Differentiated thyroid cancer:: Determinants of disease progression in patients <21 years of age at diagnosis -: A report from the Surgical Discipline Committee of the Children's Cancer Group
Differentiated thyroid cancer:: Determinants of disease progression in patients <21 years of age at diagnosis -: A report from the Surgical Discipline Committee of the Children's Cancer Group
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DOI：
10.1097/00000658-199804000-00014
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发表时间：
1998-04-01
影响因子：
9
通讯作者：
La Quaglia, MP
中科院分区：
文献类型：
--
作者：
Newman, KD;Black, T;La Quaglia, MP
目的本研究旨在明确诊断时年龄小于 21 岁的分化型甲状腺癌患者的疾病范围，并评估分期和治疗变量对无进展生存期的影响。 背景数据摘要年轻患者的分化型甲状腺癌与早期区域淋巴结受累和远处实质转移相关。尽管如此，总体长期生存率仍大于 90%，这表明生物因素而非治疗因素对结果的影响更大。方法在 329 名患者的多机构队列中分析了对无进展生存的影响的变量，包括年龄、既往甲状腺照射、甲状腺外肿瘤扩展、大小、淋巴结受累、远处转移、甲状腺手术和淋巴清扫技术、(131) 碘初始治疗、残留宫颈癌疾病和组织病理学亚型。手术并发症与在甲状腺或颈部淋巴管上完成的具体手术相关。结果 10 年总体无进展生存率为 67%（95%，CI：61%-73%），其中 2 例与疾病相关的死亡。分别有 74% 和 25% 的患者存在区域淋巴结和远处转移。年轻患者（p = 0.009）和甲状腺手术后有残留宫颈疾病的患者（p = 0.001）的无进展生存期较短。甲状腺全切除或次全切除后，永久性低钙血症更常见（p = 0.001），而根治性颈清扫术后伤口并发症增加（p < 0.00001）。结论：完全切除后和老年患者的无进展生存率更高。肺叶切除术或更广泛的甲状腺手术后，无进展生存率相同，但由于晚期疾病患者甲状腺全切除术或次全切除术的使用增加，比较结果变得混乱。当进行甲状腺全切除术或次全切除术时，永久性低钙血症的风险会增加。单独的甲状腺叶切除术可能适合局部病变较小的患者，而对于更广泛的肿瘤，应考虑甲状腺全切除术或次全切除术。
ObjectiveThis study was done to define the extent of disease and evaluate the effect of staging and treatment variables on progression-free survival in patients with differentiated thyroid carcinoma who were less than 21 years of age at diagnosis.Summary Background DataDifferentiated thyroid cancer in young patients is associated with early regional lymph node involvement and distant parenchymal metastases. Despite this, the overall long-term survival rate is greater than 90%, which suggests that biologic rather than treatment factors have a greater effect on outcome.MethodsVariables analyzed for their impact on progression-free survival in a multi-institutional cohort of 329 patients included age, antecedent thyroid irradiation, extrathyroidal tumor extension, size, nodal involvement, distant metastases, technique of thyroid surgery and lymphatic dissection, initial treatment with (131) iodine, residual cervical disease, and histopathologic subtype. Surgical complications were correlated with the specific procedures completed on the thyroid gland or cervical lymphatics.ResultsThe overall progression-free survival rate was 67% (95%, Cl: 61%-73%) at 10 years with 2 disease-related deaths. Regional lymph node and distant metastases were present in 74% and 25% of patients, respectively. Progression-free survival was less in younger patients (p = 0.009) and those with residual cervical disease after thyroid surgery (p = 0.001). Permanent hypocalcemia was more frequent after total or subtotal thyroidectomy (p = 0.001) while wound complications increased after radical neck dissections (p < 0.00001).ConclusionsThe progression-free survival rate was better after a complete resection and in older patients. Progression-free survival rate was the same after lobectomy or more extensive thyroid procedures, but comparison was confounded by the increased use of total or subtotal thyroidectomy in patients with advanced disease. the risk of permanent hypocalcemia increased when total or subtotal thyroidectomy was done. Thyroid lobectomy alone may be appropriate for patients with small localized lesions while total or subtotal thyroidectomy should be considered for more extensive tumors.