Clinical Features And Prognostic Analysis Of Thyroid Carcinoma In The Youths

Objective:This thesis aims to discuss pathological features and prognostic affecting factors of thyroid carcinoma in youths, in hope of better clinical treatments of this disease.Methods:It analyzes all the 63 teenager patients, who are under 20 years old and who have suffered from thyroid carcinoma, in the First Affiliated Hospital of Fujian Medical University during 2002 and 2011. These patients are aged between 11 and 20 years old, with the median age being 18 and average age being 17.33±2.09. Among them, there are 11 patients who are no older than 15 years old and 52 patients older than 15. It randomly selects 975 patients with thyroid carcinoma, who are over 20 but under 45 years old, and who are treated simultaneously, as the control group, to do a comparative analysis of clinical and pathological features of these two groups. Besides, it does follow-up visits to the teenager group. SPSS20.0 is employed in this thesis. It does chi-square test to analyze clinical and pathological features of these two sets of data, adopts Kaplan-Meier to analyze prognostic situations of the teenager group, employs Log-rank test to do comparisons between affecting factors, and uses Cox regression model to do multi-factor analysis. When P<0.05, it has statistical significance.Results:1.Clinical pathological features of the teenager group and the control group:The teenager group: 19 male patients, 44 female patients, male vs female: 1:2.32. The size of tumor(maximum diameter): 0.67-4.85 cm, average : 2.46±0.98 cm, TNM Stage One: 61 patients(96.83%,61/63), more than Stage Two: 2 patients( 3.17%,2/63). Multifocal 35 patients( 55.56% 35/63). Papillary carcinoma 58 patients(92.06%,58/63). Follicular carcinoma 3 patients(4.76%,3/63). Encephaloid carcinoma 2 patients(3.17%,2/63). No undifferentiated carcinoma. Merge hashimoto thyroiditis 14 patients( 22.22%, 14/63). Lymph node transferring 43 patients (68.25%,43/63). Palindromia 6 patients(9.52%,6/63). Further transferring 5 patients(7.94%,5/63).The control group: 203 male patients, 772 female patients, male vs female: 1:3.80. The size of tumor 0.03-10 cm, average: 1.27±1.01 cm. Multifocal 220 patients(22.56%,220/975).TNM Stage One: 966 patients(99.08%,966/975), more than Stage Two: 9 patients(0.92%,9/975). Papillary carcinoma 931 patients( 95.49%,931/975), Follicular carcinoma 31 patients( 3.18%,31/975), Encephaloid carcinoma 11 patients(1.13%,11/975), undifferentiated carcinoma 2 patients(0.21%,2/975). Merge hashimoto thyroiditis 123 patients(12.61%,123/975). Lymph node transferring 425 patients(43.59%,425/975). Palindromia 56 patients(5.74%,56/975). Further transferring 29 patients(2.97%,29/975).The comparative analysis: the teenager group is featured with bigger tumor, more multifocal, higher merge hashimoto thyroiditis, and later clinical stages. The difference has statistical significance(P<0.05=).Male occupies higher in the teenager group than in the control group(30.16% VS 20.82%), but the gender difference between the two groups has no statistical significance(P=0.057). The teenager group has higher rate of palindromia( 9.52% VS 5.74%), but the difference has no statistical significance(P=0.220). The two groups do not have significant difference in pathologic types(P=0.452).2.Operation methods of thyroid carcinoma in youths:Operations and postoperative TSH inhibition therapy are conducted on all these 63 patients. 23 patients take side lobe resection, 26 patients affected side of the gland+ the large part of the side, 14 patients take the resection of double-size gland side. 34 patients take central-district(IV-district) lymphadenectomy, 15 patients local lymphadenectomy,11 patients modified neck dissection, and 3 patients radical neck dissection(Before operation, 10 patients take thyroid simple tumor resection in another hospital; postoperative pathology indicates malignant and the patients are transferred to this hospital for treatments). 12 patients take 131 I treatment.3.Analysis of prognostic affecting factors in the teenager group:61 patients received follow-up visits while 2 patients are lost. The rate of follow-up visits is up to 96.83%. The time span of follow-up visits is 22 to 156 months. The median time span is 72 months. The average time span is 98.24±33.20 months. There are 3 deaths and the reasons are further transferring and/or local palindromia. The cumulative survival rate of the five years, calculated by employing Kaplan-Meier, is 95.29%. Univariate analysis indicates that further transferring( P= 0.000), 131 I treatments(P=0.026), clinical stages(P=0.003) and histological type are prognostic factors affecting throid carcinoma in youths. Cox regression multi-factor analysis indicates that further transferring(P=0.001) is the independent prognostic factor affecting thyroid carcinoma in the youths.Conclusion1. Teenager patients are featured with bigger tumor, more multifocal, higher merge hashimoto rate, later clinical stages and more transferring lymph nodes, recurrence and further transferring lymph nodes.2. The major treatment of thyroid carcinoma in youths is excision. Full preoperative preparation is required with the consideration of age characteristics of the youths. Based on this, a proper operation range is chosen, which is cooperated with reasonable postoperative TSH inhibition treatment and 131 I treatment.3. Analysis of prognostic affecting factors of the teenager group: Univariate analysis indicates pathological type, clinical stages, 131 I treatment, further transferring, lymphadenectomy all affect prognostic situation; multi-factor analysis indicates that further transferring is the independent factor affecting prognostic situation of teenagers patients with thyroid carcinoma.