Advances in diagnostic practices affect thyroid cancer incidence in France
Advances in diagnostic practices affect thyroid cancer incidence in France
复制标题
DOI：
10.1530/eje.0.1500133
复制
发表时间：
2004-02-01
影响因子：
5.8
通讯作者：
De Vathairelo, F
中科院分区：
文献类型：
--
作者：
Leenhardt, L;Bernier, MO;De Vathairelo, F
目的：分析甲状腺疾病诊断实践的趋势，并将其与法国甲状腺癌发病率随时间的增加联系起来。（三个内分泌中心和三个核医学中心）对20名连续的甲状腺疾病患者的记录进行了研究，每个中心每5年取样一次。随着时间的推移，人口和诊断程序（甲状腺超声检查（US），放射性核素扫描，细胞学和激素测量）的特点进行了描述。手术患者和癌症患病率的变化趋势进行了分析，以及对癌症incidence.Results的做法的影响：该研究包括471例（82%女性，平均年龄46.7，范围9-84岁），提到结节性甲状腺疾病（66.7%）或甲状腺功能障碍（33.3%）。随着时间的推移，观察到US（3 - 84.8%）和细胞学实践（4.5 - 23%）显著增加，放射性核素扫描程序减少（89.4 - 49.6%）。虽然接受手术的患者比例保持不变（24.8%），但手术患者的癌症患病率从12.5%增加到37%（P = 0.006）。在根据患者临床特征分层的考克斯比例风险模型中，只有细胞学实践（无论其结果如何）与癌症的发生显著相关：相对风险（RR）= 4.4（95%置信区间（CI）：1.1 - 16; P = 0.04）。结论：从1980年至2000年，临床实践的重大演变导致法国报告的甲状腺癌增加。在衡量发病率时，必须考虑到医疗以及外科和病理做法的这种变化。
Objective: To analyse trends in diagnostic practices of thyroid diseases and to relate them to the increase in thyroid cancer incidence in France over time.Design: From 1980 to 2000, a French retrospective multicentric (three endocrinology and three nuclear medicine centres) study of thyroid diseases was conducted on 20 consecutive unselected patients' records, sampled every 5 years in each centre.Methods: Characteristics of the population and diagnosis procedures (thyroid ultrasonography (US), radionuclide scan, cytology and hormonal measurements) were described over time. Changing trends in operated patients and in cancer prevalence were analysed as well as the impact of practices on cancer incidence.Results: The study included 471 patients (82% female, mean age 46.7, range 9-84 years), referred for nodular thyroid diseases (66.7%) or thyroid dysfunctions (33.3%). A significant increase in US (3 to 84.8%) and cytological practices (4.5 to 23%), and a decrease (89.4 to 49.6%) in radionuclide scan procedures were observed over time. Although the proportion of patients undergoing surgery remained constant (24.8%), the prevalence of cancer increased among operated patients from 12.5 to 37% (P = 0.006). In a Cox's proportional hazard model stratified on the clinical characteristics of patients, only the cytological practice, regardless of its results, was significantly associated with the occurrence of cancer: relative risk (RR) = 4.4 (95% confidence interval (Cl): 1.1 - 16; P = 0.04).Conclusions: From 1980 to 2000, a major evolution in clinical practices has led to the increase in thyroid cancer reported in France. Such changes in medical, as well as in surgical and pathological, practices must be taken into account in incidence measurement.