对1997年至2008年期间，白俄罗斯一群在切尔诺贝利事故后接触过放射性碘的儿童和青少年进行三轮筛查时所发现的甲状腺恶性病理结果的分析。
Analysis of thyroid malignant pathologic findings identified during 3 rounds of screening (1997-2008) of a cohort of children and adolescents from belarus exposed to radioiodines after the Chernobyl accident.
作者信息
Zablotska Lydia B, Nadyrov Eldar A, Rozhko Alexander V, Gong Zhihong, Polyanskaya Olga N, McConnell Robert J, O'Kane Patrick, Brenner Alina V, Little Mark P, Ostroumova Evgenia, Bouville Andre, Drozdovitch Vladimir, Minenko Viktor, Demidchik Yuri, Nerovnya Alexander, Yauseyenka Vassilina, Savasteeva Irina, Nikonovich Sergey, Mabuchi Kiyohiko, Hatch Maureen
机构信息
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
出版信息
Cancer. 2015 Feb 1;121(3):457-66. doi: 10.1002/cncr.29073. Epub 2014 Oct 28.
BACKGROUND
Recent studies of children and adolescents who were exposed to radioactive iodine-131 (I-131) after the 1986 Chernobyl nuclear accident in Ukraine exhibited a significant dose-related increase in the risk of thyroid cancer, but the association of radiation doses with tumor histologic and morphologic features is not clear.
METHODS
A cohort of 11,664 individuals in Belarus who were aged ≤18 years at the time of the accident underwent 3 cycles of thyroid screening during 1997 to 2008. I-131 thyroid doses were estimated from individual thyroid activity measurements taken within 2 months after the accident and from dosimetric questionnaire data. Demographic, clinical, and tumor pathologic characteristics of the patients with thyroid cancer were analyzed using 1-way analysis of variance, chi-square tests or Fisher exact tests, and logistic regression.
RESULTS
In total, 158 thyroid cancers were identified as a result of screening. The majority of patients had T1a and T1b tumors (93.7%), with many positive regional lymph nodes (N1; 60.6%) but few distant metastases (M1; <1%). Higher I-131 doses were associated with higher frequency of solid and diffuse sclerosing variants of thyroid cancer (P < .01) and histologic features of cancer aggressiveness, such as lymphatic vessel invasion, intrathyroidal infiltration, and multifocality (all P < .03). Latency was not correlated with radiation dose. Fifty-two patients with self-reported thyroid cancers which were diagnosed before 1997 were younger at the time of the accident and had a higher percentage of solid variant cancers compared with patients who had screening-detected thyroid cancers (all P < .0001).
CONCLUSIONS
I-131 thyroid radiation doses were associated with a significantly greater frequency of solid and diffuse sclerosing variants of thyroid cancer and various features of tumor aggressiveness.
背景
近期对1986年乌克兰切尔诺贝利核事故后接触放射性碘-131（I-131）的儿童和青少年进行的研究显示，甲状腺癌风险出现了与剂量相关的显著增加，但辐射剂量与肿瘤组织学和形态学特征之间的关联尚不清楚。
方法
白俄罗斯的一个队列中有11664名个体在事故发生时年龄≤18岁，他们在1997年至2008年期间接受了3轮甲状腺筛查。I-131甲状腺剂量是根据事故后2个月内进行的个体甲状腺活性测量以及剂量学问卷调查数据估算得出的。采用单因素方差分析、卡方检验或Fisher精确检验以及逻辑回归分析甲状腺癌患者的人口统计学、临床和肿瘤病理特征。
结果
通过筛查共确诊158例甲状腺癌。大多数患者患有T1a和T1b肿瘤（93.7%），有许多区域淋巴结阳性（N1；60.6%），但远处转移较少（M1；<1%）。较高的I-131剂量与甲状腺癌实性和弥漫性硬化变体的较高频率相关（P < 0.01），以及与癌症侵袭性的组织学特征相关，如淋巴管侵犯、甲状腺内浸润和多灶性（所有P < 0.03）。潜伏期与辐射剂量无关。与筛查发现甲状腺癌的患者相比，1997年前自我报告诊断为甲状腺癌的52例患者在事故发生时年龄更小，实性变体癌的比例更高（所有P < 0.0001）。
结论
I-131甲状腺辐射剂量与甲状腺癌实性和弥漫性硬化变体的显著更高频率以及肿瘤侵袭性的各种特征相关。
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