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小児がん生存者における散発性甲状腺がんと比較した小児がん生存者における後続の甲状腺がんの発現と転帰:全国一致調査
Presentation and outcome of subsequent thyroid cancer among childhood cancer survivors compared to sporadic thyroid cancer: a matched national study.
PMID: 32449692 DOI: 10.1530/EJE-20-0153.
抄録
目的:
小児がん生存者(CCS)は、放射線治療後に主に分化型甲状腺がん(後続DTC)を発症するリスクが高い。CCSにおける後続DTCが散発性DTCとは異なる症状や転帰を示すかどうかについては、十分にはわかっていない。
Objective: Childhood cancer survivors (CCS) are at increased risk to develop differentiated thyroid cancer predominantly after radiotherapy (subsequent DTC). It is insufficiently known whether subsequent DTC in CCS has a different presentation or outcome than sporadic DTC.
方法:
後発性DTC患者(n = 31)と散発性DTC患者(n = 93)を性別、年齢、診断年でマッチングさせ、症状とDTCの転帰を比較した。臨床データはレトロスペクティブに収集した。
Methods: Patients with subsequent DTC (n = 31) were matched to patients with sporadic DTC (n = 93) on gender, age and year of diagnosis to compare presentation and DTC outcomes. Clinical data were collected retrospectively.
結果:
後発DTCを有するCCSのうち、1人を除くすべてのCCSが小児がんで化学療法を受けており、19人(61.3%)が甲状腺領域を含む放射線治療を受け、3人(9.7%)が131I-MIBGを受け、8人(25.8%)が化学療法のみの治療を受けていた。その後のDTCは、頸部触診によるサーベイランス(46.2%)、自称腫瘤(34.6%)、または偶然に発見された。散発性DTC患者では、自己発見が優勢であった(68.8%)。DTC後のCCS患者は平均的に腫瘍が小さく(それぞれ1.9cm vs 2.4cm、P = 0.051)、両側性であることが多かった(5/25(60.0%) vs 28/92(30.4%)、P = 0.024)。手術合併症の発生、再発率、疾患関連死には有意差はなかった。
Results: Among the CCS with subsequent DTC, all but one had received chemotherapy for their childhood cancer, 19 (61.3%) had received radiotherapy including the thyroid region, 3 (9.7%) 131I-MIBG and 8 (25.8%) had received treatment with chemotherapy only. Subsequent DTC was detected by surveillance through neck palpation (46.2%), as a self-identified mass (34.6%), or by chance. Among sporadic DTC patients, self detection predominated (68.8%). CCS with subsequent DTC tended to have on average smaller tumors (1.9 vs 2.4 cm, respectively, (P = 0.051), and more often bilateral (5/25 (60.0%) vs 28/92 (30.4%), P = 0.024). There were no significant differences in the occurrence of surgical complications, recurrence rate or disease-related death.
結論:
散発性DTC患者と比較すると、DTC後のCCSでは腫瘍が小さく、両側の腫瘍の頻度が高いようである。治療成績も同様のようである。後発DTC症例の3分の1が化学療法で治療されていたという知見は、さらなる調査が必要である。これらの結果は、DTCのリスクがあるCCSのサーベイランスプログラムの開発や、その後のDTCの治療ガイドラインを作成する上で重要である。
Conclusion: When compared to patients with sporadic DTC, CCS with subsequent DTC seem to present with smaller tumors and more frequent bilateral tumors. Treatment outcome seems to be similar. The finding that one-third of subsequent DTC cases had been treated with chemotherapy only needs further investigation. These results are important for the development of surveillance programs for CCS at risk for DTC and for treatment guidelines of subsequent DTC.