Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India.
Department of Neurosurgery, Oklahoma University of Health Sciences Center, Oklahoma City, Oklahoma, USA.
Thyroid. 2021 Oct;31(10):1502-1513. doi: 10.1089/thy.2021.0158. Epub 2021 Jul 2.
Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) reclassification has significantly influenced the field of thyroidology. However, the extent of this impact depends upon the incidence of NIFTP in a given population. In this meta-analysis, we aimed to obtain robust information about the actual incidence of NIFTP worldwide by reviewing the published data. Comprehensive literature search was performed using electronic databases of PubMed and Web of Science over a five-year period (January 1, 2016, to January 30, 2021). The incidence of NIFTP was calculated by dividing the number of NIFTPs by the number of papillary thyroid carcinomas (PTCs). Meta-analysis of proportion and their 95% confidence interval [CI] were pooled using the random-effect model. Heterogeneity across the included studies was assessed using statistics. Egger's regression test and funnel plot of estimates were used to evaluate the publication bias. -Value <0.05 was considered significant. From 505 publications, we included 50 studies, all retrospective, with 100,780 PTCs and 3990 NIFTP from 92 institutions worldwide. The overall incidence of NIFTP was 6.0% [CI 4.4-8.2] among PTCs or thyroid malignancies with a high level of heterogeneity among the included studies ( = 98.6%). NIFTP incidence was largely similar in North America and Europe (9.3% vs. 9.6%), with a significantly lower overall rate in Asia (2.1%). There was a significant decline in the reported incidence of NIFTP in non-Asian studies published after 2017 ( = 0.002). On applying our data on global thyroid cancer statistics, this reclassification would affect ∼30,881 patients annually, with a lower impact in Asia compared with North America and Europe. This comprehensive meta-analysis confirms that the worldwide NIFTP incidence is much lower than estimated initially. The NIFTP rates are significantly lower in Asian compared with North American and European countries. Apart from geography, NIFTP rates are significantly influenced by the nature of study, type of database used for sample collection, and the diagnostic criteria used. Introduction of NIFTP may potentially spare over 30,000 patients worldwide annually from clinical and psychological consequences of a thyroid cancer diagnosis.
非侵袭性滤泡甲状腺肿瘤伴乳头状核特征（NIFTP）的重新分类对甲状腺学领域产生了重大影响。然而，这种影响的程度取决于特定人群中 NIFTP 的发病率。在这项荟萃分析中，我们旨在通过回顾已发表的数据，获得有关全球 NIFTP 实际发病率的可靠信息。使用电子数据库 PubMed 和 Web of Science 进行了为期五年的全面文献搜索（2016 年 1 月 1 日至 2021 年 1 月 30 日）。通过将 NIFTP 数量除以甲状腺乳头状癌（PTC）数量来计算 NIFTP 的发病率。使用随机效应模型对比例及其 95%置信区间 [CI] 进行荟萃分析。使用 χ 2 统计量评估纳入研究之间的异质性。Egger 回归检验和估计的漏斗图用于评估发表偏倚。P 值<0.05 被认为具有统计学意义。从 505 篇出版物中，我们纳入了 50 项研究，均为回顾性研究，共纳入来自全球 92 个机构的 100780 例 PTC 和 3990 例 NIFTP。PTC 或甲状腺恶性肿瘤中 NIFTP 的总发病率为 6.0%[CI 4.4-8.2]，纳入研究之间存在高度异质性（ χ 2 =98.6%）。在北美和欧洲，NIFTP 的发病率大致相似（9.3%比 9.6%），而亚洲的总体发病率明显较低（2.1%）。2017 年后发表的非亚洲研究报告的 NIFTP 发病率显著下降（ χ 2 =0.002）。根据我们对全球甲状腺癌统计数据的应用，这种重新分类将每年影响约 30881 名患者，与北美和欧洲相比，亚洲的影响较小。这项全面的荟萃分析证实，全球 NIFTP 的发病率远低于最初估计。与北美和欧洲国家相比，亚洲的 NIFTP 发病率明显较低。除了地理位置，NIFTP 发病率还受到研究性质、用于样本收集的数据库类型以及使用的诊断标准的显著影响。NIFTP 的引入可能会使全球每年超过 30000 名患者免受甲状腺癌诊断的临床和心理后果。
