Incidence and mortality of thyroid cancer in 50 countries: a joinpoint regression analysis of global trends

Exploring temporal trends and influencing factors for thyroid cancer in Guangzhou, China: 2004-2018

PURPOSE

Describe and analyze the trends of thyroid cancer incidence and mortality in Guangzhou, explore the potential influencing factors, and provide evidence for the government to formulate prevention and treatment measures.

METHODS

Incident and death cases of thyroid cancer were retrieved from the Guangzhou cancer registry. The joinpoint regression models were used to estimate the incidence and mortality trends. Age-period-cohort models were used to estimate the age, period, and cohort effects on the time trends. Grey correlation analysis was performed to explore possible connections between thyroid cancer and social factors.

RESULTS

A total of 15,955 new cases of thyroid cancer were registered in Guangzhou during 2004-2018, the age-standardized incidence rate (ASIR) of thyroid cancer increased from 4.29/105 in 2004 to 22.36/105 in 2018, with the average annual percentage change (AAPC) of 13.40%. The overall increase can be attributed to the increase in the incidence of papillary thyroid carcinoma (PTC), which was dominated by tumors <2 cm. The ASIR was higher in women (16.12/105) compared to men (5.46/105), and young and middle-aged individuals had higher incidence rates than older people. The number of thyroid cancer deaths registered between 2010 and 2018 was 356, and the age-standardized mortality rates (ASMRs) were stable (approximately 0.42/105). Men's ASMR (0.34/105) and women's (0.49/105) were similar, and those 60 and older had greater mortality. The period and cohort relative risks showed an overall increasing trend. Furthermore, there was a strong positive correlation between the ASIRs and social determinants.

CONCLUSIONS

During the study period, the incidence rate of thyroid cancer among young and middle-aged people in Guangzhou showed a rapidly increasing trend, and the mortality was relatively stable. In the future, more effective preventive measures should be taken for this age group to reduce the burden of disease and avoid overdiagnosis.

Association Between a History of Breast Cancer and Decreased Thyroid Cancer-specific Mortality

CONTEXT

The clinical relevance of the well-known association between thyroid cancer (TC) and breast cancer (BC) remains to be further defined.

OBJECTIVE

This work aimed to investigate the effect of history of BC on the prognosis of TC.

METHODS

This was a comparative cohort study of tumor behaviors and TC-specific mortality in 5598 patients with papillary thyroid cancer (PTC) and 604 patients with follicular thyroid cancer (FTC), all with a history of BC (TC-BC patients), and their propensity score-matched TC patients without a history of BC (TCnoBC patients) in Surveillance, Epidemiology and End Results (SEER) 18. The main outcome measure was TC-specific mortality.

RESULTS

Lower TC distant metastasis rates of 2.4% vs 3.0% in PTC and 6.1% vs 9.1% in FTC and TC-specific mortality rates of 1.3% vs 2.6% in PTC and 5.8% vs 8.4% in FTC were found in TC-BC patients vs matched TCnoBC patients (all P < .05). Comparing TC-BC patients with matched TCnoBC patients, hazard ratios (HRs) for mortality were 0.472 (95% CI, 0.370-0.601) in PTC and 0.656 (95% CI, 0.461-0.934) in FTC (all P < .05). Such HRs for mortality in PTC were 0.397 (95% CI, 0.268-0.588; P < .001) when TC occurred before BC vs 0.607 (95% CI, 0.445-0.827; P = .002) when BC occurred before TC.

CONCLUSION

This study demonstrates a robust protective effect of a history of BC on TC-specific patient survival, which has strong implications for more precise prognostication of TC in such patients.

Age- and Race-Specific Changes in ESKD Incidence over Four Decades

SIGNIFICANCE STATEMENT

ESKD incidence has changed substantially in the past four decades, but differences by age and race have been unexplored. Using data from the United States Renal Data System, we found that ESKD incidence rose for Black and White teenagers, adults, and older adults for two decades beginning in 1980. Growth in incidence slowed for most groups by 1993, and by 2006, the annual percent change (APC) in ESKD incidence had declined for all groups, except White adults, for whom rates continued to rise. By 2019, ESKD incidence among Black and White adolescents nearly returned to 1980 levels, but no other group achieved that degree of improvement. Nonetheless, the ESKD incidence rate among Black American patients exceeds that of White patients in every age group. Distinct patterns in ESKD incidence among patients of different age, sex, and racial groups are shown. These findings could reflect changes in dialysis acceptance rates, access to preventive health care, incidence of diabetes mellitus, implementation of evidence-based guidelines for treatment of CKD, or other unrecognized factors. There may be population-specific opportunities to change the growth of the US ESKD population and address current racial disparities.

