Pulmonary metastases in children and adolescents with papillary thyroid cancer in China: prognostic factors and outcomes from treatment with 131I
Pulmonary metastases in children and adolescents with papillary thyroid cancer in China: prognostic factors and outcomes from treatment with 131I
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中国儿童和青少年甲状腺乳头状癌的肺转移：预后因素和 131I 治疗的结果
DOI：
10.1007/s12020-018-1678-1
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发表时间：
2018-10-01
期刊：
影响因子：
3.7
通讯作者：
Luo, Quan-Yong
中科院分区：
文献类型：
--
作者：
Zhang, Xin-Yun;Song, Hong-Jun;Luo, Quan-Yong
目的甲状腺乳头状癌(PTC)合并肺转移在儿童和青少年中很少见。与成人不同，有关患有这种疾病的儿童的数据有限。因此，本研究对年龄小于21岁的PTC肺转移患者的治疗效果和预后因素进行了评估。方法对76例儿童青少年PTC肺转移患者行I-131治疗。通过血清甲状腺球蛋白(TG)和胸部CT检查评价疗效。结果76例患者中年龄小于15岁者占22.4%(17/76)，女性占65.8%(50/76)。RAI治疗有效38例(55.9%)，稳定18例(26.5%)，无效12例(17.6%)。解剖影像显示完全缓解(CR)、部分缓解(PR)、稳定(SD)和进展(PD)分别为8.5、62.0、15.5和14.1%。单因素分析显示，肺转移灶大小和肿瘤倍增时间是影响疗效的独立因素。甲状腺外侵犯、肿瘤直径、肿瘤倍增时间是影响无进展生存率的独立因素，而肿瘤倍增时间和肿瘤直径是影响总生存率的显著危险因素。结论放射性碘治疗儿童青少年PTC肺转移是一种有效的治疗方法。甲状腺外扩展与疾病进展有关，但对总体存活率没有明显影响。肿瘤倍增时间和肿瘤直径是影响无进展生存期和总生存期的主要因素。
Purpose Papillary thyroid carcinoma (PTC) with pulmonary metastases is rare in children and adolescents. Unlike adults, limited data are available on children with this disease. Thus, this study evaluated the therapeutic efficacy and prognostic factors of individuals less than 21 years of age with pulmonary metastases from PTC.Methods Seventy-six children and adolescents with pulmonary metastases from PTC treated with I-131 were retrospectively analyzed. Therapeutic efficacy was evaluated by changes in serum thyroglobulin (Tg) and chest computed tomography (CT). Factors predictive of progression-free survival and overall survival were measured by the Kaplan-Meier method.Results Among the 76 patients included in this study, 22.4% (17 of 76) were less than 15 years old and 65.8% (50 of 76) were female. Under the evaluation of stimulated serum Tg levels, RAI treatment were effective in 55.9% (38 of 68), stable in 26.5% (18 of 68) and ineffectvie in 17.6% (12 of 68) of patients. Changes on anatomical imaging suggested complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) in 8.5, 62.0, 15.5, and 14.1% of individuals, respectively. Univariate analysis showed that size and tumor doubling time of pulmonary metastases were independent factors affecting therapeutic efficacy. Extra-thyroidal extension, tumor diameter of pulmonary metastases and tumor doubling time were significant independent factors regarding progression-free survival rates, while only tumor doubling time and tumor diameter were significant risk factors associated with overall survival rate.Conclusions Radioactive iodine therapy is an effective treatment for children and adolescents with pulmonary metastases from PTC. Extra-thyroid extension was associated with disease progression while did not show significant influence on overall survival. Tumor doubling time and tumor diameter were the main factors influencing both progression-free survival and overall survival.