BMJ:韩国甲状腺癌的“流行”与其进行的甲状腺肿瘤筛查有关

2016-12-01 xing.T MedSci原创

目前韩国“流行”的甲状腺癌是由于在对小肿瘤检测能力提高导致的,很有可能是过度检测的结果。在对无症状的一般人群减少不必要的甲状腺超声检查上,全国协调一致的努力是必要的。

最近,顶级医学杂志BMJ上发表了一篇来自韩国国立癌症中心国家癌症研究所的Sohee Park副教授及其研究团队的文章,旨在探讨韩国甲状腺癌的“流行”是否因韩国现在进行的甲状腺肿瘤筛查导致的。 

在该研究中,研究人员通过审查具有全国代表性样本中分别在1999年、2005年和2008年被诊断为甲状腺癌患者的医疗记录。研究人员将人群按地区分层后采用系统抽样的方法从韩国全国癌症登记处随机抽取样本病例。 

该项目的参与者包括5796例甲状腺癌患者(891例在1999年被诊断,2355例在2005年被诊断和2550例在2008年被诊断)。 

主要结局指标为年龄标准化的甲状腺癌发病率和从1999年至2008年期间根据所用的甲状腺肿瘤检测方法(筛查与临床检测与非特异性检测)导致的发病率变化情况。

1999年至2008年期间,甲状腺癌发病率增加了6.4倍(95%可信区间为4.9-8.4倍),从每100,0006.4例(95%可信区间为6.2-6.6例)上升至每100,00040.7例(40.2-41.2例)。在增加的肿瘤患者中,94.4%(每100,00034.4例)患者肿瘤小于20mm,并且主要通过筛查手段来发现的。根据监测、流行病学和最终结果(SEER)进行总结分期,研究人员发现在所有增加的肿瘤患者中,97.1%的患者肿瘤为局部和区域的肿瘤。在通过临床手段发现的病例中,相比同期增加的甲状腺癌患者99.9%(每100,0006.4例)肿瘤小于20mm 

由此可见,目前韩国“流行”的甲状腺癌是由于在对小肿瘤检测能力提高导致的,很有可能是过度检测的结果。在对无症状的一般人群减少不必要的甲状腺超声检查上,需要全国协调一致的努力。 

原始出处: 

Sohee Park,et al. Association between screening and the thyroid cancer “epidemic” in South Korea: evidence from a nationwide study. BMJ.30 November 2016.

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    2017-05-24 gaoxiaoe
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    2016-12-05 doctorJiangchao

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    2016-12-05 doctorJiangchao

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    2016-12-03 忠诚向上

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