Belfiore A, La Rosa G L, La Porta G A, Giuffrida D, Milazzo G, Lupo L, Regalbuto C, Vigneri R
Cattedra di Endocrinologia, University of Catania, Ospedale Garibaldi, Italy.
Am J Med. 1992 Oct;93(4):363-9. doi: 10.1016/0002-9343(92)90164-7.
We evaluated the frequency of thyroid cancer in patients with cold thyroid nodules in relation to iodine intake, sex, age, and multinodularity in a consecutive series of patients with nodular thyroid diseases.
In the period from 1980 to 1990, 5,637 patients were studied: 4,176 patients were from an iodine-sufficient area (ISA) and 1,461 from an adjacent iodine-deficient area (IDA). Surgery was performed in 792 patients on the basis of a suspicious or malignant finding at fine-needle aspiration biopsy.
The overall thyroid cancer frequency was 4.6% (259 patients had cancer). Iodine intake affected the cancer rate in patients with cold nodules. The frequency of cancer in patients with cold thyroid nodules was 5.3% in the ISA and 2.7% in the IDA. This difference, however, was significant only in females. Sex had a major influence on the malignant rate of cold nodules; although female patients were more frequently observed (n = 5,028) than male patients (n = 609), the frequency of cancer was significantly lower in female patients with cold nodules (4.2%) than in males (8.2%). Age was an important factor in both sexes. The proportion of nodules that were malignant was smallest in patients of the 4th decade and was greatest in patients younger than 30 years or older than 60 years. Multivariate analysis showed that sex and age interact in determining the cancer risk in patients with thyroid nodules. Finally, the frequency of thyroid cancer in patients with a solitary nodule was not different from the frequency in patients with multiple nodules.
Our study indicates that thyroid cancer risk in a patient with a nodular goiter varies markedly according to iodine intake, sex, and age but not in relation to multinodularity, as assessed by clinical examination. The knowledge of these epidemiologic aspects of thyroid cancer may increase the accuracy of the preoperative selection of patients with cold nodules of the thyroid.
我们评估了一系列连续性甲状腺结节疾病患者中，冷甲状腺结节患者的甲状腺癌发生频率与碘摄入量、性别、年龄及结节多发情况之间的关系。
在1980年至1990年期间，共研究了5637例患者：4176例患者来自碘充足地区（ISA），1461例来自相邻的碘缺乏地区（IDA）。792例患者因细针穿刺活检发现可疑或恶性病变而接受了手术。
总体甲状腺癌发生率为4.6%（259例患者患有癌症）。碘摄入量影响冷结节患者的癌症发生率。冷甲状腺结节患者的癌症发生率在ISA地区为5.3%，在IDA地区为2.7%。然而，这种差异仅在女性中具有统计学意义。性别对冷结节的恶性率有重大影响；尽管女性患者（n = 5028）比男性患者（n = 609）更为常见，但冷结节女性患者的癌症发生率（4.2%）显著低于男性（8.2%）。年龄在两性中都是一个重要因素。40岁患者的结节恶性比例最小，30岁以下或60岁以上患者的结节恶性比例最大。多因素分析表明，性别和年龄在决定甲状腺结节患者的癌症风险方面存在相互作用。最后，孤立结节患者的甲状腺癌发生率与多发结节患者的发生率没有差异。
我们的研究表明，结节性甲状腺肿患者的甲状腺癌风险根据碘摄入量、性别和年龄有显著差异，但与临床检查评估的结节多发情况无关。了解甲状腺癌的这些流行病学特征可能会提高甲状腺冷结节患者术前选择的准确性。
