中国实用外科杂志

中国实用外科杂志

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儿童及青少年甲状腺癌的流行病学及病因特点

邬一军，朱丽娴   

  1. 浙江大学医学院附属第一医院甲状腺外科，浙江杭州310003
  • 出版日期:2022-06-01

  • Online:2022-06-01

摘要： 甲状腺癌在儿童及青少年中较为少见，其病理学类型以甲状腺乳头状癌（PTC）为主。不同年龄阶段儿童及青少年甲状腺癌的流行病学特点、病理学类型、临床表现及预后存在差异。儿童时期电离辐射暴露是甲状腺癌唯一确定的危险因素，并存在线性的剂量-效应关系。5%～10%的儿童及青少年甲状腺癌病人有甲状腺肿瘤相关疾病的家族史，具有家族性非髓样甲状腺癌家族史的儿童及青少年患癌风险更高。与成人不同，儿童甲状腺癌中RET/PTC基因重排更为常见，可能是电离辐射相关的致癌因素。家族性非髓样甲状腺癌表现出类似低外显率的常染色体疾病或多基因疾病模式，并具有较高的遗传异质性，其中关键的遗传分子改变目前仍不清楚。儿童及青少年中自身免疫性甲状腺疾病与甲状腺癌的共患率呈逐年上升趋势，我国儿童合并桥本甲状腺炎时发生PTC的风险更高。超重和肥胖可能与儿童及青少年期甲状腺癌的发生有关，并且会增加成年后甲状腺癌的患病风险。儿童时期碘缺乏可导致甲状腺功能减退、甲状腺肿、发育异常等诸多问题；当暴露于电离辐射后，碘缺乏地区的儿童成年后具有更高的甲状腺癌发病率。此外，儿童甲状腺癌还受重金属、食品添加剂、环境致癌物等其他环境与营养因素的影响。儿童及青少年时期相关危险因素的暴露甚至会影响成年后的甲状腺癌的发生与疾病预后，但其具体机制仍有待进一步研究和探索。

关键词: 甲状腺癌, 儿童, 青少年, 流行病学, 病因

Abstract: Epidemiological characteristics and etiological analysis of thyroid carcinoma in children and adolescents        WU Yi-jun, ZHU Li-xian.  Department of Thyroid Surgery, the First Affiliated Hospital Zhejiang University School of Medicine， Hangzhou 310003, China
Corresponding author：WU Yi-jun，E-mail:wuwu5925@zju.edu.cn
Abstract    Thyroid carcinoma is relatively rare in children and adolescents，with papillary thyroid cancer being the predominant type. Differences exhibit in the epidemiological characteristics，pathological types，clinical manifestations and long-term outcomes of thyroid cancer in in children and adolescents of various. Exposure to ionizing radiation in childhood is the sole established risk factor for thyroid cancer，with a linear dose-response association. About 5%～10% of thyroid cancers in children and adolescents have a family history of thyroid tumor-related disease，and young ages with a family history of non-medullary thyroid cancer are at a higher risk of cancer.  RET/PTC gene rearrangements are more common in pediatric thyroid cancer than in adult, and may act as a potential ionizing radiation-related carcinogen. Familial non-medullary thyroid cancers show an inheritance pattern compatible with autosomal or polygenic disease associated with low-penetrant alleles and a high genetic heterogeneity，in which key genetic molecular alterations remain unclear. The comorbidity incidence of autoimmune thyroid disease and thyroid cancer in children and adolescents is increasing，and Chinese children with Hashimoto's thyroiditis present a higher risk of developing PTC. Overweight and obesity may be associated with thyroid cancer risk in childhood and adolescence , as well as a tendency to thyroid cancer in adulthood. Iodine deficiency in childhood may lead to hypothyroidism，goiters，and developmental abnormalities. Children from iodine-deficient areas are more likely to develop thyroid cancer in adulthood when exposed to ionizing radiation. In addition，pediatric thyroid cancers may also be influenced by other physiological factors such as heavy metals，food additives，and environmental carcinogens. Further studies are necessary in order to investigate the possible risk factors and associated pathophysiological mechanisms so as to be able to control and potentially slow down the continuous increase of thyroid cancer incidence.

Key words: thyroid carcinoma, children, adolescents, epidemiology, etiology