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<sup>131</sup>I治疗分析

齐萌芳; 田甜; 黄蕤

doi:10.19401/j.cnki.1007-3639.2022.05.005

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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

专题论著 | 更新时间：2025-12-31

- 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
- 中国癌症杂志 2022年32卷第5期页码：404-409
- 作者机构：
  
  四川大学华西医院核医学科,四川成都 610041
- 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。" ]
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2022.05.005
  中图分类号： R736.1
- 收稿：2022-04-06，
  
  修回：2022-05-03，
  
  纸质出版：2022-05-30
- 稿件说明：
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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.

Mengfang QI, Tian TIAN, Rui HUANG. 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.
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. DOI： 10.19401/j.cnki.1007-3639.2022.05.005.

Mengfang QI, Tian TIAN, Rui HUANG. 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. DOI： 10.19401/j.cnki.1007-3639.2022.05.005.

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

131

I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

#x02014;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

#x02264;10岁）、围青春期（10岁

年龄

#x02264;14岁）及青春期（14岁

年龄

#x02264;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

131

I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

131

I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（

0.05）。3组患者的远处转移率分别为63.2%、42.1%和20.2%（

=16.839

=0.000）

高危患者分别占88.9%、60.5%和46.4%（

=12.447

=0.009）。3组患者首次

131

I治疗后动态风险评估的差异有统计学意义（

=21.744

=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

131

I治疗且TgAb低于40 U/mL

首次

131

I治疗后3组的中位sTg降幅分别为41.31%、38.02%和60.38%（

=4.642

=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

131

I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。

Abstract

Background and purpose:

Previous studies have found different clinicopathological characteristics and prognosis between differentiated thyroid carcinoma (DTC) in children and adolescents who are

#x02264;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

131

I 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

#x02264;10 years)

peri-pubertal (10 years

age

#x02264;14 years) and pubertal (14 years

age

#x02264;18 years). Clinicopathological characteristics

initial recurrence risk

dynamic risk assessment after initial

131

I 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 (

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 (

=16.839

=0.000). High-risk recurrence patients accounted for 88.9%

60.5%

46.4% in three age groups

respectively (

=12.447

=0.009). Dynamic risk assessment after initial

131

I treatment was obviously different among three age groups (

=21.744

=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

131

I treatment

and the median

#x00394;sTg% in three group was 41.31%

38.02% and 60.38% (

=4.642

=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

131

I 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.

关键词

Keywords

references

CHO Y Y , JANG H W , JOUNG J Y , et al . Trends in thyroid cancer incidence in Korean children (1999-2012) based on palpation and nonpalpation detection methods [J ] . Eur Thyroid J , 2015 , 4 ( 4 ): 252 - 259 . DOI: 10.1159/000442047 http://doi.org/10.1159/000442047 https://etj.bioscientifica.com/doi/10.1159/000442047 https://etj.bioscientifica.com/doi/10.1159/000442047

VERGAMINI L B , FRAZIER A L , ABRANTES F L , et al . Increase in the incidence of differentiated thyroid carcinoma in children, adolescents, and young adults: a population-based study [J ] . J Pediatr , 2014 , 164 ( 6 ): 1481 - 1485 . DOI: 10.1016/j.jpeds.2014.01.059 http://doi.org/10.1016/j.jpeds.2014.01.059 https://linkinghub.elsevier.com/retrieve/pii/S0022347614000870 https://linkinghub.elsevier.com/retrieve/pii/S0022347614000870

PAULSON V A , RUDZINSKI E R , HAWKINS D S . Thyroid cancer in the pediatric population [J ] . Genes , 2019 , 10 ( 9 ): 723 . DOI: 10.3390/genes10090723 http://doi.org/10.3390/genes10090723 https://www.mdpi.com/2073-4425/10/9/723 https://www.mdpi.com/2073-4425/10/9/723

HOWLADER N , NOONE A M , KRAPCHO M , et al . SEER Cancer Statistics Review, 1975-2016, National Cancer Institute [EB/OL ] . ( 2019 -04)[2022-05-05 ] . https://seer.cancer.gov/csr/1975_2016/ https://seer.cancer.gov/csr/1975_2016/ https://seer.cancer.gov/csr/1975_2016/

国家儿童医学中心 , 国家儿童肿瘤监测中心 , 中华医学会小儿外科学分会 , 等 . 中国儿童甲状腺结节及分化型甲状腺癌专家共识 [J ] . 中华实用儿科临床杂志 , 2020 , 35 ( 20 ): 1521 - 1530 .

National Children’s Medical Center , National Children’s Tumor Surveillance Center , Pediatric Surgery Branch of Chinese Medical Association , et al . Expert consensus on thyroid nodules and differentiated thyroid cancer for Chinese children [J ] . Chin J Appl Clin Pediatr , 2020 , 35 ( 20 ): 1521 - 1530 .

