背景：儿童分化型甲状腺癌（DTC）并不常见；近几十年来的临床表现尚未完全表征。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 转诊中心、位于格利维采的 Maria Sklodowska-Curie 国家肿瘤研究所（该中心有可用记录）接受治疗的连续 DTC 青少年的人口和疾病特征。记录性别、年龄、组织病理学特征和 DTC 分期。我们的目的是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危险因素。使用 Cochran-Armitage 检验和 Spearman 相关性评估这些变量的趋势。进行多变量逻辑回归以确定与淋巴结或远处转移相关的危险因素。结果：479 例患者中的 475 例（99.2%）纳入分析；大约一半的人年龄≥15 岁，10% 的人年龄<10 岁。甲状腺乳头状癌 (PTC) 占病例的 88%，滤泡状甲状腺癌 (FTC) 占 11%。有相关数据的病例中肿瘤≤2cm占56%； >4厘米的占12%。 37% 观察到多灶性，22% 观察到甲状腺外侵犯。 59% 出现淋巴结转移，16% 出现远处转移。在观察期内，新病例的显着趋势包括： 15 岁以上青少年比例增加；肿瘤≤2cm的频率增加，多灶性率降低，PTC与FTC的比例增加。甲状腺外侵袭率始终保持较高水平，在 1990 年之后的 5 年研究子期间，范围为 17% 至 28%。颈部中央淋巴结转移的频率显着增加，而侧位部位的淋巴结转移仍然常见；远处转移的存在显着减少。在多变量分析中，多灶性、甲状腺外侵犯和肿瘤大小与侧淋巴结转移以及多灶性、较大肿瘤大小和远处扩散的 N1b 转移独立相关。结论：我们观察到青春期诊断比例的上升、原发肿瘤大小的减小以及多灶性和远处转移频率的降低可能反映了早期疾病阶段侵袭性较低的 DTC 患者的检测增加。尽管如此，我们发现局部晚期疾病特征（多灶性、甲状腺外侵犯和淋巴结转移）的比例持续较高，多变量分析表明这些特征与侧淋巴结和/或远处转移具有显着相关性。

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.