2019年7月[JAMA Otolaryngol Head Neck Surg.]杂志在线发表了来自加利福尼亚州斯坦福市斯坦福大学医学院耳鼻咽喉-头颈外科科，加利福尼亚州斯坦福市Lucile Packard儿童医院，斯坦福儿童保健中心儿童甲状腺中心
[Kara D. Meister]等学者的论著文章揭示1973-2013年美国小儿甲状腺癌的发病率和死亡率趋势。
重要性：
甲状腺癌的发病率每年增加3％。人们通常认为这种增加是由于成年人的过度诊断所致。先前的研究报道小儿甲状腺癌的发病率每年增加1.1％。但是，该分析仅限于1973年至2004年，并且是以线性方式进行的，这不能说明发病率趋势随时间的变化。
目的
根据诊断时的人口统计学和肿瘤特征分析小儿甲状腺癌发病率趋势。
设计，设置和参加者
这项横断面研究纳入了从1973年至2013年在监测，流行病学和最终结果（SEER）数据库中诊断为甲状腺癌的20岁以下的个体。使用《国际疾病分类》确定了甲状腺癌的病例肿瘤学，第三版，按组织学类型，分期和肿瘤大小分类。
主要成果和措施
使用 joinpoint regression analysis计算发病率的年百分比变化Annual percent change (APC) 。
结果
在分析的1806名患者中，女性为1454名（80.5％），白人为1503名（83.2％）。大多数患者年龄在15至19岁之间。甲状腺癌的总发病率从1973年的每100000人年0.48每年增加到2013年的每100000人年1.14的每年。发病率从1973年到2006年逐渐增加（APC，1.11％； 95％CI，0.56％ -1.67％），然后从2006年到2013年显着增长（APC，9.56％； 95％CI，5.09％-14.22％）。大肿瘤（> 20 mm）的发病率从1983年至2006年逐渐增加（APC，2.23％; 95％CI，0.93％-3.54％），然后从2006年至2013年显着增加（APC，8.84％; 95％CI ，3.20％-14.79％）；这些比率与小肿瘤（1-20毫米）的发生率没有显着差异。从1973年到2006年，区域性甲状腺癌的发病率逐渐增加（APC，1.44％; 95％CI，0.68％-2.21％），然后从2006年至2013年显着增加（APC，11.16％; 95％CI，5.26％ -17.40％）;这些发生率与局部疾病的发生率没有显着差异。
结论和相关性
2006年至2013年，儿科甲状腺癌的发病率比1973年至2006年增长更快。研究结果表明，除了提高检测率外，儿科人群中甲状腺癌可能同时发生。
Key Points
Question What are the trends in US pediatric thyroid cancer incidence rates?
Findings In this cross-sectional study of 1806 pediatric patients with thyroid cancer diagnosed from 1973 to 2013, the annual percent change in pediatric thyroid cancer incidence increased from 1.1% per year from 1973 to 2006 to 9.5% per year from 2006 to 2013.
Meaning The findings suggest that the marked increase in pediatric thyroid cancer between 2006 and 2013 was not solely attributable to enhanced detection.
Abstract
Importance The incidence of thyroid cancer is increasing by 3% annually. This increase is often thought to be attributable to overdiagnosis in adults. A previous study reported a 1.1% annual increase in the incidence of pediatric thyroid cancer. However, the analysis was limited to the period from 1973 to 2004 and was performed in a linear fashion, which does not account for changes in incidence trends over time.
Objective To analyze trends in pediatric thyroid cancer incidence based on demographic and tumor characteristics at diagnosis.
Design, Setting, and Participants This cross-sectional study included individuals younger than 20 years who had a diagnosis of thyroid cancer in the Surveillance, Epidemiology, and End Results (SEER) 9 database from 1973 to 2013. Cases of thyroid cancer were identified using the International Classification of Diseases for Oncology, Third Edition and were categorized by histologic type, stage, and tumor size.
Main Outcomes and Measures Annual percent change (APC) in the incidence rates was calculated using joinpoint regression analysis.
Results Among 1806 patients included in the analysis, 1454 (80.5%) were female and 1503 (83.2%) were white; most patients were aged 15 to 19 years. The overall incidence rates of thyroid cancer increased annually from 0.48 per 100 000 person-years in 1973 to 1.14 per 100 000 person-years in 2013. Incidence rates gradually increased from 1973 to 2006 (APC, 1.11%; 95% CI, 0.56%-1.67%) and then markedly increased from 2006 to 2013 (APC, 9.56%; 95% CI, 5.09%-14.22%). The incidence rates of large tumors (>20 mm) gradually increased from 1983 to 2006 (APC, 2.23%; 95% CI, 0.93%-3.54%) and then markedly increased from 2006 to 2013 (APC, 8.84%; 95% CI, 3.20%-14.79%); these rates were not significantly different from incidence rates of small (1-20 mm) tumors. The incidence rates of regionally extended thyroid cancer gradually increased from 1973 to 2006 (APC, 1.44%; 95% CI, 0.68%-2.21%) and then markedly increased from 2006 to 2013 (APC, 11.16%; 95% CI, 5.26%-17.40%); these rates were not significantly different from the incidence rates of localized disease.
Conclusions and Relevance The incidence rates of pediatric thyroid cancer increased more rapidly from 2006 to 2013 than from 1973 to 2006. The findings suggest that there may be a co-occurring increase in thyroid cancer in the pediatric population in addition to enhanced detection.
