Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, California.
Department of Biostatistics, UCLA School of Public Health, Los Angeles, California.
J Clin Endocrinol Metab. 2020 Jun 1;105(6). doi: 10.1210/clinem/dgaa121.
The increased incidence of thyroid cancer globally over the past several decades is principally attributed to small, indolent papillary thyroid cancers. A possible concomitant increase in thyroid cancer-specific mortality remains debated.
The changes in thyroid cancer incidence and incidence-based mortality were assessed using a large population-based cohort over an 18-year period.
DESIGN & PATIENTS: A retrospective analysis of all thyroid cancers reported in the California Cancer Registry was performed (2000-2017). Age-adjusted incidence and incidence-based mortality rates were analyzed using a log-linear model to estimate annual percent change.
We identified 69 684 individuals (76% female, median age 50 years) diagnosed with thyroid cancer. The incidence of thyroid cancer increased across all histological subtypes (papillary, follicular, medullary, and anaplastic) and all tumor sizes. The incidence increased from 6.43 to 11.13 per 100 000 person-years (average increase 4% per year; P < 0.001) over the study period. Thyroid cancer-specific mortality rates increased on average by 1.7% per year (P < 0.001). The increased mortality rates were greater in men (2.7% per year, P < 0.001) and patients with larger tumors (2-4 cm) (3.4% per year, P < 0.05).
Data from this statewide registry demonstrate that the incidence of thyroid cancer is increasing, and that this phenomenon is not restricted to small papillary thyroid cancers. Rising incidence in thyroid cancers of all sizes with concurrent increase of incidence-based mortality in men and those with larger tumors suggest a true increase in clinically significant disease.
过去几十年，全球甲状腺癌的发病率呈上升趋势，主要归因于小的、惰性的甲状腺乳头状癌。甲状腺癌特异性死亡率是否随之增加仍存在争议。
本研究通过一个大型人群队列，在 18 年的时间里评估了甲状腺癌的发病率和发病率为基础的死亡率的变化。
对加州癌症登记处报告的所有甲状腺癌病例进行了回顾性分析（2000-2017 年）。使用对数线性模型分析年龄调整后的发病率和发病率为基础的死亡率，以估计每年的百分比变化。
共确定了 69684 例（76%为女性，中位年龄为 50 岁）甲状腺癌患者。所有组织学亚型（甲状腺乳头状癌、滤泡状癌、髓样癌和间变性癌）和所有肿瘤大小的甲状腺癌发病率均呈上升趋势。研究期间，甲状腺癌发病率从 6.43/100000 人年增加到 11.13/100000 人年（平均每年增加 4%；P<0.001）。甲状腺癌特异性死亡率平均每年增加 1.7%（P<0.001）。男性（每年 2.7%，P<0.001）和肿瘤较大（2-4cm）的患者（每年 3.4%，P<0.05）的死亡率增加幅度更大。
本州范围内登记处的数据表明，甲状腺癌的发病率正在上升，且这种现象不仅限于小的甲状腺乳头状癌。所有大小的甲状腺癌的发病率上升，同时男性和肿瘤较大的患者的发病率为基础的死亡率上升，提示临床上有真正的疾病增加。
