Мультифокальний папілярний рак щитоподібної залози у дітей і дорослих. Лекція
DOI:
https://doi.org/10.30978/CEES-2022-3-47Ключові слова:
папілярний рак щитоподібної залози, предиктори, мультифокальністьАнотація
Рак щитоподібної залози (РЩЗ) посідає 9‑те місце в світі за рівнем захворюваності. У 2020 р. у світі зареєстровано 586 тис. випадків РЩЗ. Рівень захворюваності серед жінок становить 10,1 на 100 тис. населення, серед чоловіків — 3,1 на 100 тис. населення. В Україні у 2019 р. стандартизований показник захворюваності на РЩЗ (світовий стандарт) становив 6,9 на 100 тис. населення (2,8 — серед чоловіків, 10,5 — серед жінок). У структурі захворюваності на злоякісні новоутворення РЩЗ посідає перше місце серед жінок віком 18—29 років (19,9 %), четверте місце — серед чоловіків віком 18—29 років (8,3 %), а також серед жінок віком 30—54 роки (8,1 %). Останніх 40 років у більшості країн спостерігається зростання рівня захворюваності на РЩЗ (зокрема на папілярний рак щитоподібної залози (ПРЩЗ)), що пояснюють різними чинниками, наприклад, надмірною діагностикою, зміною поширеності модифікованих чинників ризику. В Україні за період з 1989 до 2012 р. рівень захворюваності на РЩЗ серед чоловіків зріс на 115 %, серед жінок — на 137 %, щорічний приріст захворюваності на РЩЗ для чоловіків і жінок становив 5 та 6 % відповідно. Мультифокальність при ПРЩЗ є характерною ознакою, що набагато частіше трапляється в дитячому віці, ніж у дорослих, але кількість досліджень у дітей обмежена, що пов’язують з меншою поширеністю захворювання у дітей. Дані досліджень щодо чинників прогнозування мультифокальності та її ролі у впливі на рецидив, персистенцію і виживаність пацієнтів з ПРЩЗ суперечливі як у дорослих, так і у дітей. Серед чинників ризику мультифокальності менша кількість суперечок стосується зв’язків з метастазуванням у лімфатичні вузли, опроміненням в анамнезі, дитячим віком, а для двобічності — з мультифокальністю первинної частки та наявністю контралатеральних доброякісних вузлів (у дорослих). Інші чинники як предиктори мультифокальності мають суперечливе значення та варті уваги у подальших дослідженнях. Визначення надійних предикторів мультифокальності, особливо за допомогою аналізу доопераційних даних, а також стратифікація ризику мультифокальності дадуть змогу полегшити складний процес прийняття рішень для правильної тактики лікування дітей і дорослих з ПРЩЗ.
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