Overdiagnosis and overtreatment of thyroid cancer: A population-based temporal trend study.
Overdiagnosis and overtreatment of thyroid cancer: A population-based temporal trend study.
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DOI：
10.1371/journal.pone.0179387
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
NICER Working Group
中科院分区：
文献类型：
--
作者：
Jegerlehner S;Bulliard JL;Aujesky D;Rodondi N;Germann S;Konzelmann I;Chiolero A;NICER Working Group
在过去的几十年里，甲状腺癌发病率的增加并没有伴随着死亡率的上升，这可能反映了越来越多的惰性形式的甲状腺癌被发现，并可能助长了不必要的甲状腺切除术。因此，我们的目的是比较甲状腺癌手术干预率与甲状腺癌发病率和死亡率的近期长期趋势，以评估过度诊断和由此导致的过度治疗。我们从1998年到2012年在瑞士进行了一项基于人口的时间趋势研究。分析了所有侵袭性甲状腺癌病例、甲状腺癌死亡病例和癌症相关甲状腺切除术病例。我们计算了年龄标准化甲状腺癌发病率的变化，按组织学亚型和肿瘤分期、甲状腺癌特异性死亡率和甲状腺切除术率分层。1998年至2012年期间，甲状腺癌年龄标准化年发病率在女性中从5.9例/10万增加到11.7例/10万（年平均绝对增加：+0.43/10万/年），在男性中从2.7例/10万增加到3.9例/10万（+0.11/10万/年）。这种增加仅限于乳头状亚型，这是甲状腺癌最惰性的形式。早期发病率急剧上升，晚期发病率略有上升，甲状腺癌死亡率略有下降。年龄标准化的年度甲状腺切除术率在两性中都增加了三到四倍。我们观察到甲状腺癌的发病率大幅增加，仅限于乳头状瘤和早期肿瘤，甲状腺切除术的发病率平行增加三到四倍。死亡率略有下降。这些发现表明，在检测到的甲状腺癌中，有相当一部分被过度诊断和过度治疗。有针对性的筛查和诊断策略是必要的，以避免过度发现和不必要的治疗甲状腺癌。
The increase in incidence of thyroid cancer during the last decades without concomitant rise in mortality may reflect the growing detection of indolent forms of thyroid cancer, and may have fueled unnecessary thyroidectomies. Our aim was therefore, to compare recent secular trends in surgical intervention rate for thyroid cancer with the incidence and mortality of thyroid cancer to assess overdiagnosis and resulting overtreatment. We conducted a population-based temporal trend study in Switzerland from 1998 to 2012. All cases of invasive thyroid cancer, deaths from thyroid cancer, and cancer-related thyroidectomies were analyzed. We calculated changes in age-standardized thyroid cancer incidence rates, stratified by histologic subtype and tumor stage, thyroid cancer-specific mortality, and thyroidectomy rates. Between 1998 and 2012, the age-standardized annual incidence of thyroid cancer increased from 5.9 to 11.7 cases/100,000 among women (annual mean absolute increase: +0.43/100,000/year) and from 2.7 to 3.9 cases/100,000 among men (+0.11/100,000/year). The increase was limited to the papillary subtype, the most indolent form of thyroid cancer. The incidence of early stages increased sharply, the incidence of advanced stages increased marginally, and the mortality from thyroid cancer decreased slightly. There was a three- to four-fold increase in the age-standardized annual thyroidectomy rate in both sexes. We observed a large increase in the incidence of thyroid cancer, limited to papillary and early stage tumors, with a three- to four-fold parallel increase in thyroidectomy. The mortality slightly decreased. These findings suggest that a substantial and growing part of the detected thyroid cancers are overdiagnosed and overtreated. Targeted screening and diagnostic strategies are warranted to avoid overdetection and unnecessary treatment of thyroid cancers.