年龄对小儿分化型甲状腺癌肿瘤特征和治疗效果的影响

IF 3.7 3区 医学 Q2 Medicine
Endocrine Pub Date : 2024-10-01 Epub Date: 2024-05-15 DOI:10.1007/s12020-024-03870-9
Juliana Chaves Garcia, Ligia Vera Montali de Assumpção, Maria Cândida Ribeiro Parisi, Denise Engelbrecht Zantut-Wittmann
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引用次数: 0

摘要

目的:在治疗小儿分化型甲状腺癌时,人们倾向于使用成人的数据,而忽视了这种疾病在儿童时期的临床特点。本研究旨在评估和比较不同年龄组儿童甲状腺癌的临床流行病学特征及其在演变过程中的意义:方法:选取年龄在21岁以下的分化型甲状腺癌(DTC)患者77例,将其分为不同的年龄组:10岁以下组、11至18岁组和19至21岁组。对各年龄组的临床流行病学数据及其对疾病进展的影响进行了分析和比较:结果:10岁以下确诊患者的肿瘤有甲状腺外扩展、区域淋巴结转移、诊断性碘-131全身扫描(WBS)中刺激甲状腺球蛋白水平较高、最后一次评估时TSH处于抑制状态。此外,在这些年轻患者中,诊断性碘-131 全身扫描和放射性碘剂量后全身扫描均发现肺转移。放射性碘治疗后的 WBS 分析结果显示,各年龄组之间存在显著差异(p = 0.0029)。在 18 岁以下和 21 岁以下的亚组中,诊断时间被确定为与极佳反应相关的因素。在 18 岁以下的亚组中,没有发现与随访 1 年、3 年和 5 年的动态反应以及疾病的持续/复发有关的因素。在21岁以下的亚组中,随访第3年出现不完全结构反应的患者复发或持续反应的几率增加了5.5倍,如果在随访第5年才发现,则增加了32.6倍:结论:年轻患者的肿瘤特征更具侵袭性,接受的治疗也更为严格。然而,11至18岁年龄组和19至21岁年龄组的治疗反应和最后一次评估的疾病状态(无论是无反应还是复发/持续反应)相似。然而,在21岁以下年龄组中,治疗后第3年和第5年获得的反应是最后一次评估中疾病持续/复发的相关因素,而在18岁以下确诊的患者中则不是,考虑到肿瘤行为在界定甲状腺癌儿童年龄范围时的相关区别。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of age on tumor characteristics and treatment outcomes in pediatric Differentiated Thyroid Carcinoma.

Purpose: There is a tendency to use data generated for adults in the management of pediatric Differentiated Thyroid Carcinoma, neglecting the clinical peculiarities of this condition in childhood. This study aimed to assess and compare the clinical-epidemiological characteristics and their significance in the evolution of thyroid carcinoma diagnosed in childhood across different age groups.

Methods: Seventy-seven patients diagnosed with Differentiated Thyroid Carcinoma (DTC) up to 21 years old were selected and divided into different age groups: up to 10 years, 11 to 18 years, and 19 to 21 years old. Clinical-epidemiological data and their influence in the disease progression were analyzed and compared across age groups.

Results: Patients diagnosed below 10 years of age were associated with tumors showing extrathyroidal extension, metastasis in regional lymph nodes, higher levels of stimulated thyroglobulin in the diagnostic iodine-131 whole-body scan (WBS), and under TSH suppression in the last assessment. Additionally, pulmonary metastasis were associated in both diagnostic and post-radioiodine dose WBSs in these younger patients. Analysis of findings in the post-radioiodine therapy WBS revealed significant differences between all age groups (p = 0.0029). The time of diagnosis was identified as a factor associated with an excellent response in subgroups up to 18 years and up to 21 years. No factors associated with dynamic responses over the 1st, 3rd and 5th years of follow-up and the persistence/recurrence of the disease were identified in the subgroup up to 18 years. In the subgroup up to 21 years, having an incomplete structural response in the 3rd year of follow-up increased the chances of recurrent or persistent response by 5.5 times, and by 32.6 times if found in the 5th year of follow-up.

Conclusions: Younger patients exhibited more aggressive tumor characteristics and underwent more rigorous treatment. However, treatment response and disease status in the last assessment, whether free or recurrent/persistence, were similar when comparing the age groups of 11 to 18 and 19 to 21 years. Nonetheless, responses obtained in the 3rd and 5th years post-treatment emerged as factors associated with the persistence/recurrence of the disease in the last assessment in the age group up to 21 years but not in patients diagnosed up to 18 years, a relevant distinction considering the tumor behavior in defining the pediatric age range in thyroid cancer.

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来源期刊
Endocrine
Endocrine 医学-内分泌学与代谢
CiteScore
6.40
自引率
5.40%
发文量
0
期刊介绍: Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.
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