Current status and temporal trend of disease burden of thyroid cancer in China from 1990 to 2019

Global and China burden of hormone-related cancers and risk factors, 1990-2021: results from the Global Burden of Disease Study 2021

BACKGROUND

Updated data on hormone-related cancers (HRCs) are crucial for their prevention, management, and treatment, aligning with the UN's Sustainable Development Goals. This study focuses on HRCs: breast, thyroid, uterine, ovarian, prostate, and testicular cancers. Despite their significance, comparative studies on these cancers are limited.

METHODS

Data for incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) related to HRCs were obtained from the Global Burden of Disease Study 2021. Statistical analyses were performed using R and Joinpoint Software. Age-standardized rates (ASR), percentage changes (1990-2021), annual percent change (APC) and average annual percent change (AAPC) are used to examine trends and risk factors associated with HRCs across various years, genders, and age groups, both in China and globally.

FINDINGS

In 2021, China reported 659450 incidence cases of six HRCs, including 527009 cases (95% UI: 398030, 684814) in females and 132442 cases (89701, 181113) in males, reflecting a 29.97% increase since 1990. Deaths attributed to HRCs totaled 176526, with 130281 cases (99207, 166654) among females and 46245 cases (33049, 62510) among males, marking an 11.07% increase during the same period. The age-standardized incidence rates (ASIR) for HRCs in China were 10.70 (38.19, 65.86) per 100,000 for females and 13.87(9.50, 18.71) for males, in contrast to global rates of 17.07(62.11, 72.57) for females and 39.21(35.75, 41.69) for males. Age-standardized death rates (ASDR) were 3.54(9.22, 15.50) for females and 5.86(4.16, 7.83) for males, compared to higher global ASDRs of 6.17(19.49, 22.98) and 13.73(12.06, 14.78),respectively. From 1990 to 2021, China and the global population saw significant increases in ASIR for most cancers, except global ovarian cancer (AAPC = -0.229). Female HRCs mortality, YLLs, and DALYs declined significantly, particularly for uterine cancer. Conversely, Chinese males experienced increased mortality, YLLs, and DALYs for breast and thyroid cancers. Testicular cancer prevalence increased among Chinese males (AAPC = 7.329). Specifically, female breast cancer mortality in China decreased from 2011 to 2014 (APC = -2.82). Uterine cancer mortality dropped sharply from 2011 to 2015 (APC = -7.91). Thyroid cancer mortality declined from 2000 to 2007 (APC = -3.54), while ovarian cancer mortality decreased from 2000 to 2004 (APC = -3.33). Male breast cancer incidence peaked around 2010, and testicular cancer incidence rose significantly from 2011 to 2015 (APC = 7.77). All above changes were statistically significant (P < 0.05). Regarding age distribution characteristics, female HRCs consistently peak in the 60-74 age group globally and in China, whereas male HRCs show greater variability. In this age bracket, female breast cancer incidence reaches 348.90 (270.60, 440.16) in China versus 483.55 (449.97, 516.08) globally, while uterine cancer rates are 71.74 (52.18, 99.03) in China compared to 151.71 (138.55, 163.03) worldwide. Similarly, ovarian cancer peaks at 39.29 (28.29, 51.02) in China and 69.95 (63.59, 75.55) globally. Prostate cancer incidence also peaks in this group, with rates of 121.87 (84.48, 168.23) in China contrasting sharply with 534.72 (491.27, 568.09) globally. Conversely, testicular cancer shows a distinct pattern, peaking in the younger age group of 25-44 years, with incidences of 5.95 (4.44, 7.85) in China and 19.21 (18.04, 20.56) globally. The 25-44 age group also remains significant for thyroid cancer, with incidences of 23.31 (17.01, 32.52) in China and 31.57 (27.61, 36.30) globally. In terms of risk factors, smoking contributed to an ASR of 0.22 (0.16, 0.27) deaths globally, while alcohol accounted for 0.39 (0.27, 0.54) deaths. In China, low physical activity resulted in an ASR of 0.18 (0.03, 0.33) deaths, where high BMI notably increased risks for female HRCs. Environmental factors significantly impacted global ovarian cancer, contributing 0.12 (0.06, 0.19) deaths, while smoking influenced prostate cancer mortality, with an ASR of 0.36 (0.16, 0.60) deaths.

INTERPRETATION

Our study reveals that rising incidence rates and age-specific patterns of female HRCs in China and globally are largely associated with shifts in lifestyle and dietary habits. To address this issue, it is essential to implement tailored prevention strategies for different cancer types and age groups and enhance management of risk factors, especially considering the growing burden of diseases affecting the elderly due to population aging.

The Association of Pretreatment Systemic Immune Inflammatory Response Index (SII) and Neutrophil-to-Lymphocyte Ratio (NLR) with Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma

Objective

Immunoinflammatory response can participate in the development of cancer. To investigate the relationship between pretreatment systemic immune inflammatory response index (SII), systemic inflammatory response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and lymph node metastasis in patients with papillary thyroid carcinoma (PTC).

Methods

A retrospective analysis was performed on 547 PTC patients treated in Meizhou People's Hospital from January 2018 to December 2021. Clinicopathological data were collected, including gender, age, Hashimoto's thyroiditis, maximum tumor diameter, extra-membrane infiltration, disease stage, BRAF V600E mutation, pretreatment inflammatory index levels, and lymph node metastasis. The optimal cutoff values of SII, SIRI, NLR, PLR and LMR were calculated by receiver operating characteristic (ROC) curve, and the relationship between inflammatory indexes and other clinicopathological features and lymph node metastasis was analyzed.

