대한두경부종양학회지 (Korean Journal of Head & Neck Oncology)

  • 제36권2호
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  • Pages.9-15
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  • 2020
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  • 1229-5183(pISSN)
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  • 2586-2553(eISSN)
대한두경부종양학회 (The Korean Society for Head and Neck Oncology)
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소아청소년 갑상선암 환자들의 예후인자

Age and Tumor Size is a Prognostic Factor in Pediatric/Adolescent Differentiated Thyroid Carcinoma

  • Byun, Byung Hyun (Department of Nuclear Medicine, Korea Cancer Center Hospital) ;
  • Lee, Guk Haeng (Department of Otolaryngology, Korea Cancer Center Hospital) ;
  • Kim, Dong Ho (Department of Pediatrics, Korea Cancer Center Hospital) ;
  • Lim, Jung Sub (Department of Pediatrics, Korea Cancer Center Hospital) ;
  • Lim, Ilhan (Department of Nuclear Medicine, Korea Cancer Center Hospital) ;
  • Lim, Sang Moo (Department of Nuclear Medicine, Korea Cancer Center Hospital) ;
  • Lee, Byeong Cheol (Department of Otolaryngology, Korea Cancer Center Hospital) ;
  • Lee, Jun Ah (Department of Pediatrics, Korea Cancer Center Hospital)
  • 투고 : 2020.07.01
  • 심사 : 2020.11.04
  • 발행 : 2020.11.30
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초록

Background/Objectives: To analyze the clinical characteristics of differentiated thyroid cancer (DTC) in children and adolescents. Materials & Methods: Medical records of 31 DTC cases that were diagnosed and treated at Korea Cancer Center Hospital between 2002 and 2018 were retrospectively reviewed. Results: Most cases were papillary carcinoma (n=26), with female predominance (n=25). Median age was 16.4 years (range, 11.9-18.6 years). Extrathyroidal extension was present in 24 cases. Twenty cases had tumor involvement at cervical lymph nodes and three had lung metastasis. Twenty-two patients received radioactive iodide treatment with a median cumulative dose of 300 mCi (range, 100-920 mCi). During a median follow-up of 68.2 months (range, 2.3-191.4 months), serum thyroglobulin level was elevated in 15 patients. Among them, two cases had remnant thyroid tissue, 4 had recurrence at cervical lymph nodes, and the remaining 9 did not have any detectable lesion. All were alive, and 5-year event-free survival (EFS) was 45.2±10.1%. Age £15 years, tumor size, lymph node status (N1b), and distant metastasis had negative effects on EFS. On multivariate analysis, age and tumor size had prognostic significance. Conclusion: For DTC of children and adolescents (£18 years old), age ≤15 years and tumor size were prognostic factor. Therefore, patients in this age group need meticulous follow-up. Further studies are necessary to answer the potential influence of age on the incidence and behavior of DTC.