BACKGROUND

Substantial changes in ESKD incidence over four decades among Black and White Americans of different ages have been incompletely explored.

METHODS

We analyzed United States Renal Data System data from 1980 to 2019 to determine ESKD incidence trends among Black and White adolescent (13-17 years), adult (18-64 years), and older adult (≥65) populations. We used the National Cancer Institute Joinpoint Regression Program to estimate annual percent change (APC) in ESKD incidence and to define points in time where a statistically significant change in APC slope occurred for each group.

RESULTS

ESKD incidence rose after 1980 for all groups, although the trends differed ( P < 0.001). Growth in incidence slowed for most by 1993, and by 2006, the APC in ESKD incidence had declined for all groups, except White adults, for whom rates continued to rise ( P < 0.05). By 2019, ESKD incidence among Black and White adolescents nearly returned to 1980 levels, but no other group achieved that degree of improvement. Nonetheless, the ESKD incidence among Black American patients exceeds that of White patients in every age group.

CONCLUSIONS

Distinct patterns in ESKD incidence among patients of different age, sex, and racial groups are shown. These findings could reflect changes in dialysis acceptance rates, access to preventive health care, incidence of diabetes mellitus, implementation of evidence-based guidelines for treatment of CKD, or other unrecognized factors.

PODCAST

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ATA risk stratification in papillary thyroid microcarcinoma has low positive predictive value when identifying recurrence

BACKGROUND

Rising incidence of papillary thyroid microcarcinomas (PTMC) has raised concerns for overdiagnosis. Utility of the American Thyroid Association Risk Stratification System (ATA-RSS) 2015 in predicting risk of disease recurrence in patients with PTMC was assessed.

METHODS

Electronic health records of patients who underwent total thyroidectomy were queried. ATA-RSS 2015 risk stratification was performed on those with PTMC, and validity for predicting disease recurrence was calculated.

RESULTS

With 10-year median follow up, recurrence was higher in PTMC patients with high/intermediate vs low ATA risk (33 ​% vs 4 ​%, p ​= ​0.002). Sensitivity of ATA-RSS for detecting recurrence was 60 ​%, specificity 90 ​%, PPV 33.3 ​%, NPV 96.6 ​%, and accuracy 88 ​%. When microscopic extrathyroidal extension (ETE) was excluded as an intermediate risk criterion, PPV improved to 50 ​% and accuracy improved to 92.5 ​% CONCLUSIONS: ATA-RSS 2015 predicts recurrence in PTMC with high NPV but low PPV. Exclusion of microscopic ETE improved PPV, which may help prevent overtreatment.

Pathogenesis and signaling pathways related to iodine-refractory differentiated thyroid cancer

Thyroid cancer is the most common malignant neoplasm within the endocrine system and the field of head and neck surgery. Although the majority of thyroid cancers, more than 90%, are well-differentiated thyroid carcinomas with a favourable prognosis, the escalating incidence of this disease has contributed to an increasing number of patients with a propensity for recurrent disease, rapid disease progression, and poor or no response to conventional treatments. These clinical challenges are commonly attributed to alterations in key thyroid oncogenes or signaling pathways, thereby initiating tumour cell dedifferentiation events, accompanied by reduced or virtually absent expression of the sodium/iodine symporter (NIS). As a result, the disease evolves into iodine-refractory differentiated thyroid cancer (RAIR-DTC), an entity that is insensitive to conventional radioiodine therapy. Despite being classified as a differentiated thyroid cancer, RAIR-DTC has an extremely poor clinical prognosis, with a 10-year survival rate of less than 10%. Therefore, it is of paramount importance to comprehensively elucidate the underlying pathogenesis of RAIR-DTC and provide specific targeted interventions. As the pathogenic mechanisms of RAIR-DTC remain elusive, here we aim to review recent advances in understanding the pathogenesis of RAIR-DTC and provide valuable insights for the development of future molecularly targeted therapeutic approaches.

