低中危儿童甲状腺乳头状癌的手术术式分析  

Analysis of surgical strategy for pediatric papillary thyroid carcinoma with low-intermediate risk

作　　者：赵力 李瀚 何雨沁 王凯 王健 鄢丹桂 倪松 朱一鸣 刘绍严 Zhao Li;Li Han;He Yuqin;Wang Kai;Wang Jian;Yan Dangui;Ni Song;Zhu Yiming;Liu Shaoyan(Department of Head and Neck Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心、国家肿瘤临床医学研究中心、中国医学科学院北京协和医学院肿瘤医院头颈外科,北京100021

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第12期1396-1402,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：中国癌症基金会北京希望马拉松专项基金(LC2020A30)。

摘　　要：目的探索甲状腺腺叶切除术(lobectomy,LT)在低、中危儿童甲状腺乳头状癌(PTC)治疗中的可行性及合理性。方法回顾性分析2000年3月至2018年12月中国医学科学院肿瘤医院初治的低、中危儿童PTC的临床病理特征以及随访资料,统计复发相关危险因素,评估不同甲状腺术式与预后的相关性。使用倾向评分匹配(PSM)校正后比较甲状腺全切除术(total thyroidectomy,TT)患者即TT组和LT组的预后差异。结果纳入研究140例,男36例,女104例,年龄6~18岁;低危43例,中危97例。中位随访时间87.5个月,随访时间范围为8~241个月,随访期间20例(14.3%)患者复发。单因素分析显示N1b期、甲状腺腺外侵犯(extrathyroidal extension,ETE)、淋巴结转移数>5个、淋巴结转移率≥0.19以及接受放射性碘(radioactive iodine,RAI)治疗为复发的危险因素(P值均<0.05),多因素分析显示淋巴结转移率≥0.19(HR=8.69,95%CI=1.08~70.21,P=0.043)为复发的独立危险因素。PSM前后TT组和LT组患者的5年无复发生存率差异无统计学意义(PSM前:82.8%比86.5%,χ2=0.219,P=0.640;PSM后:89.6%比90.4%,χ2=0.099,P=0.753)。结论不同术式组间的无复发生存率无明显差异。无复发危险因素的低、中危患者接受LT存在一定可行性。Objective To explore the feasibility and rationality of lobectomy in the treatment of pediatric thyroid papillary carcinoma(PTC)with low-intermediate risk.Methods The clinicopathological features and follow-up data of pediatric PTC with low-intermediate risk were reviewed from March 2000 to December 2018 in Cancer Hospital of Chinese Academy of Medical Sciences.The correlations between different surgical procedures and prognoses were evaluated.Propensity score matching(PSM)was used to adjust for risk factors,and the difference in prognoses between the total thyroidectomy(TT)group and the lobectomy(LT)group was compared.Results A total of 140 patients were included in the study,including 36 males and 104 females.The age range was from 6-year-old to 18-year-old.There were 43 low-risk patients and 97 intermediate-risk patients.The median follow-up time was 87.5 months,ranging from 8 to 241 months,and 20 patients(14.3%)showed recurrence during the follow-up period.Univariate analysis showed that N1b,extrathyroidal extension,the number of lymph node metastasis>5,the ratio of lymph node metastasis≥0.19,and radioactive iodine treatment were risk factors for recurrence(all P value below 0.05),but multivariate analysis showed that only the ratio of lymph node metastasis≥0.19(HR=8.69,95%CI=1.08-70.21,P=0.043)was an independent risk factor for recurrence.There was no significant difference in the 5-year recurrence free survival rates between TT group and LT group before propensity score matching(82.8%vs.86.5%,χ2=0.219,P=0.640)and after propensity score matching(89.6%vs.90.4%,χ2=0.099,P=0.753).Conclusion There is no significant difference in recurrence-free survival between TT group and LT group.Lobectomy is feasible for selective pediatric PTC with low-intermediate risk.

关 键 词：甲状腺肿瘤 癌 乳头状 儿科 复发 手术 

分 类 号：R736.1[医药卫生—肿瘤]