中国与美国分化型甲状腺癌的临床病理和外科治疗比较：一项多中心基于医院的研究。
Clinicopathological and surgical comparisons of differentiated thyroid cancer between China and the USA: A multicentered hospital-based study.
机构信息
Office of National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cancer Prevention, Institute of Cancer and Basic Medicine (IBMC), The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Chinese Academy of Sciences, Hangzhou, China.
出版信息
Front Public Health. 2022 Sep 28;10:974359. doi: 10.3389/fpubh.2022.974359. eCollection 2022.
BACKGROUND
Thyroid cancer (TC), was the fastest-rising tumor of all malignancies in the world and China, predominantly differentiated thyroid cancer (DTC). However, evidence on TC stage distribution and influencing factors of late-stage were limited in China.
METHODS
We carried out a retrospective study and enrolled TC patients who were first diagnosed and hospitalized in 8 hospitals in China in 2017. Logistic regression was used to evaluate associations between influencing factors and DTC stage. We extracted eligible primary DTC records newly diagnosed in 2017 from the USA's Surveillance, Epidemiology, and End Results (SEER) database. We compared clinicopathological features and surgical treatment between our DTC records and those from the SEER database.
RESULTS
A total of 1970 eligible patients were included, with 1861 DTC patients with known stage. Among patients ≥45 years old, males (OR = 1.76, 95%CI 1.17-2.65) and those with new rural cooperative medical scheme insurance (NCMS) (OR = 1.99, 95%CI 1.38-2.88) had higher risks of late-stage DTC (stage III-IV). Compared with SEER database, over-diagnosis is more common in China [more DTC patients with onset age< 45 years old (50.3 vs. 40.7%, < 0.001), with early-stage (81.2 vs. 76.0%, < 0.001), and with tumors<2cm (74.9 vs. 63.7%, < 0.001)]. Compared with the USA, TC treatment is more conservative in China. The proportion of lobectomy in our database was significantly higher than that in the SEER database (41.3 vs. 17.0%, < 0.001).
CONCLUSIONS
Unique risk factors are found to be associated with late-stage DTC in China. The differences in the aspect of clinicopathological features and surgical approaches between China and the USA indicate that potential over-diagnosis and over-surgery exist, and disparities on surgery extent may need further consideration. The findings provided references for other countries with similar patterns.
背景
甲状腺癌（TC）是全球和中国所有恶性肿瘤中增长最快的肿瘤，主要为分化型甲状腺癌（DTC）。然而，中国关于 TC 分期分布和晚期影响因素的证据有限。
方法
我们进行了一项回顾性研究，纳入了 2017 年在中国 8 家医院首次诊断和住院的 TC 患者。使用逻辑回归评估影响因素与 DTC 分期之间的关系。我们从美国监测、流行病学和最终结果（SEER）数据库中提取了 2017 年新诊断的合格原发性 DTC 记录。我们比较了我们的 DTC 记录和 SEER 数据库中的临床病理特征和手术治疗。
结果
共纳入 1970 例合格患者，其中 1861 例 DTC 患者分期明确。在年龄≥45 岁的患者中，男性（OR=1.76，95%CI 1.17-2.65）和新型农村合作医疗（NCMS）患者（OR=1.99，95%CI 1.38-2.88）患晚期 DTC（III-IV 期）的风险更高。与 SEER 数据库相比，中国更常见过度诊断[更多发病年龄<45 岁的 DTC 患者（50.3%比 40.7%，<0.001），早期（81.2%比 76.0%，<0.001），肿瘤<2cm（74.9%比 63.7%，<0.001）]。与美国相比，中国的 TC 治疗更为保守。我们数据库中 lobectomy 的比例明显高于 SEER 数据库（41.3%比 17.0%，<0.001）。
结论
在中国，发现了与晚期 DTC 相关的独特危险因素。中国和美国在临床病理特征和手术方法方面的差异表明存在潜在的过度诊断和过度手术，手术范围的差异可能需要进一步考虑。研究结果为其他具有类似模式的国家提供了参考。
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