Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-6860, USA.
J Am Coll Surg. 2013 Apr;216(4):571-7; discussion 577-9. doi: 10.1016/j.jamcollsurg.2012.12.022. Epub 2013 Feb 8.
The incidence of thyroid cancer in patients treated operatively for thyroid disease has been historically low (<5%). Previous series have not specifically addressed cancer rates in both euthyroid and hyperthyroid patients. This study examined cancer frequency in patients referred for removal of benign thyroid disease in a multi-institutional series.
A total of 2,551 patients underwent thyroidectomy at 3 high-volume institutions. Indeterminate/malignant fine-needle aspiration diagnosis was excluded (n = 1,028). Cancer cases were compared among 1,523 patients with Graves' disease (n = 264), nodular goiter (n = 1,095), and toxic nodular goiter (n = 164). Fisher's exact test, chi-square test, Wilcoxon rank sum, Kruskal-Wallis nonparametric t-tests, and multivariable logistic regression were used.
Overall, 238 (15.6%) cancers were recorded: Graves' disease (6.1%), nodular goiter (17.5%), and toxic nodular goiter (18.3%). Cancer rates were significantly different among these groups (p < 0.01) and significantly higher in nodular goiter and toxic nodular goiter vs Graves' disease (p < 0.01); no significant differences in cancer rates were noted among institutions. Overall, 275 patients had thyroiditis (18%). There was a significant association with younger age, male sex, nodular thyroids, and cancer (p < 0.05). Presence of thyroiditis or performance of preoperative fine-needle aspiration was not associated with cancer. Mean cancer size was 1.1 cm (46% >0.5 cm; 39% >1 cm). Most patients underwent total thyroidectomy (80%).
These data confirm higher than expected incidental thyroid cancer rates (15.6%) in the largest multi-institutional surgical series to date. Nodular thyroids, males, and young patients were more likely to harbor incidental carcinoma. These data support consideration of initial total thyroidectomy as the preferred approach for patients referred to the surgeon with bilateral nodular disease.
在接受手术治疗甲状腺疾病的患者中，甲状腺癌的发病率历来较低（<5%）。以前的系列研究并未专门针对甲状腺功能正常和甲状腺功能亢进患者的癌症发生率。本研究在多机构系列研究中检查了良性甲状腺疾病切除患者的癌症频率。
共有 2551 名患者在 3 家高容量机构接受了甲状腺切除术。排除了不确定/恶性细针抽吸诊断（n = 1028）。对 264 例格雷夫斯病（Graves' disease）患者（n = 264）、1095 例结节性甲状腺肿（nodular goiter）患者和 164 例毒性结节性甲状腺肿（toxic nodular goiter）患者的癌症病例进行了比较。使用 Fisher 精确检验、卡方检验、Wilcoxon 秩和检验、Kruskal-Wallis 非参数 t 检验和多变量逻辑回归。
总体而言，记录了 238 例（15.6%）癌症：Graves' disease（6.1%）、结节性甲状腺肿（17.5%）和毒性结节性甲状腺肿（18.3%）。这些组之间的癌症发生率存在显著差异（p < 0.01），结节性甲状腺肿和毒性结节性甲状腺肿的癌症发生率明显高于 Graves' disease（p < 0.01）；各机构之间的癌症发生率无显著差异。总体而言，275 例患者患有甲状腺炎（18%）。年龄较小、男性、结节性甲状腺和癌症与甲状腺炎存在显著关联（p < 0.05）。甲状腺炎的存在或术前细针抽吸的进行与癌症无关。癌症的平均大小为 1.1 厘米（46% > 0.5 厘米；39% > 1 厘米）。大多数患者接受了全甲状腺切除术（80%）。
这些数据证实了迄今为止最大的多机构手术系列中意外甲状腺癌发生率（15.6%）高于预期。结节性甲状腺、男性和年轻患者更有可能存在偶发性癌。这些数据支持考虑对双侧结节性疾病转介给外科医生的患者首选初始全甲状腺切除术。