Geriatric Importance of Histopathological Parameters Evaluated in Thyroidectomy Specimens: A Single Center Retrospective Analysis

Nowadays, the aging human population exerts a notable influence on the treatment of thyroid diseases. The most appropriate approach for the treatment of benign and malignant thyroid diseases in older adults has not yet been determined. The aim of our study is to evaluate the effect of thyroidectomies in geriatric patients considering age, sex and histopathological parameters and to determine the importance of thyroidectomy as a treatment option in the geriatric population. A total of 910 cases from all age groups were included, for which thyroidectomies were examined and reported. In accordance with the College of American Pathologists Cancer Protocol for thyroid reporting, considering geriatric patients, the rate of Thyroid Follicular Nodular Disease was significantly higher among the tumor types in the benign tumor group (p = 0.033), while Anaplastic Thyroid Carcinoma rate was higher in the malignant tumor group. The diagnosis rate of malignant tumors was higher in males, reflecting a more advanced pT stage (p < 0.001), larger tumor size (p < 0.001) and increased lymph node involvement rate (p = 0.039). Given that increasing age is associated with a heightened incidence of thyroid disease, the safety of surgery for geriatric patients is an important issue. Thyroidectomy should be considered in the treatment of these patients, especially in males, as the rate of malignant diagnosis and worse histopathological parameters are seen with increasing age.

Quality of Life in Chinese Youth Following Open Thyroid Surgery: A Qualitative Study

BACKGROUND

Because of the increased incidence of thyroid cancer and good survival rates and with research into scarless techniques, it is increasingly important to understand the quality of life of thyroid cancer patients and identify areas for improvement. Therefore, it is necessary to explore the importance of neck appearance after thyroidectomy for thyroid cancer survivors in China.

OBJECTIVE

The purpose of this study was to investigate the effect of scarring after open thyroid surgery on the quality of life of young patients.

METHODS

A descriptive qualitative design was used. Data were collected using face-to-face semistructured interviews and analyzed using directed content analysis.

RESULTS

Five men and 19 women participated in the study. The following 3 broad themes and 9 subthemes emerged, which were (1) emotional functioning, including low self-esteem due to high visibility of scars, concerns and helplessness about scarring lesions, and feelings of isolation due to lack of support; (2) social functioning, including restricted choice of employment, avoidance of socializing with others, and reduced participation in social activities; and (3) information seeking, acceptance, and living with the scar, including bargaining, seeking professional help, and use of social media.

CONCLUSIONS

After open surgery for thyroid cancer, patients experience a variety of scarring features that affect their quality of life. Therefore, preoperative communication and long-term postoperative care should be emphasized in clinical practice and research.

IMPLICATIONS FOR PRACTICE

Understanding the experience of carrying scars after thyroid cancer surgery helps provide adequate information, expectation management, and informed decision-making.

Causal analysis of the gut microbiota in differentiated thyroid carcinoma: a two-sample Mendelian randomization study

Objective: Numerous studies have highlighted an association between the gut microbiota (GM) and thyroid tumors. Employing Mendelian randomization methodology, we seek to elucidate the causal link between the gut microbiota and thyroid neoplasms. Methods: We procured data from the Mibiogen database encompassing 211 distinct gut microbiota taxa, alongside extensive genome-wide association studies (GWAS) summary data for differentiated thyroid carcinoma (DTC). Our principal analytical approach involved the application of the Inverse-Variance Weighted method (IVW) within the framework of Mendelian randomization. Simultaneously, we conducted sensitivity analyses to assess result heterogeneity, horizontal pleiotropy, and outcome stability. Results: IVW analysis revealed a dual role of the GM in thyroid carcinoma. The phylum Actinobacteria (OR, 0.249 [95% CI, 0.121-0.515]; p < 0.001) was associated with a decreased risk of DTC. Conversely, the genus Ruminiclostridium9 (OR, 11.276 [95% CI, 4.406-28.860]; p < 0.001), class Mollicutes (OR, 5.902 [95% CI, 1.768-19.699]; p = 0.004), genus RuminococcaceaeUCG004 (OR, 3.831 [95% CI, 1.516-9.683]; p = 0.005), genus Paraprevotella (OR, 3.536 [95% CI, 1.330-9.401]; p = 0.011), and phylum Tenericutes (OR, 5.902 [95% CI, 1.768-19.699]; p = 0.004) were associated with an increased risk of DTC. Conclusion: Our findings underscore that the presence of genus Ruminiclostridium9, class Mollicutes, genus RuminococcaceaeUCG004, genus Paraprevotella, and phylum Tenericutes is associated with an elevated risk of DTC, whereas the presence of the phylum Actinobacteria is linked to a decreased risk. These discoveries enhance our comprehension of the relationship between the GM and DTC.

