Hospices Civils de Lyon, Registre Rhône Alpin des Cancers Thyroïdiens - Centre de Médecine Nucléaire et Fédération d'Endocrinologie, Groupement Hospitalier Est, Lyon, France.
Hospices Civils de Lyon, Service de Biostatistique - Bioinformatique, Service d'Anatomie et Cytologie Pathologiques et Service de Chirurgie Digestive et Endocrinienne, Groupement Hospitalier Lyon Sud, Pierre Bénite, France.
Clin Endocrinol (Oxf). 2018 Dec;89(6):824-833. doi: 10.1111/cen.13833. Epub 2018 Sep 11.
To investigate the impact of the volume of thyroid surgery and pathologic detection on the risk of thyroid cancer.
We investigated the influence of the volume of thyroid surgery in a first study that included 23 384 thyroid surgeries and 5302 thyroid cancers collected between 2008 and 2013. Standardized incidence ratios (SIRs) and thyroid intervention rates (STIRs) were used as indicators of cancer risk and surgery volume, respectively. The influence of pathologic detection, using the number of cuts per gram of tissue as the indicator, was studied in a second study that included 1257 thyroid specimens, collected in 2014.
We found departmental variations in SIRs and a significant effect of the STIR on the SIR (men, P = 0.0008; women, P < 0.0001). A 1/100 000 increase in the STIR resulted in a 3% and 1.3% increase in the SIR in men and women, respectively. This effect was greatest for microcancers and absent for tumours >4 cm. The risk of cancer diagnosis was significantly associated with the number of cuts per gram of tissue (OR 6.1, P < 0.001), and was greater for total thyroidectomy than for lobectomy (P = 0.014) and when FNA cytology had been preoperatively performed (P < 0.001). The prevalence of incidental microcancers was highest in the centres performing the highest number of cuts per gram.
The risk of thyroid cancer, particularly microcancer, is related to the volume of surgery and to the level of pathologist scrutiny. Both factors contribute to the increase in overdiagnosis. This further advocates for appropriate selection of patients for thyroid surgery.
研究甲状腺手术量和病理检测对甲状腺癌风险的影响。
我们进行了两项研究。第一项研究纳入了 2008 年至 2013 年间的 23384 例甲状腺手术和 5302 例甲状腺癌病例，研究了甲状腺手术量的影响。使用标准化发病比（SIR）和甲状腺干预率（STIR）分别作为癌症风险和手术量的指标。第二项研究纳入了 2014 年的 1257 例甲状腺标本，使用每克组织的切痕数作为指标，研究了病理检测的影响。
我们发现 SIR 存在科室差异，STIR 对 SIR 有显著影响（男性，P=0.0008；女性，P＜0.0001）。STIR 每增加 1/100000，男性和女性的 SIR 分别增加 3%和 1.3%。这种影响在微癌中最大，而在肿瘤＞4cm 时则不存在。癌症诊断风险与每克组织的切痕数显著相关（OR 6.1，P＜0.001），全甲状腺切除术的风险大于甲状腺叶切除术（P=0.014），且术前进行细针穿刺细胞学检查时风险更高（P＜0.001）。在每克组织切痕数最高的中心，偶然发现的微癌的患病率最高。
甲状腺癌（尤其是微癌）的风险与手术量和病理学家的检查水平有关。这两个因素都导致了过度诊断的增加。这进一步提倡对甲状腺手术的患者进行适当选择。
