Kuhlen Michaela, Wellbrock Maike, Kunstreich Marina, Trübenbach Claudia, Ronckers Cecile, Redlich Antje, Erdmann Friederike
Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.
Research Group Aetiology and Inequalities in Childhood Cancer, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Thyroid. 2024 Dec;34(12):1540-1550. doi: 10.1089/thy.2024.0534. Epub 2024 Oct 30.
The increasing incidence of differentiated thyroid carcinoma (DTC) in children and adolescents has become a growing concern. This study provides the first extensive assessment of incidence patterns and temporal trends of pediatric DTC in Germany, using the best available data from the German Malignant Endocrine Tumor (MET) Registry and the German Childhood Cancer Registry (GCCR) covering a period of 25 years. We conducted a register-based incidence and time series analysis, identifying all children and adolescents diagnosed with DTC at ages 0-17 years between 1997 and 2021 in Germany, as recorded in the German MET Registry and/or the GCCR. Age-specific and age-standardized incidence rates (ASR) over time, average annual percentage changes (AAPC), and cross-tabulations were used to evaluate incidence and temporal patterns. We identified 469 DTC cases, including 85.7% papillary thyroid cancer and 9.4% follicular thyroid cancer. The average ASR for the period 1997-2021 was 1.16 per million, with higher rates in females compared with males (1.64 vs. 0.72 per million, respectively). Incidence rates increased with increasing age. The overall ASR increased from 0.84 per million in 1997-2001 to 1.48 per million in 2017-2021, with an AAPC of 3.46% [confidence interval or CI: 2.12-4.83]. The increase was most pronounced in adolescents aged 15-17 years (AAPC: 6.79% [CI: 4.43-9.19]). The proportion of incidentalomas rose from 5% in 1997-2001 to 26% in 2017-2021, yet we observed no marked shift in tumor size between symptomatic and incidental cases. Our study revealed a significant increase in pediatric DTC incidence in Germany, most pronounced among adolescents. The observation of an increasing incidence mirrors global trends and presents a complex public health challenge. While improved detection likely contributes to this trend, the stable tumor size distribution suggests that other factors are also in play. The rising detection of incidentalomas suggests enhanced diagnostic practices unrelated to symptoms of thyroid neoplasia. These findings highlight the need to carefully evaluate diagnostic and screening practices in pediatric populations.
儿童和青少年分化型甲状腺癌（DTC）发病率的不断上升已引起越来越多的关注。本研究利用德国恶性内分泌肿瘤（MET）登记处和德国儿童癌症登记处（GCCR）提供的25年最佳可用数据，首次对德国儿童DTC的发病模式和时间趋势进行了广泛评估。我们进行了基于登记处的发病率和时间序列分析，确定了1997年至2021年期间在德国被诊断为0至17岁DTC的所有儿童和青少年，这些信息记录在德国MET登记处和/或GCCR中。使用特定年龄和年龄标准化发病率（ASR）随时间的变化、平均年度百分比变化（AAPC）以及交叉表来评估发病率和时间模式。我们共识别出469例DTC病例，其中85.7%为甲状腺乳头状癌，9.4%为甲状腺滤泡状癌。1997年至2021年期间的平均ASR为每百万1.16例，女性发病率高于男性（分别为每百万1.64例和0.72例）。发病率随年龄增长而增加。总体ASR从1997 - 2001年的每百万0.84例增加到2017 - 2021年的每百万1.48例，AAPC为3.46%[置信区间或CI：2.12 - 4.83]。这种增加在15 - 17岁的青少年中最为明显（AAPC：6.79%[CI：4.43 - 9.19]）。偶然瘤的比例从1997 - 2001年的5%上升到2017 - 2021年的26%，但我们观察到有症状病例和偶然发现病例之间的肿瘤大小没有明显变化。我们的研究表明德国儿童DTC发病率显著上升，在青少年中最为明显。发病率上升的观察结果反映了全球趋势，并带来了复杂的公共卫生挑战。虽然检测手段的改进可能促成了这一趋势，但肿瘤大小分布稳定表明还有其他因素在起作用。偶然瘤检出率的上升表明与甲状腺肿瘤症状无关的诊断方法有所改进。这些发现凸显了仔细评估儿科人群诊断和筛查做法的必要性。
