.0)
DSVPTC	2 (10.5)	1(2.6)	0(0.0)
FTC	1 (5.3)	0(0.0)	2(2.0)
Distant metastases				χ²=16.839	0.000
M₀	7 (36.8)	22 (57.9)	79 (79.8)
M₁	12 (63.2)	16 (42.1)	20 (20.2)
Initial recurrence risk (N=153)				χ²=12.447	0.009^*
Low risk	0 (0.0)	0 (0.0)	5 (5.2)
Intermediate risk	2 (11.1)	15 (39.5)	47 (48.4)
High risk	16 (88.9)	23 (60.5)	45 (46.4)

Item	0-10 (N=10)	10-14 (N=13)	14-18 (N=40)	H value	P value
¹³¹I dose D/GBq	3.70 (3.70-5.55)	3.70 (2.96-7.40)	3.7 (2.96-7.40)	2.014	0.365
sTg1 ρ_B/(ug·L^-1)	143.35 (9.90-1 000.00)	212.90(3.00-4 240.00)	32.70 (0.13-3 381.00)	7.219	0.027
sTg2 ρ_B/(ug·L^-1)	81.76 (0.34-2 757.00)	115.90 (1.24-3 886.00)	8.22 (0.04-2 954.00)	7.433	0.024
ΔsTg%	41.31%	38.02%	60.38%	4.642	0.098

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

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

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