FRANCIS G L , WAGUESPACK S G , BAUER A J , et al . Management guidelines for children with thyroid nodules and differentiated thyroid cancer [J ] . Thyroid , 2015 , 25 ( 7 ): 716 - 759 . DOI: 10.1089/thy.2014.0460 http://doi.org/10.1089/thy.2014.0460 https://www.liebertpub.com/doi/10.1089/thy.2014.0460 https://www.liebertpub.com/doi/10.1089/thy.2014.0460

HAY I D , JOHNSON T R , KAGGAL S , et al . Papillary thyroid carcinoma (PTC) in children and adults: comparison of initial presentation and long-term postoperative outcome in 4432 patients consecutively treated at the mayo clinic during eight decades (1936-2015) [J ] . World J Surg , 2018, 42 ( 2 ): 329 - 342 . DOI: 10.1007/s00268-017-4279-x http://doi.org/10.1007/s00268-017-4279-x http://link.springer.com/10.1007/s00268-017-4279-x http://link.springer.com/10.1007/s00268-017-4279-x

ALZAHRANI A S , ALSWAILEM M , MORIA Y , et al . Lung metastasis in pediatric thyroid cancer: radiological pattern, molecular genetics, response to therapy, and outcome [J ] . J Clin Endocrinol Metab , 2019 , 104 ( 1 ): 103 - 110 . DOI: 10.1210/jc.2018-01690 http://doi.org/10.1210/jc.2018-01690 https://academic.oup.com/jcem/article/104/1/103/5107762 https://academic.oup.com/jcem/article/104/1/103/5107762

AMIN M B , GREENE F L , EDGE S B , et al . The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging [J ] . CA A Cancer J Clin , 2017 , 67 ( 2 ): 93 - 99 . DOI: 10.3322/caac.21388 http://doi.org/10.3322/caac.21388 http://doi.wiley.com/10.3322/caac.21388 http://doi.wiley.com/10.3322/caac.21388

HAUGEN B R , ALEXANDER E K , BIBLE K C , et al . 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer [J ] . Thyroid , 2016 , 26 ( 1 ): 1 - 133 . DOI: 10.1089/thy.2015.0020 http://doi.org/10.1089/thy.2015.0020 https://www.liebertpub.com/doi/10.1089/thy.2015.0020 https://www.liebertpub.com/doi/10.1089/thy.2015.0020

HOGAN A R , YING Z G , PEREZ E A , et al . Pediatric thyroid carcinoma: incidence and outcomes in 1 753 patients [J ] . J Surg Res , 2009 , 156 ( 1 ): 167 - 172 . DOI: 10.1016/j.jss.2009.03.098 http://doi.org/10.1016/j.jss.2009.03.098 https://linkinghub.elsevier.com/retrieve/pii/S0022480409001802 https://linkinghub.elsevier.com/retrieve/pii/S0022480409001802

ALZAHRANI A S , ALKHAFAJI D , TULI M , et al . Comparison of differentiated thyroid cancer in children and adolescents (≤20 years) with young adults [J ] . Clin Endocrinol , 2016 , 84 ( 4 ): 571 - 577 . DOI: 10.1111/cen.12845 http://doi.org/10.1111/cen.12845 https://onlinelibrary.wiley.com/doi/10.1111/cen.12845 https://onlinelibrary.wiley.com/doi/10.1111/cen.12845

OKADA T , SASAKI F , TAKAHASHI H , et al . Management of childhood and adolescent thyroid carcinoma: long-term follow-up and clinical characteristics [J ] . Eur J Pediatr Surg , 2006 , 16 ( 1 ): 8 - 13 . DOI: 10.1055/s-2006-923795 http://doi.org/10.1055/s-2006-923795 http://www.thieme-connect.de/DOI/DOI?10.1055/s-2006-923795 http://www.thieme-connect.de/DOI/DOI?10.1055/s-2006-923795

CHOW S M , LAW S C K , MENDENHALL W M , et al . Differentiated thyroid carcinoma in childhood and adolescence-clinical course and role of radioiodine [J ] . Pediatr Blood Cancer , 2004 , 42 ( 2 ): 176 - 183 . DOI: 10.1002/pbc.10410 http://doi.org/10.1002/pbc.10410 https://onlinelibrary.wiley.com/doi/10.1002/pbc.10410 https://onlinelibrary.wiley.com/doi/10.1002/pbc.10410

LEE Y A , LEE H , IM S W , et al . NTRK and RET fusion-directed therapy in pediatric thyroid cancer yields a tumor response and radioiodine uptake [J ] . J Clin Invest , 2021 , 131 ( 18 ): e144847 . DOI: 10.1172/JCI144847 http://doi.org/10.1172/JCI144847 https://www.jci.org/articles/view/144847 https://www.jci.org/articles/view/144847

POTTER S L , REUTHER J , CHANDRAMOHAN R , et al . Integrated DNA and RNA sequencing reveals targetable alterations in metastatic pediatric papillary thyroid carcinoma [J ] . Pediatr Blood Cancer , 2021 , 68 ( 1 ): e28741 .

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DOI：10.19401/j.cnki.1007-3639.2022.05.005

摘要

Abstract

关键词

Keywords

references

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