甲状腺癌过度诊断和过度治疗：厄瓜多尔一家甲状腺癌转诊中心的横断面研究。
Thyroid cancer overdiagnosis and overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador.
机构信息
Otolaryngology Head and Neck Department, Stanford University, Palo Alto, California, USA.
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
出版信息
BMC Cancer. 2021 Jan 8;21(1):42. doi: 10.1186/s12885-020-07735-y.
BACKGROUND
In contrast to the rapid increase in thyroid cancer incidence, the mortality has remained low and stable over the last decades. In Ecuador, however, thyroid cancer mortality has increased. The objective of this study is to determine possible drivers of high rates of thyroid cancer mortality, through a cross-sectional analysis of all patients attending a thyroid cancer referral center in Ecuador.
METHODS
From June 2014 to December 2017, a cross-sectional study was conducted at the Hospital de Especialidades Eugenio Espejo, a regional reference public hospital for endocrine neoplasia in adults in Quito, Ecuador. We identified the mechanism of detection, histopathology and treatment modalities from a patient interview and review of clinical records.
RESULTS
Among 452 patients, 74.8% were young adults and 94.2% (426) were female. 13.7% had a family history of thyroid cancer, and patients' median tumor size was 2 cm. The incidental finding was 54.2% whereas 45.8% was non-incidental. Thyroid cancer histology reported that 93.3% had papillary thyroid cancer (PTC), 2.7% follicular, 1.5% Hurtle cells, 1.6% medullary, 0.7% poor differentiated, and 0.2% anaplastic carcinoma. The mean MACIS (metastasis, age, completeness, invasion, and size) score was 4.95 (CI 4.15-5.95) with 76.2% of the thyroid cancer patients having MACIS score less than or equal to 6. The very low and low risk of recurrence was 18.1% (79) and 62% (271) respectively. An analysis of 319 patients with non-metastatic thyroid cancer showed that 10.7% (34) of patients had surgical complications. Moreover, around 62.5% (80 from 128 patients with thyroglobulin laboratory results) of TC patients had a stimulated-thyroglobulin value equal or higher than 2 ng/ml. Overall, a poor surgical outcome was present in 35.1% (112) patients. Out of 436 patients with differentiated thyroid carcinoma, 86% (375) received radioactive iodine.
CONCLUSION
Thyroid cancer histological characteristics and method of diagnosis are like those described in other reports without any evidence of the high frequency of aggressive thyroid cancer histology. However, we observed evidence of overtreatment and poor surgical outcomes that demand additional studies to understand their association with thyroid cancer mortality in Ecuador.
背景
与甲状腺癌发病率的快速增长形成对比的是，过去几十年来，甲状腺癌死亡率一直保持较低且稳定的水平。然而，在厄瓜多尔，甲状腺癌死亡率有所上升。本研究的目的是通过对厄瓜多尔一家甲状腺癌转诊中心的所有患者进行横断面分析，确定导致甲状腺癌高死亡率的可能因素。
方法
本研究为 2014 年 6 月至 2017 年 12 月在厄瓜多尔基多的 Eugenio Espejo 专科医院进行的横断面研究。我们通过对患者的访谈和临床记录的回顾，确定了检测方法、组织病理学和治疗方式。
结果
在 452 名患者中，74.8%为青年成年人，94.2%（426 名）为女性。13.7%的患者有甲状腺癌家族史，患者的肿瘤中位数大小为 2 厘米。偶然发现的占 54.2%，而非偶然发现的占 45.8%。甲状腺癌组织学报告显示，93.3%为甲状腺乳头状癌（PTC），2.7%为滤泡状癌，1.5%为 Hurthle 细胞癌，1.6%为髓样癌，0.7%为低分化癌，0.2%为间变性癌。平均 MACIS（转移、年龄、完整性、浸润和大小）评分为 4.95（CI 4.15-5.95），76.2%的甲状腺癌患者 MACIS 评分为 6 或以下。复发的极低和低风险分别为 18.1%（79 名）和 62%（271 名）。对 319 名无转移甲状腺癌患者的分析显示，10.7%（34 名）的患者存在手术并发症。此外，约 62.5%（128 名患者的甲状腺球蛋白实验室结果）的 TC 患者的刺激甲状腺球蛋白值等于或高于 2ng/ml。总体而言，35.1%（112 名）患者的手术结局不佳。在 436 名分化型甲状腺癌患者中，86%（375 名）接受了放射性碘治疗。
结论
甲状腺癌的组织学特征和诊断方法与其他报告中的描述相似，没有任何证据表明存在高频率的侵袭性甲状腺癌组织学。然而，我们观察到过度治疗和手术结局不佳的证据，这需要进一步研究以了解其与厄瓜多尔甲状腺癌死亡率的关系。
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