小儿分化的甲状腺癌的临床表现改变了波兰：一项回顾性队列研究，跨越了45年

背景：儿童中分化的甲状腺癌（DTC）并不常见。近几十年来的临床表现未完全表征。方法：这项回顾性队列研究分析了1970年至2015年在波兰最大的儿科DTC转介中心，玛丽亚·斯库洛多夫斯卡·库里国家研究所Gliwice，Gliwice的玛丽亚·斯库洛多夫斯卡·科里国家研究所，与1970年至2015年的DTC分析了连续的DTC的人口统计学和疾病特征。记录了性，年龄，组织病理学特征和DTC阶段。我们旨在确定这些变量随时间的变化以及淋巴结或远处转移的独立风险因素的变化。使用Cochran-Armitage测试和Spearman相关性评估了这些变量的趋势。进行了多变量逻辑回归，以识别与淋巴结或远处转移相关的危险因素。结果：分析中包括479例患者中的475例（99.2％）；大约一半的年龄≥15岁，10％，<10岁。甲状腺乳头状癌（PTC）代表88％的病例和卵泡甲状腺癌（FTC）11％。 ≤2cm的肿瘤占具有相关数据的病例的56％；这些> 4厘米占12％。在37％和22％的手感外侵袭中观察到了多焦点。淋巴结转移在59％中被发现，远处转移量为16％。在观察期间，新病例之间的重大趋势包括：青少年比例增加> 15年；肿瘤的频率增加≤2cm，多焦点率降低以及PTC与FTC的比例增加。整个过程中，手感外侵袭率在1990年以后的5年研究子周期中的范围从17％到28％不等。淋巴结转移量显着增加，中央颈的频率显着增加，在横向部位始终普遍存在；远处转移的存在显着降低。在多变量分析中，多焦点，肌外侵袭和肿瘤大小与侧向淋巴结转移和多焦点，较大的肿瘤大小和N1B转移均独立相关。结论：我们对青春期诊断比例增加的观察结果，原发性肿瘤大小的减少以及多焦点和远处转移的频率降低可能反映了对早期疾病阶段侵略性DTC较低的患者的发现增加。尽管如此，我们发现局部晚期疾病特征（多焦点，甲状腺外侵袭和淋巴结转移）持续很高的速率，多变量分析表明，这与侧向淋巴结和/或远处转移具有显着关联。

Background: Differentiated thyroid carcinoma (DTC) in children is uncommon; clinical presentation over recent decades is incompletely characterized. Methods: This retrospective cohort study analyzed demographic and disease characteristics of consecutive juveniles with DTC treated from 1970 to 2015 at Poland's largest pediatric DTC referral center, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, who had available records. Sex, age, histopathological characteristics, and DTC stage were documented. We aimed to identify changes in these variables over time and independent risk factors for lymph node or distant metastases. Trends in these variables were assessed using the Cochran-Armitage test and Spearman correlation. Multivariable logistic regression was performed to identify risk factors associated with lymph node or distant metastases. Results: 475 of 479 patients (99.2%) were included in the analysis; roughly half were age ≥15 years, 10%, <10 years. Papillary thyroid carcinoma (PTC) represented 88% of cases and follicular thyroid carcinoma (FTC) 11%. Tumors ≤2 cm constituted 56% of cases with relevant data; those >4 cm accounted for 12%. Multifocality was observed in 37% and extrathyroidal invasion in 22%. Lymph node metastases were noted in 59% and distant metastases in 16%. Over the observation period, significant trends among new cases included: increased proportion of adolescents >15 years; increased frequency of tumors ≤2 cm, decreased multifocality rates, and increased proportion of PTC versus FTC. Extrathyroidal invasion rates remained appreciable throughout, ranging from 17 to 28% during the 5-year study subperiods after 1990. Lymph node metastases significantly increased in frequency in the central neck, remaining consistently common in lateral sites; presence of distant metastases significantly decreased. In multivariable analysis, multifocality, extrathyroidal invasion, and tumor size were independently associated with lateral lymph node metastases and multifocality, larger tumor size, and N1b metastases with distant spread. Conclusions: Our observations of a rising proportion of diagnoses in adolescence, reductions in primary tumor size, and decreased frequency of multifocality and distant metastases may reflect increased detection of patients with less aggressive DTC at earlier disease stages. Nonetheless, we found persistently substantial rates of locoregionally advanced disease features (multifocality, extrathyroidal invasion, and lymph node metastases), which multivariable analyses suggested have significant associations with lateral lymph node and/or distant metastases.