Delisle M J, Schvartz C, Theobald S, Maes B, Vaudrey C, Pochart J M
Service de Médecine Nucléaire, Institut Jean Godinot, Reims.
Ann Endocrinol (Paris). 1996;57(1):41-9.
Since 1966, data from 1536 patients with a thyroid carcinoma, living in the French region Champagne-Ardenne, a geographical area with 1,350,000 inhabitants were registered. The creation of a multidisciplinary group and the involvement of the general practitioners, allowed us to reach an exhaustive and continued registration process for the French administrative area of Marne and Ardennes (855,000 inhibitants, 627 patients). The sex-ratio F/M was 3.8 and the median ages were respectively equal to 46 [10-93] and 52 [13-82] in females and males. In the age groups 10-14 and 15-19, 3 cases and 13 cases were respectively registered. An history of external irradiation was noted in 2.9% of the patients. The study of the incidence around the Chooz nuclear plant (Ardennes) did not show an increase of the risk. For the French administrative area Marne and Ardennes, for the period 1975-1979, the incidence rates, standardized on the European population, were equal to 1.75/100,000 in males (SD = 0.15) and 6.38/100,000 (SD = 0.29) in females. These values among the highest from the data published by the other European registries should be explained by a more intensive diagnosis procedure and an improvement in the accuracy of histological diagnosis. An increase of the incidence rate was observed between the periods 1975-1983 and 1984-1992 from 1.04 to 2.05/100,000 and 4.99 to 6.39/100,000 in males and females respectively. This was associated with changes in clinical and histological features and an improvement in survival curves. For patients under the age of 19, we have compared both periods before and after the accident of Chernobyl. The incidence rates increased from 0.13 to 0.45/100,000 and 0.49 to 1.81/100,000 in the age groups 10-14 and 15-19 respectively. This change was at the order of magnitude to this observed in our adults population. We did not found the histological aggressiveness which characterized the Chernobyl-induced thyroid cancer in children. The knowledge of the significant prognostic factors determined by multifactorial analyses is a major foundation of our therapeutic strategy.
自1966年以来，对居住在法国香槟-阿登大区（一个拥有135万居民的地理区域）的1536例甲状腺癌患者的数据进行了登记。多学科团队的组建以及全科医生的参与，使我们能够对法国马恩省和阿登省行政区（85.5万居民，627例患者）进行详尽且持续的登记工作。女性与男性的性别比为3.8，女性和男性的年龄中位数分别为46岁[10 - 93岁]和52岁[13 - 82岁]。在10 - 14岁和15 - 19岁年龄组中，分别登记了3例和13例。2.9%的患者有外部照射史。对舒兹核电站（位于阿登省）周边地区发病率的研究未显示风险增加。对于法国马恩省和阿登省行政区，在1975 - 1979年期间，经欧洲人口标准化后的发病率，男性为1.75/10万（标准差 = 0.15），女性为6.38/10万（标准差 = 0.29）。这些数值在其他欧洲登记处公布的数据中处于较高水平，这应归因于诊断程序更加密集以及组织学诊断准确性的提高。在1975 - 1983年和1984 - 1992年期间，男性和女性的发病率分别从1.04/10万增至2.05/10万以及从4.99/10万增至6.39/10万。这与临床和组织学特征的变化以及生存曲线的改善相关。对于19岁以下的患者，我们比较了切尔诺贝利事故前后两个时期。10 - 14岁和15 - 19岁年龄组的发病率分别从0.13/10万增至0.45/10万以及从0.49/10万增至1.81/10万。这种变化与我们在成年人群中观察到的情况处于同一数量级。我们未发现切尔诺贝利事故导致的儿童甲状腺癌所具有的组织学侵袭性特征。通过多因素分析确定的显著预后因素的知识是我们治疗策略的主要基础。
