【作者】 李崴； 高子璐； 吴宝潮； 岳恺； 骆惊涛； 张文超； 陶英杰； 金锐； 王旭东； 程俊萍； 张仑；

【Author】 LI Wei;GAO Zilu;WU Baochao;YUE Kai;LUO Jingtao;ZHANG Wenchao;TAO Yingjie;JIN Rui;WANG Xudong;CHENG Junping;ZHANG Lun;Department of Maxillofacial and E.N.T Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer.Keylaboratory of Cancer Prevention and Therapy;Tongling People’s Hospital, Thyroid and Breast Department;

【机构】 天津医科大学肿瘤医院颌面耳鼻喉头颈外科国家肿瘤临床医学研究中心天津市"肿瘤防治"重点实验室； 安徽省铜陵市人民医院甲状腺乳腺科；

【摘要】 目的:研究青少年甲状腺乳头状癌的临床特征,治疗及预后。方法:回顾性分析天津医科大学附属肿瘤医院1990年至2008年收治的230例青少年甲状腺乳头状癌病例,qRT-PCR检测青少年及成人甲状腺乳头状癌标本RAC1b表达。结果:230例患者中,男性49例,女性181例,年龄在4-12岁之间。男女比例为3.69∶1。手术方式包括甲状腺全切(16例),甲状腺次全切除(5例),患侧甲状腺腺叶切除及同侧中央区淋巴结清扫(16例),全甲状腺切除及患侧中央区淋巴结清扫(3例),患侧甲状腺腺叶切除及同侧功能性颈淋巴结清扫(103例)。单纯患侧功能性颈淋巴结清扫(22例)。全甲状腺切除及一侧功能性颈淋巴结清扫(17例)。全甲状腺切除及双侧功能性颈淋巴结清扫(48例)。原发灶平均最大直径为2.15cm(0.4~4.2cm)。180例术后证实淋巴结转移(78.3%)。原发灶大小与淋巴结转移区域呈中度相关(r=0.664)。4~12岁年龄组和13~21岁年龄组间,Ⅱ,Ⅲ,Ⅳ,Ⅴ区平均淋巴结转移个数存在显著差异(p<0.05),而Ⅵ和Ⅶ区无显著性差异(p>0.05)。PTC患者RAC1b表达明显升高(p<0.05),而4~12岁年龄组较13~21岁年龄组及成人组明显升高(p<0.05)。所有患者术后口服左甲状腺素钠片,剂量50~150μg/日。随访时间5~24年(平均8.95年)。6例术后复发。2例发生肺转移。结论:青少年甲状腺乳头状癌发病率女性高于男性,就诊时常常已不是早期。发生区域淋巴结转移的机会高于远处转移。对T1N0M0期患者建议行患侧甲状腺腺叶切除及中央区颈淋巴结清扫。对于T2,T3,T4或cN+的患者除行甲状腺腺叶切除外应行功能性颈淋巴结清扫。与13~21岁年龄组相比,4~12岁年龄组更易发生Ⅱ,Ⅲ,Ⅳ,Ⅴ区淋巴结转移。手术联合激素替代治疗能获得满意的疗效。更多还原

【Abstract】 Objective: To study the clinical features, diagnosis and therapy of papillary thyroid carcinoma in children and adolescence. Methods: A retrospective study was performed on 230 patients with papillary thyroid carcinoma(PTC) who were treated in Tianjin Medical University Cancer Institute and Hospital from January 1990 to December 2008. RAC1 b expression levels of children, adolescents and adults were determined by quantitative RT-PCR. Result: Of the 230 cases, there were 49 boys and 181 girls. The ratio of female to male was 3.69:1. 5 cases were received near-total thyroid lobectomy, 16 case received thyroid lobectomy. 16 cases were received thyroid lobectomy combined with clearance ipsilateral central compartment. 3 cases were received total thyroidectomy combined with clearance the ipsilateral central compartment. 103 cases were thyroid lobectomy combined with ipsilateral modified neck dissection. 22 cases were unilateral modified neck dissection. 17 cases were total thyroidectomy combined with unilateral modified neck dissection. 48 cases were total thyroidectomy combined with bilateral modified neck dissection. The mean tumor size was 2.15 cm in maximum diameter(range = 0.4~4.2 cm). Neck lymph nodes metastases were 180 cases(78.3%). The correlation between the size of prime tumors and regions of lymph nodes metastases is moderate(r=0.664). There was significant difference between 4~12 year-old sector and 13~21 year-old counterparts in the matter of average lymph nodes metastases in the levelⅡ,Ⅲ,Ⅳ,Ⅴ(p<0.05) but not in level Ⅵ and Ⅶ(p>0.05). RAC1 b was overexpressed in PTC patients(p<0.05). Furthermore, RAC1 b expression in patients aged 4~12 yrs was significantly higher than patients aged 13~21 yrs or adults(p<0.05). All the patients took the levothyroxine after operation with dosage from 50 to 150μg per day. The period of follow-up was 3 to 22 years(median was 6.95 years). Recurrences happened in 6 cases. There are 2 cases got lung metastasis Conclusion: PTC happened more frequently in girls than in boys and was not in the early stage when came to clinic. The incidence of local lymph metastasis is higher than metastases. It is recommended to perform central compartment neck dissection for T1N0M0 and modified neck dissection for T2, T3 and T4 or cN+ stage besides doing thyroid lobectomy. Metastasis tends to levelⅡ,Ⅲ,Ⅳ,Ⅴaged 4~12 compared with aged 13~21. The surgical therapy with hormone replacement treatment for PTC may lead to satisfactory outcomes in children and adolescence.更多还原