20세 이하 분화 갑상선암 : 임상병리적 특징과 예후인자

Abstract

Purpose: This study investigated the clinicopathological characteristics and prognostic factors in young patients with differentiated thyroid carcinoma.

Methods: Among the 3,837 patients with DTC who were treated in the Department of Surgery at Yonsei University College of Medicine from March 1986 to March 2005, 71 patients were less than 20 years of age when diagnosed. The mean age was 14.9 years (range, 4～20 years). There were 59 females and 12 males with a mean follow-up period of 91.8 months (range, 14～205 months).

Results: The cause specific and the progression-free survivals at 10 years were 100% and 80.3%, respectively. Eleven patients (15%) experienced a recurrence and 1 patient showed a progression of a pulmonary metastasis at diagnosis. Compared with 39 patients older than 15, 32 patients younger than 15 years of age tended to have a higher incidence of a N1b and M1 stage, and a lower progression-free survival rate. Univariate analysis revealed that an age ≤15 years, multicentricity, N1b stage, M1 stage, and bilateral radical neck dissection had a negative impact on the progression-free survival. However, multivariate analysis showed that the age at diagnosis and the M1 stage were independent prognostic factors for progression- free survival.

Conclusion: Being younger 15 years and the M1 stage are the most significant prognostic factors negatively influencing the progression-free survival. The high incidence of lateral neck and lung metastasis justifies a total thyroidectomy and modified radical neck dissection, followed by postoperative 131I therapy even in patients younger than 15 years of age.