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참고문헌

  1. Siegel DA, King J, Tai E, Buchanan N, Ajani UA, Li J. Cancer incidence rates and trends among children and adolescents in the United States, 2001-2009. Pediatrics. 2014;134:e945-955. https://doi.org/10.1542/peds.2013-3926
  2. Cho YY, Jang HW, Joung JY, Park SM, Jeong DJ, Kim SW, et al. Trends in thyroid cancer incidence in Korean children (1999-2012) based on palpation and nonpalpation detection methods. Eur Thyroid. 2015;4:252-259. https://doi.org/10.1159/000442047
  3. Welch Dinauer CA, Tuttle RM, Robie DK, McClellan DR, Svec RL, Adair C, et al. Clinical features associated with metastasis and recurrence of differentiated thyroid cancer in children, adolescents and young adults. Clin Endocrinol (Oxf). 1998;49:619-628. https://doi.org/10.1046/j.1365-2265.1998.00584.x
  4. Jarzab B, Handkiewicz Junak D, Wloch J, Kalemba B, Roskosz J, Kukulska A, et al. Multivariate analysis of prognostic factors for differentiated thyroid carcinoma in children. Eur J Nucl Med. 2000;27:833-841. https://doi.org/10.1007/s002590000271
  5. Handkiewicz-Junak D, Wloch J, Roskosz J, Krajewska J, Kropinska A, Pomorski L, et al. Total thyroidectomy and adjuvant radioiodine treatment independently decrease locoregional recurrence risk in childhood and adolescent differentiated thyroid cancer. J Nucl Med. 2007;48:879-888. https://doi.org/10.2967/jnumed.106.035535
  6. Russo M, Malandrino P, Moleti M, Vermiglio F, D'Angelo A, La Rosa G, et al. Differentiated thyroid cancer in children: Heterogeneity of predictive risk factors. Pediatr Blood Cancer. 2018;65:e27226. https://doi.org/10.1002/pbc.27226
  7. Niedziela M. Pathogenesis, diagnosis and management of thyroid nodules in children. Endocr Relat Cancer. 2006;13:427-453. https://doi.org/10.1677/erc.1.00882
  8. Gharib H, Papini E, Valcavi R, Baskin HJ, Crescenzi A, Dottorini ME, et al. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologimedical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2006;12:63-102. https://doi.org/10.4158/EP.12.1.63
  9. Gupta A, Ly S, Castroneves LA, Frates MC, Benson CB, Feldman HA, et al. A standardized assessment of thyroid nodules in children confirms higher cancer prevalence than in adults. J Clin Endocrinol Metab. 2013;98:3238-3245. https://doi.org/10.1210/jc.2013-1796
  10. Parisi MT, Eslamy H, Mankoff D. Management of differentiated thyroid cancer in children: Focus on the American Thyroid Association pediatric guidelines. Semin Nucl Med. 2016;46:147-164. https://doi.org/10.1053/j.semnuclmed.2015.10.006
  11. Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti JM, et al. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid. 2015;25:716-759. https://doi.org/10.1089/thy.2014.0460
  12. Penko K, Livezey J, Fenton C, Patel A, Nicholson D, Flora M, et al. BRAF mutations are uncommon in papillary thyroid cancer of young patients. Thyroid. 2005;15:320-325. https://doi.org/10.1089/thy.2005.15.320
  13. Yamashita S, Saenko V. Mechanisms of disease: Molecular genetics of childhood thyroid cancers. Nat Clin Pract Endocrinol Metab. 2007;3:422-429. https://doi.org/10.1038/ncpendmet0499
  14. Lee YA, Jung HW, Kim HY, Choi H, Kim HY, Hah JH, et al. Pediatric patientswith multifocal papillary thyroid cancer have higher recurrence rates than adult patients: a retrospective analysis of a large pediatric thyroid cancer cohort over 33 years. J Clin Endocrinol Metab. 2015;100:1619-1629. https://doi.org/10.1210/jc.2014-3647
  15. Mihailovic J, Nikoletic K, Srbovan D. Recurrent disease in juvenile differentiated thyroid carcinoma: prognostic factors, treatments, and outcomes. J Nucl Med. 2014;55:710-717. https://doi.org/10.2967/jnumed.113.130450
  16. Newman KD, Black T, Heller G, Azizkhan RG, Holcomb 3rd GW, Sklar C, et al. 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. Ann Surg. 1998;227:533-541. https://doi.org/10.1097/00000658-199804000-00014
