美国儿童甲状腺癌发病率和死亡率趋势，1973-2013 年。
Pediatric Thyroid Cancer Incidence and Mortality Trends in the United States, 1973-2013.
机构信息
Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.
Children's Thyroid Center, Stanford Children's Health, Lucile Packard Children's Hospital, Stanford, California.
出版信息
JAMA Otolaryngol Head Neck Surg. 2019 Jul 1;145(7):617-623. doi: 10.1001/jamaoto.2019.0898.
IMPORTANCE
The incidence of thyroid cancer is increasing by 3% annually. This increase is often thought to be attributable to overdiagnosis in adults. A previous study reported a 1.1% annual increase in the incidence of pediatric thyroid cancer. However, the analysis was limited to the period from 1973 to 2004 and was performed in a linear fashion, which does not account for changes in incidence trends over time.
OBJECTIVE
To analyze trends in pediatric thyroid cancer incidence based on demographic and tumor characteristics at diagnosis.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included individuals younger than 20 years who had a diagnosis of thyroid cancer in the Surveillance, Epidemiology, and End Results (SEER) 9 database from 1973 to 2013. Cases of thyroid cancer were identified using the International Classification of Diseases for Oncology, Third Edition and were categorized by histologic type, stage, and tumor size.
MAIN OUTCOMES AND MEASURES
Annual percent change (APC) in the incidence rates was calculated using joinpoint regression analysis.
RESULTS
Among 1806 patients included in the analysis, 1454 (80.5%) were female and 1503 (83.2%) were white; most patients were aged 15 to 19 years. The overall incidence rates of thyroid cancer increased annually from 0.48 per 100 000 person-years in 1973 to 1.14 per 100 000 person-years in 2013. Incidence rates gradually increased from 1973 to 2006 (APC, 1.11%; 95% CI, 0.56%-1.67%) and then markedly increased from 2006 to 2013 (APC, 9.56%; 95% CI, 5.09%-14.22%). The incidence rates of large tumors (>20 mm) gradually increased from 1983 to 2006 (APC, 2.23%; 95% CI, 0.93%-3.54%) and then markedly increased from 2006 to 2013 (APC, 8.84%; 95% CI, 3.20%-14.79%); these rates were not significantly different from incidence rates of small (1-20 mm) tumors. The incidence rates of regionally extended thyroid cancer gradually increased from 1973 to 2006 (APC, 1.44%; 95% CI, 0.68%-2.21%) and then markedly increased from 2006 to 2013 (APC, 11.16%; 95% CI, 5.26%-17.40%); these rates were not significantly different from the incidence rates of localized disease.
CONCLUSIONS AND RELEVANCE
The incidence rates of pediatric thyroid cancer increased more rapidly from 2006 to 2013 than from 1973 to 2006. The findings suggest that there may be a co-occurring increase in thyroid cancer in the pediatric population in addition to enhanced detection.
重要性
甲状腺癌的发病率每年增长 3%。这种增长通常被认为是成年人过度诊断的结果。先前的一项研究报告称，儿科甲状腺癌的发病率每年增加 1.1%。然而，该分析仅限于 1973 年至 2004 年期间，并且以线性方式进行，未考虑发病率趋势随时间的变化。
目的
根据诊断时的人口统计学和肿瘤特征分析儿科甲状腺癌的发病趋势。
设计、设置和参与者：这项横断面研究纳入了 1973 年至 2013 年期间 SEER9 数据库中年龄小于 20 岁的甲状腺癌患者。使用国际肿瘤疾病分类学第三版识别甲状腺癌病例，并根据组织学类型、分期和肿瘤大小进行分类。
主要结局和测量
使用连接点回归分析计算发病率的年百分变化（APC）。
结果
在纳入分析的 1806 例患者中，1454 例（80.5%）为女性，1503 例（83.2%）为白人；大多数患者年龄在 15 至 19 岁之间。甲状腺癌的总体发病率从 1973 年的 0.48/100000 人年逐渐增加到 2013 年的 1.14/100000 人年。发病率从 1973 年至 2006 年逐渐增加（APC，1.11%；95%CI，0.56%-1.67%），然后从 2006 年至 2013 年显著增加（APC，9.56%；95%CI，5.09%-14.22%）。从 1983 年至 2006 年，大肿瘤（>20mm）的发病率逐渐增加（APC，2.23%；95%CI，0.93%-3.54%），然后从 2006 年至 2013 年显著增加（APC，8.84%；95%CI，3.20%-14.79%）；这些发病率与 1-20mm 大小肿瘤的发病率无显著差异。从 1973 年至 2006 年，区域扩展甲状腺癌的发病率逐渐增加（APC，1.44%；95%CI，0.68%-2.21%），然后从 2006 年至 2013 年显著增加（APC，11.16%；95%CI，5.26%-17.40%）；这些发病率与局部疾病的发病率无显著差异。
结论和相关性
从 2006 年至 2013 年，儿科甲状腺癌的发病率比从 1973 年至 2006 年增加得更快。这些发现表明，除了检测能力增强之外，儿科人群中甲状腺癌的发病率可能同时增加。
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