小児甲状腺分化癌に対する手術治療
小児甲状腺癌においても初期治療は手術が基本である。甲状腺切除範囲についてはガイドラインも含め，海外では甲状腺全摘術が勧められている。日本においてはかつて成人のみならず，小児例においても腺葉切除術を標準術式としてきた施設が多く，良好な成績も示されている。海外からの報告は臨床的危険因子を勘案せずに全摘術と腺葉切除術での再発率を比較し，全摘術の優位性を示したものが多い。しかし，成人同様，危険因子の有無に応じたリスク分類を模索し，治療方針を検討することが望ましい。本稿では当院での経験例をもとに得られたリスク分類を紹介し，小児甲状腺癌においても，リスクの応じた手術の有用性を示した。一方で，発生率が少ない...
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| Published in | 日本内分泌・甲状腺外科学会雑誌 Vol. 38; no. 3; pp. 163 - 167 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本内分泌外科学会・日本甲状腺外科学会
2021
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| Subjects | |
| Online Access | Get full text |
| ISSN | 2186-9545 |
| DOI | 10.11226/jaesjsts.38.3_163 |
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| Abstract | 小児甲状腺癌においても初期治療は手術が基本である。甲状腺切除範囲についてはガイドラインも含め，海外では甲状腺全摘術が勧められている。日本においてはかつて成人のみならず，小児例においても腺葉切除術を標準術式としてきた施設が多く，良好な成績も示されている。海外からの報告は臨床的危険因子を勘案せずに全摘術と腺葉切除術での再発率を比較し，全摘術の優位性を示したものが多い。しかし，成人同様，危険因子の有無に応じたリスク分類を模索し，治療方針を検討することが望ましい。本稿では当院での経験例をもとに得られたリスク分類を紹介し，小児甲状腺癌においても，リスクの応じた手術の有用性を示した。一方で，発生率が少ない本症であるため，一施設でまとまった症例数を集積するには，長期間を要する。そのため，医療機器の精度の変遷があるため，過去と現在での症例における診断精度の差違があることが否定できない。 |
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| AbstractList | 小児甲状腺癌においても初期治療は手術が基本である。甲状腺切除範囲についてはガイドラインも含め，海外では甲状腺全摘術が勧められている。日本においてはかつて成人のみならず，小児例においても腺葉切除術を標準術式としてきた施設が多く，良好な成績も示されている。海外からの報告は臨床的危険因子を勘案せずに全摘術と腺葉切除術での再発率を比較し，全摘術の優位性を示したものが多い。しかし，成人同様，危険因子の有無に応じたリスク分類を模索し，治療方針を検討することが望ましい。本稿では当院での経験例をもとに得られたリスク分類を紹介し，小児甲状腺癌においても，リスクの応じた手術の有用性を示した。一方で，発生率が少ない本症であるため，一施設でまとまった症例数を集積するには，長期間を要する。そのため，医療機器の精度の変遷があるため，過去と現在での症例における診断精度の差違があることが否定できない。 |
| Author | 伊藤, 公一 杉野, 公則 |
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| References | 8. Handkiewicz-Junak D, Wloch J, Roskosz J, et al.: Total thyroidectomy and adjuvant radioiodine treatment independently decrease locoregional recurrence risk in childhood and adolescent differentiated thyroid cancer. J Nucl Med 48: 879-888, 2007 7. Hay ID, Gonzalez-Losada T, Reinalda MS, et al.: Long-term outcome in 215 children and adolescents with papillary thyroid cancer treated during 1940 through 2008. World J Surg 34: 1192-1202, 2010 4. Francis GL, Waguespack SG, Bauer AJ, et al.: Management guidelines for children with thyroid nodules and differentiated thyroid cancer. The American thyroid association guidelines task force on pediatric thyroid cancer. Thyroid 25: 716-759, 2015 17. Sugino K, Nagahama M, Kitagawa W, et al.: Distant metastasis in pediatric and adolescent differentiated thyroid cancer: clinical outcomes and risk factor analyses. J Clin Endocrinol Metab 105:dgaa545, 2020 14. Wada N, Sugino K, Mimura T, et al.: Treatment strategy of papillary thyroid carcinoma in children and adolescents: clinical significance of the initial nodal manifestation. Ann Surg Oncol 16: 3442-3449, 2009 6. Niedziela M, Handkiewicz-Junak D, Matecka-Tendera E, et al.: Diagnostics and treatment of differentiated thyroid carcinoma in children-Guidelines of Polish national societies. Encokrynologia Polska 67: 628-642, 2016 12. Enomoto Y, Enomoto K, Uchino S, et al.: Clinical features, treatment, and long-term outcome of papillary thyroid cancer in children and adolescents without radiation exposure. World J Surg 36: 1241-1246, 2012 13. Ito Y, Kihara M, Takamura Y, et al.: Prognosis and prognostic factors of papillary thyroid carcinoma in patients under 20 years. Endocr J 59: 539-545, 2012 3. Lee YA, Yun HR, Lee J, et al.: Trends in pediatric thyroid cancer incidence, treatment, and clinical course in Korea during 2004-2016: A nationwide population-based study. Thyroid 31: 902-911, 2021 5. Lebbink CA, Dekker BJ, Bocca G, et al.: New national recommendations for the treatment of pediatric differentiated thyroid carcinoma in the Netherlands. Eur J Endocrinol 183: 11-18, 2020 1. Bernier MO, Withrow DR, de Gonzalez AB, et al.: Trend in pediatric thyroid cancer incidence in the United States, 1998-2013. Cancer 125: 2497-2505, 2019 2. Qian ZJ, Jin MC, Meister KD, et al.: Pediatric thyroid cancer incidence and mortality trends in the United States, 1973-2013. JAMA Otolaryngol Head Neck Surg 145: 617-623, 2019 10. Machens A, Lorenz K, Nguyen Thanh P, et al.: Papillary thyroid cancer in children and adolescents does not differ in growth pattern and metastatic behavior. J Pediatr 157: 648-652, 2010 15. Wassner AJ: Risk stratification in pediatric thyroid cancer: growing evidence for individualized therapy. J Clin Endocrinol Metab 106:e1471-e1472, 2021 18. Nies M, Vassilopoulou-Sellin R, Bassett RL, et al.: Distant metastases from childhood differentiated thyroid carcinoma: clinical course and mutational landscape. J Clin Endocrinol Metab 106:e1683-e1697, 2021 9. Popovtzer A, Shpitzer T, Bahar G, et al.: Thyroid cancer in children: management and outcome experience of a referral center. Otolaryngol Head Neck Surg 135: 581-584, 2006 11. Newman KD, Black T, Heller G, et al.: Differentiated thyroid cancer: determinants of disease progression in patients < 21 years of age at diagnosis: a report from the Surgical Discipline Committee of the Children’s Cancer Group. Ann Surg 227: 533-541, 1998 16. Sugino K, Nagahama M, Kitagawa W, et al.: Risk stratification of pediatric patients with differentiated thyroid cancer: Is total thyroidectomy necessary for patients at any risk? Thyroid 30: 548-556, 2020 |
