Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.
Thyroid. 2022 May;32(5):560-570. doi: 10.1089/thy.2021.0662. Epub 2022 Mar 15.
Thyroid cancer incidence has significantly increased in the United States over the past few decades. Recent studies have suggested a change in thyroid cancer incidence trends following 2013. The main objective of this study was to update the data on thyroid cancer incidence and mortality trends in the United States. Thyroid cancer incidence and incidence-based mortality trends were evaluated using the Surveillance, Epidemiology, and End Results-18 cancer registry. Cases of thyroid cancer diagnosed in 2000-2018 and thyroid cancer deaths during 2000-2018 were included. Annual percent change (APC) was calculated using joinpoint regression analysis. Among 197,070 patients, female (75.6%) and white (81.0%) patients comprised the majority of cases. Papillary thyroid carcinoma (PTC) was the most common histology (89.1%). Incidence rates increased during 2000-2009 (APC 6.80, 95% confidence interval [CI 6.46 to 7.13]) and 2009-2014 (APC 2.58 [CI 1.71 to 3.47]) and then decreased during 2014-2018 (APC -2.33 [CI -3.15 to -1.51]). The incidence trends for PTC overall, localized disease, and tumors ≤1.0 cm mirrored the overall thyroid cancer trends, while incidence rates for regional disease stabilized during 2015-2018 (APC -1.65 [CI -4.09 to 0.84]). The incidence of distant disease decreased during 2015-2018 (APC -17.86 [CI -26.47 to -8.25]). The incidence of tumors ≤1.0 cm decreased (APC -5.83 [CI -7.24 to -4.40]), while the incidence of tumors 1.1-2.0 cm (APC -0.10 [CI -1.16 to 0.96]), 2.1-4.0 cm (APC 1.12 [CI -0.17 to 2.43]), and >4.0 cm (APC -1.13 [CI -4.58 to 2.45]) stabilized during the most recent 4-6 years. Incidence-based mortality increased throughout 2000-2018 (average APC 1.35 [CI 0.88 to 1.82]). Thyroid cancer incidence rates have declined since 2014. Similar declines are noted for PTC, localized disease, and tumors ≤1.0 cm, but not for tumors >2.0 cm. Incidence-based mortality rates continue to increase. These findings suggest that changing patterns in the management of thyroid nodules may have led to a decrease in diagnosis of small indolent tumors, but not more advanced tumors.
在美国，过去几十年来甲状腺癌的发病率显著上升。最近的研究表明，2013 年后甲状腺癌的发病率趋势发生了变化。本研究的主要目的是更新美国甲状腺癌发病率和死亡率趋势的数据。使用监测、流行病学和最终结果-18 癌症登记处评估甲状腺癌发病率和基于发病率的死亡率趋势。包括 2000 年至 2018 年诊断的甲状腺癌病例和 2000 年至 2018 年死于甲状腺癌的病例。使用连接点回归分析计算年度百分比变化 (APC)。在 197070 名患者中，女性 (75.6%)和白人 (81.0%)患者占多数。乳头状甲状腺癌 (PTC) 是最常见的组织学类型 (89.1%)。发病率在 2000-2009 年期间上升 (APC6.80，95%置信区间 [CI 6.46 至 7.13])，在 2009-2014 年期间上升 (APC2.58 [CI 1.71 至 3.47])，然后在 2014-2018 年期间下降 (APC-2.33 [CI-3.15 至-1.51])。总体而言，PTC、局部疾病和≤1.0cm 的肿瘤的发病率趋势与总体甲状腺癌趋势一致，而 2015-2018 年期间局部疾病的发病率稳定 (APC-1.65 [CI-4.09 至 0.84])。远处疾病的发病率在 2015-2018 年期间下降 (APC-17.86 [CI-26.47 至-8.25])。≤1.0cm 的肿瘤发病率下降 (APC-5.83 [CI-7.24 至-4.40])，而 1.1-2.0cm 的肿瘤发病率下降 (APC-0.10 [CI-1.16 至 0.96])，2.1-4.0cm 的肿瘤发病率下降 (APC1.12 [CI-0.17 至 2.43])，>4.0cm 的肿瘤发病率稳定 (APC-1.13 [CI-4.58 至 2.45])。2000-2018 年期间，基于发病率的死亡率一直上升 (平均 APC1.35 [CI 0.88 至 1.82])。自 2014 年以来，甲状腺癌的发病率有所下降。PTC、局部疾病和≤1.0cm 的肿瘤发病率也出现类似下降，但>2.0cm 的肿瘤发病率没有下降。基于发病率的死亡率继续上升。这些发现表明，甲状腺结节管理模式的变化可能导致较小惰性肿瘤的诊断减少，但不会导致更晚期的肿瘤。
