Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Goyang, Korea.
Endocrinol Metab (Seoul). 2023 Feb;38(1):81-92. doi: 10.3803/EnM.2023.1668. Epub 2023 Feb 27.
The true benefit of thyroid cancer screening is incompletely understood. This study investigated the impact of ultrasound screening on thyroid cancer outcomes through a comparison with symptomatic thyroid cancer using data from a nationwide cohort study in Korea.
Cox regression analysis was performed to assess the hazard ratios (HRs) for all-cause and thyroid cancer-specific mortality. Considering the possible bias arising from age, sex, year of thyroid cancer registration, and confounding factors for mortality (including smoking/drinking status, diabetes, and hypertension), all analyses were conducted with stabilized inverse probability of treatment weighting (IPTW) according to the route of detection.
Of 5,796 patients with thyroid cancer, 4,145 were included and 1,651 were excluded due to insufficient data. In comparison with the screening group, the clinical suspicion group was associated with large tumors (17.2±14.6 mm vs. 10.4±7.9 mm), advanced T stage (3-4) (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.09 to 1.41), extrathyroidal extension (OR, 1.16; 95% CI, 1.02 to 1.32), and advanced stage (III-IV) (OR, 1.16; 95% CI, 1.00 to 1.35). In IPTW-adjusted Cox regression analysis, the clinical suspicion group had significantly higher risks of all-cause mortality (HR, 1.43; 95% CI, 1.14 to 1.80) and thyroid cancer-specific mortality (HR, 3.07; 95% CI, 1.77 to 5.29). Mediation analysis showed that the presence of thyroid-specific symptoms was directly associated with a higher risk of cancer-specific mortality. Thyroid-specific symptoms also indirectly affected thyroid cancer-specific mortality, mediated by tumor size and advanced clinicopathologic status.
Our findings provide important evidence for the survival benefit of early detection of thyroid cancer compared to symptomatic thyroid cancer.
甲状腺癌筛查的真正获益尚未完全明确。本研究通过与韩国全国性队列研究中的症状性甲状腺癌进行比较，利用数据探讨了超声筛查对甲状腺癌结局的影响。
采用 Cox 回归分析评估全因死亡率和甲状腺癌特异性死亡率的风险比（HR）。考虑到年龄、性别、甲状腺癌登记年份和死亡率的混杂因素（包括吸烟/饮酒状态、糖尿病和高血压）可能产生的偏倚，所有分析均根据检测途径采用稳定的逆概率治疗加权（IPTW）进行。
在 5796 例甲状腺癌患者中，纳入 4145 例，因数据不足排除 1651 例。与筛查组相比，临床疑诊组肿瘤较大（17.2±14.6mm 比 10.4±7.9mm），T 分期较晚（3-4 期）（比值比[OR]，1.24；95%置信区间[CI]，1.09 至 1.41）、甲状腺外侵犯（OR，1.16；95%CI，1.02 至 1.32）和较晚分期（III-IV 期）（OR，1.16；95%CI，1.00 至 1.35）。在 IPTW 校正的 Cox 回归分析中，临床疑诊组全因死亡率（HR，1.43；95%CI，1.14 至 1.80）和甲状腺癌特异性死亡率（HR，3.07；95%CI，1.77 至 5.29）的风险显著更高。中介分析显示，甲状腺特异性症状的存在与癌症特异性死亡率的升高直接相关。甲状腺特异性症状还通过肿瘤大小和较晚的临床病理分期间接影响甲状腺癌特异性死亡率。
本研究结果为与症状性甲状腺癌相比，甲状腺癌的早期发现对生存获益提供了重要证据。