  17. Remiker AS, Chuang J, Corathers S, Rutter MM, Rutter MJ, Myer 4th CM, et al. Differentiated thyroid cancer in the pediatric/adolescent population: evolution of treatment. J Pediatr Hematol Oncol. 2019;41:532-536. https://doi.org/10.1097/MPH.0000000000001493
  18. Roberts KG. Genetics and prognosis of ALL in children vs adults. Hematology Am Soc Hematol Educ Program. 2018;2018:137-145. https://doi.org/10.1182/asheducation-2018.1.137
  19. Huang X, Shu C, Chen L, Yao B. Impact of sex, body mass index and initial pathologic diagnosis age on the incidence and prognosis of different types of cancer. Oncol Rep. 2018;40:1359-1369. https://doi.org/10.3892/or.2018.6529
  20. Mitsutake N, Knauf JA, Mitsutake S, Mesa C Jr, Zhang L, Fagin JA. Conditional BRAFV600E expression induces DNA synthesis, apoptosis, dedifferentiation, and chromosomal instability in thyroid PCCL3 cells. Cancer Res. 2005;65:2465-2473. https://doi.org/10.1158/0008-5472.CAN-04-3314
  21. Saavedra HI, Knauf JA, Shirokawa JM, Wang J, Ouyang B, Elisei R, et al. The RAS oncogene induces genomic instability in thyroid PCCL3 cells via the MAPK pathway. Oncogene. 2000;19:3948-3954. https://doi.org/10.1038/sj.onc.1203723
  22. Monaco SE, Pantanowitz L, Khalbuss WE, Benkovich VA, Ozolek J, Nikiforova MN, et al. Cytomorphological and molecular genetic findings in pediatric thyroid fine-needle aspiration. Cancer Cytopathol. 2012;120:342-350. https://doi.org/10.1002/cncy.21199
  23. Fenton CL, Lukes Y, Nicholson D, Dinauer CA, Francis GL, Tuttle RM. The ret/ PTC mutations are common in sporadic papillary thyroid carcinoma of children and young adults. J Clin Endocrinol Metab. 2000;85:1170-1175. https://doi.org/10.1210/jcem.85.3.6472
  24. Van Nostrand D, Neutze J, Atkins F. Side effects of ''rational dose'' iodine-131 therapy for metastatic well-differentiated thyroid carcinoma. J Nucl Med. 1986;27:1519-1527.
  25. Smith MB, Xue H, Takahashi H, Cangir A, Andrassy RJ. Iodine 131 thyroid ablation in female children and adolescents: long-term risk of infertility and birth defects. Ann Surg Oncol. 1994;1:128-131. https://doi.org/10.1007/BF02303556
  26. Baugnet-Mahieu L, Lemaire M, Leonard ED, Leonard A, Gerber GB. Chromosome aberrations after treatment with radioactive iodine for thyroid cancer. Radiat Res. 1994;140:429-431. https://doi.org/10.2307/3579122
  27. Sawka AM, Lakra DC, Lea J, Alshehri B, Tsang RW, Brierley JD, et al. A systematic review examining the effects of therapeutic radioactive iodine on ovarian function and future pregnancy in female thyroid cancer survivors. Clin Endocrinol. 2008;69:479-490. https://doi.org/10.1111/j.1365-2265.2008.03222.x
  28. Sawka AM, Lea J, Alshehri B, Straus S, Tsang RW, Brierley JD, et al. A systematic review of the gonadal effects of therapeutic radioactive iodine in male thyroid cancer survivors. Clin Endocrinol. 2008;68:610-617. https://doi.org/10.1111/j.1365-2265.2007.03081.x
  29. Rivkees SA, Mazzaferri EL, Verburg FA, Reiners C, Luster M, Breuer CK, et al. The treatment of differentiated thyroid cancer in children: emphasis on surgical approach and radioactive iodine therapy. Endocr Rev. 2011;32:798-826. https://doi.org/10.1210/er.2011-0011
  30. Rubino C, de Vathaire F, Dottorini ME, Hall P, Schvartz C, Couette JE, et al. Second primary malignancies in thyroid cancer patients. Br J Cancer. 2003;89:1638-1644. https://doi.org/10.1038/sj.bjc.6601319
  31. Hay ID, Gonzalez-Losada T, Reinalda MS, Honetschlager JA, Richards ML, Thompson GB. Long-term outcome in 215 children and adolescents with papillary thyroid cancer treated during 1940 through 2008. World J Surg. 2010;34:1192-1202. https://doi.org/10.1007/s00268-009-0364-0
  32. Iyer NG, Morris LG, Tuttle RM, Shaha AR, Ganly I. Rising incidence of second cancers in patients with low risk (T1N0) thyroid cancer who receive radioactive iodine therapy. Cancer. 2011;117:4439-4446. https://doi.org/10.1002/cncr.26070