福岛医科大学医院220例儿童、青少年及年轻成人甲状腺癌患者的临床病理特征

背景：作为福岛健康管理调查（FHMS）的一部分，甲状腺超声检查（TUE）旨在监测福岛第一核电站事故后居民的健康状况，因担心儿童甲状腺癌发病率升高，这与切尔诺贝利核电站事故后的观察类似。本研究报道了通过FHMS诊断并在福岛医科大学医院治疗的甲状腺癌患者的临床病理特征。方法：收集并评估了甲状腺癌患者的临床病理资料。本研究为描述性研究。结果：截至2021年9月，共诊断出263例甲状腺癌，其中220例经细胞学诊断为甲状腺癌的患者由FHMS转诊接受治疗。诊断时的中位年龄（四分位数）为18.6（16.2-20.3）岁。最大肿瘤直径的中位值为13.0（10.4-18.0）毫米。为减少手术侵袭性，199例（90.1%）接受了单侧叶切除术。病理表现提示216例（98.2%）为乳头状甲状腺癌（PTC）；其中205例为经典型PTC。此外，216例（98.2%）为I期疾病。112例（50.9%）观察到肿瘤细胞侵及胸甲状软骨肌或甲状腺周围软组织，123例（55.9%）存在微观淋巴血管侵犯。两年龄组（<18.6岁和≥18.6岁）在临床或病理特征方面未见显著差异：风险分类（p=0.69）及美国甲状腺协会儿科风险等级（p=0.24）。与以往报道相比，手术并发症较少。结论：通过TUE诊断的甲状腺癌患者接受了安全且微创的手术，并提供了细致的术后随访。病理结果显示，大多数为经典乳头状癌，约一半患者存在甲状腺外侵或淋巴血管侵犯。两年龄组在临床及病理特征方面无显著差异。

Background: Thyroid ultrasound examinations (TUEs), conducted as part of the Fukushima Health Management Survey (FHMS), were initiated to monitor the health status of residents after the Fukushima Daiichi Nuclear Power Plant accident owing to concerns regarding the increased incidence of thyroid cancer among children, as observed after the Chernobyl Nuclear Power Plant accident. This study reported the clinicopathological characteristics of patients with thyroid cancer diagnosed through the FHMS and treated at the Fukushima Medical University Hospital. Methods: Data regarding the clinicopathological characteristics of patients with thyroid cancer were collected and evaluated in this descriptive study. Results: Among the 263 patients diagnosed with thyroid cancer as of September 2021, 220 patients with cytologically diagnosed thyroid cancer were treated as referrals from the FHMS. The median (interquartile range) age at the time of diagnosis was 18.6 (16.2-20.3) years. The median maximum tumor diameter was 13.0 (10.4-18.0) mm. To reduce surgical invasiveness, 199 patients (90.1%) underwent unilateral lobectomy. Pathological findings were suggestive of papillary thyroid carcinomas (PTC) in 216 (98.2%) patients; among them, 205 patients had PTC of the classical type. In addition, 216 (98.2%) patients had stage I disease. Cancer cell extension in the sternothyroid muscle or perithyroidal soft tissues and microscopic lymphovascular invasion were observed in 112 (50.9%) and 123 (55.9%) patients, respectively. No differences were observed between the two age groups (<18.6 years and ≥18.6 years) in terms of the clinical or pathological characteristics of thyroid cancer: risk classification (p = 0.69) and American Thyroid Association pediatric risk level (p = 0.24). Compared with those from previous reports, few surgical complications were observed. Conclusions: Patients with thyroid cancer diagnosed with TUEs underwent safe and minimally invasive operations, and careful postoperative follow-up was provided. The pathological findings of the detected thyroid cancers indicated that the majority were classical papillary carcinomas, and approximately half of the patients had extrathyroidal or lymphovascular invasion. No differences were observed between the two age groups in terms of the clinical or pathological characteristics of thyroid cancer.