Thyroid Cancer in Pediatric Age: A Single Institution Experience

Hyo-Cheol Kim, Ji-Won Han, J. Youn, Hee-Beom Yang, Chaeyoun Oh, Hyun Young Kim, Sung-Eun Jung, K. Park
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Abstract

Purpose: Thyroid cancer is a rare disease in pediatric population, but its incidence rate is increasing. The aim of this report is to present a single institution experience of pediatric thyroid cancer and to identify clinical features, predisposing factors, and postoperative course of pediatric thyroid cancer. Methods: We retrospectively reviewed 35 pediatric patients who underwent operation due to thyroid cancer at Seoul National University Children’s Hospital between May 1997 and January 2017. The median follow-up period was 70 months (range, 5-238 months). Results: The mean age at operation was 12.0±5.91 years and 27 patients were female. The underlying conditions in patients included history of chemoradiotherapy for previous other malignancies (n=4), hypothyroidism (n=3), history of chemotherapy (n=2), family history of thyroid cancer (n=1) and history of radiation therapy (n=1). The initial symptoms were palpable neck mass (n=21) and incidental findings (n=11). Total thyroidectomy (n=30) or unilateral lobectomy (n=5) were performed. There were 15 postoperative complications including transient hypocalcemia in 14 patients and Horner’s syndrome in 1 patient. The most common pathologic cell type was papillary thyroid cancer (n=29). Extrathyroid extension and lymph node invasion were found in 25 patients and 27 patients, respectively. Thirteen patients showed multifocality. During follow-up period, 5 patients underwent additional operation because of tumor recurrence in lymph nodes. Lung metastasis was detected in 3 patients at the time of diagnosis and in 3 patients during follow-up period. The mortality rate was zero and mean disease-free survival was 83.7±47.9 months. Conclusion: Pediatric thyroid cancer has lower mortality rate and recurrence rate as seen in this study despite the advanced stage at diagnosis. A thorough follow-up of patients with an underlying condition such as history of chemoradiotherapy and understanding new pediatric guideline can be helpful to maximize patients’ survival and prognosis.
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甲状腺癌在儿童年龄:单一机构的经验
目的:甲状腺癌是一种罕见的儿科疾病,但发病率呈上升趋势。本报告的目的是介绍儿童甲状腺癌的单一机构经验,并确定儿童甲状腺癌的临床特征、易感因素和术后病程。方法:回顾性分析1997年5月至2017年1月在首尔国立大学儿童医院因甲状腺癌接受手术的35例儿童患者。中位随访期为70个月(范围5-238个月)。结果:平均手术年龄12.0±5.91岁,女性27例。患者基础条件包括既往其他恶性肿瘤放化疗史(n=4)、甲状腺功能减退(n=3)、化疗史(n=2)、甲状腺癌家族史(n=1)和放疗史(n=1)。最初症状为可触及的颈部肿块(n=21)和偶然发现(n=11)。行甲状腺全切除术(n=30)或单侧肺叶切除术(n=5)。术后并发症15例,其中短暂性低血钙14例,霍纳综合征1例。最常见的病理细胞类型是甲状腺乳头状癌(n=29)。甲状腺外展25例,淋巴结浸润27例。13例患者表现为多灶性。随访期间,有5例患者因淋巴结肿瘤复发而追加手术。3例患者在诊断时发现肺转移,3例患者在随访期间发现肺转移。死亡率为零,平均无病生存期为83.7±47.9个月。结论:本研究显示,尽管儿童甲状腺癌的诊断阶段较晚,但其死亡率和复发率较低。对有基础疾病的患者进行彻底的随访,如放化疗史和了解新的儿科指南,有助于最大限度地提高患者的生存和预后。
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