| References_xml | – reference: 10. Machens A, Lorenz K, Nguyen Thanh P, et al.: Papillary thyroid cancer in children and adolescents does not differ in growth pattern and metastatic behavior. J Pediatr 157: 648-652, 2010 – reference: 13. Ito Y, Kihara M, Takamura Y, et al.: Prognosis and prognostic factors of papillary thyroid carcinoma in patients under 20 years. Endocr J 59: 539-545, 2012 – reference: 8. Handkiewicz-Junak D, Wloch J, Roskosz J, et al.: Total thyroidectomy and adjuvant radioiodine treatment independently decrease locoregional recurrence risk in childhood and adolescent differentiated thyroid cancer. J Nucl Med 48: 879-888, 2007 – reference: 18. Nies M, Vassilopoulou-Sellin R, Bassett RL, et al.: Distant metastases from childhood differentiated thyroid carcinoma: clinical course and mutational landscape. J Clin Endocrinol Metab 106:e1683-e1697, 2021 – reference: 6. Niedziela M, Handkiewicz-Junak D, Matecka-Tendera E, et al.: Diagnostics and treatment of differentiated thyroid carcinoma in children-Guidelines of Polish national societies. Encokrynologia Polska 67: 628-642, 2016 – reference: 15. Wassner AJ: Risk stratification in pediatric thyroid cancer: growing evidence for individualized therapy. J Clin Endocrinol Metab 106:e1471-e1472, 2021 – reference: 9. Popovtzer A, Shpitzer T, Bahar G, et al.: Thyroid cancer in children: management and outcome experience of a referral center. Otolaryngol Head Neck Surg 135: 581-584, 2006 – reference: 3. Lee YA, Yun HR, Lee J, et al.: Trends in pediatric thyroid cancer incidence, treatment, and clinical course in Korea during 2004-2016: A nationwide population-based study. Thyroid 31: 902-911, 2021 – reference: 5. Lebbink CA, Dekker BJ, Bocca G, et al.: New national recommendations for the treatment of pediatric differentiated thyroid carcinoma in the Netherlands. Eur J Endocrinol 183: 11-18, 2020 – reference: 1. Bernier MO, Withrow DR, de Gonzalez AB, et al.: Trend in pediatric thyroid cancer incidence in the United States, 1998-2013. Cancer 125: 2497-2505, 2019 – reference: 7. Hay ID, Gonzalez-Losada T, Reinalda MS, et al.: Long-term outcome in 215 children and adolescents with papillary thyroid cancer treated during 1940 through 2008. World J Surg 34: 1192-1202, 2010 – reference: 14. Wada N, Sugino K, Mimura T, et al.: Treatment strategy of papillary thyroid carcinoma in children and adolescents: clinical significance of the initial nodal manifestation. Ann Surg Oncol 16: 3442-3449, 2009 – reference: 11. Newman KD, Black T, Heller G, et al.: Differentiated thyroid cancer: determinants of disease progression in patients < 21 years of age at diagnosis: a report from the Surgical Discipline Committee of the Children’s Cancer Group. Ann Surg 227: 533-541, 1998 – reference: 12. Enomoto Y, Enomoto K, Uchino S, et al.: Clinical features, treatment, and long-term outcome of papillary thyroid cancer in children and adolescents without radiation exposure. World J Surg 36: 1241-1246, 2012 – reference: 2. Qian ZJ, Jin MC, Meister KD, et al.: Pediatric thyroid cancer incidence and mortality trends in the United States, 1973-2013. JAMA Otolaryngol Head Neck Surg 145: 617-623, 2019 – reference: 4. Francis GL, Waguespack SG, Bauer AJ, et al.: Management guidelines for children with thyroid nodules and differentiated thyroid cancer. The American thyroid association guidelines task force on pediatric thyroid cancer. Thyroid 25: 716-759, 2015 – reference: 17. Sugino K, Nagahama M, Kitagawa W, et al.: Distant metastasis in pediatric and adolescent differentiated thyroid cancer: clinical outcomes and risk factor analyses. J Clin Endocrinol Metab 105:dgaa545, 2020 – reference: 16. Sugino K, Nagahama M, Kitagawa W, et al.: Risk stratification of pediatric patients with differentiated thyroid cancer: Is total thyroidectomy necessary for patients at any risk? Thyroid 30: 548-556, 2020 |
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| Title | 小児甲状腺分化癌に対する手術治療 |
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