Results

There were 303 (55.4%) PTC patients with lymph node metastasis. The levels of SII, SIRI, NLR, and PLR in patients with lymph node metastasis were significantly higher than those in patients without lymph node metastasis, while the levels of LMR were significantly lower than those in patients without lymph node metastasis (all p<0.05). When lymph node metastasis was taken as the endpoint, the critical value of SII was 625.375, the SIRI cutoff value was 0.705, the NLR cutoff value was 1.915 (all area under the ROC curve >0.6). The results of regression logistic analysis showed that age <55 years old (OR: 1.626, 95% CI: 1.009-2.623, p=0.046), maximum tumor diameter >1cm (OR: 2.681, 95% CI: 1.819-3.952, p<0.001), BRAF V600E mutation (OR: 2.709, 95% CI: 1.542-4.759, p=0.001), SII positive (≥625.375/<625.375, OR: 2.663, 95% CI: 1.560-4.546, p<0.001), and NLR positive (≥1.915/<1.915, OR: 1.808, 95% CI: 1.118-2.923, p=0.016) were independent risk factors for lymph node metastasis of PTC.

Conclusion

Age <55 years old, maximum tumor diameter >1cm, BRAF V600E mutation, SII positive, and NLR positive were independent risk factors for lymph node metastasis in PTC.

An Improved k-Nearest Neighbor Algorithm for Recognition and Classification of Thyroid Nodules

OBJECTIVES

To complete the task of automatic recognition and classification of thyroid nodules and solve the problem of high classification error rates when the samples are imbalanced.

METHODS

An improved k-nearest neighbor (KNN) algorithm is proposed and a method for automatic thyroid nodule classification based on the improved KNN algorithm is established. In the improved KNN algorithm, we consider not only the number of class labels for various classes of data in KNNs, but also the corresponding weights. And we use the Minkowski distance measure instead of the Euclidean distance measure.

RESULTS

A total of 508 ultrasound images of thyroid nodules, including 415 benign nodules and 93 malignant nodules, were used in the paper. Experimental results show the improved KNN has 0.872549 accuracy, 0.867347 precision, 1 recall, and 0.928962 F1-score. At the same time, we also considered the influence of different distance weights, the value of k, different distance measures on the classification results.

CONCLUSIONS

A comparison result shows that our method has a better performance than the traditional KNN and other classical machine learning methods.

Ultrasound radiomics signature for predicting central lymph node metastasis in clinically node-negative papillary thyroid microcarcinoma

BACKGROUND

Whether prophylactic central lymph node dissection is necessary for patients with clinically node-negative (cN0) papillary thyroid microcarcinoma (PTMC) remains controversial. Herein, we aimed to establish an ultrasound (US) radiomics (Rad) score for assessing the probability of central lymph node metastasis (CLNM) in such patients.

METHODS

480 patients (327 in the training cohort, 153 in the validation cohort) who underwent thyroid surgery for cN0 PTMC at two institutions between January 2018 and December 2020 were included. Radiomics features were extracted from the US images. Least absolute shrinkage and selection operator logistic regression were utilized to generate a Rad score. A nomogram consisting of the Rad score and clinical factors was then constructed for the training cohort. Both cohorts assessed model performance using discrimination, calibration, and clinical usefulness.

RESULTS

Based on the six most valuable radiomics features, the Rad score was calculated for each patient. A multivariate analysis revealed that a higher Rad score (P < 0.001), younger age (P = 0.006), and presence of capsule invasion (P = 0.030) were independently associated with CLNM. A nomogram integrating these three factors demonstrated good calibration and promising clinical utility in the training and validation cohorts. The nomogram yielded areas under the curve of 0.795 (95% confidence interval [CI], 0.745-0.846) and 0.774 (95% CI, 0.696-0.852) in the training and validation cohorts, respectively.

CONCLUSIONS

The radiomics nomogram may be a clinically useful tool for the individual prediction of CLNM in patients with cN0 PTMC.

Global, regional, and national thyroid cancer age-period-cohort modeling and Bayesian predictive modeling studies: A systematic analysis of the global burden of disease study 2019

Objective

To analyze the changing trend of the global burden of thyroid cancer (TC) and its associated risk factors using data from the Global Burden of Disease study 2019 (GBD 2019).

Methods

This study utilized the GBD 2019 database to analyze the burden trend of TC in various regions and countries from 1990 to 2019, while also examining the age-period-cohort (APC) effect. Additionally, the study used Bayesian age-period-cohort (BAPC) and predictive models to forecast TC incidence up until 2030.

Results

According to data from 2019, there were 233,846.64 (95 % UI 211,636.89-252,806.55) cases of TC worldwide. The burden of TC varies among regions and countries, with higher incidence rates observed in moderate and above SDI regions. Age and gender also play a role, with incidence rates peaking in the >95 age group for men and the 70-74 age group for women. Additionally, women have a higher incidence than men. The APC model revealed that the impact of age was most significant among individuals aged 95 years and older, while it was lowest among those aged 0-14 years. Additionally, the period effect showed a relatively low risk of morbidity with a Period RR < 0 during 1990-2004 and a high relative risk of morbidity with a Period RR > 0 during 2005-2019. Furthermore, the cohort effect demonstrated that the relative risk of developing the disease was lower before 1950 and higher after 1950. Predicted values show an increasing trend in thyroid incidence over the next 30 years.

Conclusions

The findings of this study highlight the continued significance of thyroid cancer as a global public health issue. It is crucial to develop targeted interventions that address the specific risk factors associated with thyroid cancer. Furthermore, health policies should be customized and adapted to the unique needs of different regions and populations.