Резистентный к радиойодтерапии дифференцированный рак щитовидной железы у детей и подростков. Ретроспективное исследование

ВВЕДЕНИЕ. Дифференцированный рак щитовидной железы (ДРЩЖ) у детей — редкое заболевание, характеризующееся склонностью к регионарному и отдаленному метастазированию, однако при этом имеющее благоприятный долгосрочный прогноз в большинстве случаев. Радиойодрезистентные (РЙР) формы заболевания представляют собой особую клиническую проблему, которая может составлять 10–30% всех случаев ДРЩЖ и требует углубленного изучения клинического течения, факторов прогноза и возможностей терапии данной подгруппы. Цель данного исследования — комплексная оценка исходов лечения у детей, получивших комбинированное лечение по поводу ДРЩЖ (операция и радиойодтерапия (РЙТ)), с акцентом на распространенные и РЙР формы заболевания.

МАТЕРИАЛЫ И МЕТОДЫ. Ретроспективно проанализированы медицинские данные 278 пациентов в возрасте от 5 до 18 лет, перенесших первичное хирургическое лечение в период с 2008 по 2022 гг. и получивших один или несколько курсов РЙТ в ФГБУ «НМИЦ эндокринологии им. академика И.И. Дедова» Минздрава России с декабря 2015 по март 2024 гг. В исследование включены пациенты с распространенным заболеванием (высокий риск рецидива на момент диагностики) и соответствующие одному из критериев РЙР, с медианой наблюдения 48,0 месяцев [21,5; 62,0].

РЕЗУЛЬТАТЫ. Из 278 пациентов у 39 (14%) выявлено распространенное заболевание, среди них 4 пациента достигли ремиссии, 29 — стабилизации, 6 — биохимического/структурного прогрессирования. Выживаемость без прогрессирования в группе РЙР пациентов составила 85%, 5-летняя общая выживаемость — 100%.

ЗАКЛЮЧЕНИЕ. По результатам исследования предложена новая классификация, основанная на исходной способности метастазов накапливать 131I и динамической оценке ответа на лечение после РЙТ (прогрессирование или стабилизация). Эта система направлена на оптимизацию алгоритмов лечения и наблюдения. Стратегия ведения детей с РЙР ДРЩЖ должна быть сбалансированной: с одной стороны — избегать избыточной терапии при стабильном течении заболевания, с другой — своевременно применять современные системные подходы при наличии факторов риска прогрессирования заболевания.

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