Knowledge mapping of immunotherapy for thyroid cancer from 1980 to 2022: A review

With the gradual development of immunotherapy for thyroid cancer, relevant research has increased. To better understand the current situation, development trend, evolution process, and research hotspots of this field, we conducted this comprehensive bibliometrics visual analysis. We retrieved papers published from 1980 to 2022 from Web of Science Core Collection on January 31, 2023. CiteSpace, Pajek, VOSviewer, R-Bibliometrix, and Scimago Graphics are the tools to perform the analysis. Analysis methods mainly include co-occurrence analysis and cluster analysis. Analysis objects are countries or regions, institutions, authors, journals, and keywords, etc. In terms of publication number, the recent decade has witnessed rapid growth. USA was the most prolific country and has the most influence in the cooperation team. Sweden took the lead in focus on this research field and lasted for 21 years. Garden State Cancer Center was released most papers (28). INSERM played a major role in institutional cooperation. Goldenberg DM published the most papers (48), with H-Index 25 and G-Index 43. Journal of Nuclear Medicine has the greatest papers published (41). The average impactor factor of the top 10 journals is 7.2058. The top keywords with high burst strength are: radioimmunotherapy (14.85), monoclonal antibody (13.78), non hodgkins lymphoma (12.54). The research field of immunotherapy for thyroid cancer will be further developed. This study provides a valuable reference for future research in the field.

The impact of multifocality on lateral lymph node metastasis in papillary thyroid carcinoma

PURPOSE

Multifocality is a common feature of papillary thyroid carcinoma (PTC) and is strongly associated with unfavorable outcome, but its association with lateral lymph node metastasis (lateral LNM) remains unclear.

METHODS

The association between tumor foci numbers and lateral LNM was assessed with unadjusted and adjusted logistic regression. Propensity score matching analysis was used to investigate the impact of tumor foci numbers on lateral LNM.

RESULTS

Increasing tumor foci numbers was strongly associated with a higher risk of lateral LNM (P < 0.05). After adjusting for several confounding factors, ≥4 tumor foci can be regarded as an independent predictor of lateral LNM (multivariable adjusted OR = 1.848, P = 0.011). Similarly, compared with solitary foci, multifocality was associated with a significantly higher risk of lateral LNM after matching propensity scores (11.9% vs. 14.4%, P = 0.018), especially for patients with ≥4 tumor foci (11.2% vs. 23.4%; P = 0.001). Furthermore, age-stratified analyses revealed multifocality was significantly positively correlated with lateral LNM in younger patients (P = 0.013) compared with older patient cohorts (P = 0.669).

CONCLUSIONS

Overall, tumor foci numbers significantly increased the risk of lateral LNM in PTCs, especially for patients with four or more tumor foci, and patient's age should be considered when interpreting the multifocality and risk of lateral LNM.

Warthin-like papillary thyroid carcinoma: a case report and comprehensive review of the literature

Background

Papillary Thyroid Carcinoma (PTC) is the most frequent endocrine malignancy with a variety of histological presentations. Warthin-like Papillary Thyroid Carcinoma (WLPTC) is an uncommon neoplasm that is recognized as a distinct subtype of PTC in the WHO classification of thyroid tumors. In this report, we present a novel case of WLPTC in a female patient and provide an in-depth review of the available literature on its clinical, pathological, and therapeutic characteristics.

Case presentation

A 27-year-old female patient was referred for neck swelling. Ultrasound showed two suspicious thyroid nodules leading to a thyroidectomy. She was diagnosed with intermediate-risk bifocal foci of classic PTC and WLPTC, arising from a background of chronic lymphocytic thyroiditis (CLT). This pT1b(m) N1b M0 malignancy was treated with adjuvant isotopic ablation and suppressive thyroxine therapy. The 1-year outcomes were favorable.

Literature review

It covered articles published from 1995 to 2022, by searching PubMed and Google Scholar using specific terms. Out of 148 articles reviewed by two authors, 25 relevant articles were selected, including 13 case reports and 12 case series. The study included 150 cases of WLPTC. Data related to clinical presentation, imaging, histological features, management, and outcomes, were extracted. The mean age of diagnosis was 39 years, with a female predominance. The most common clinical presentation was neck swelling. Thyroid autoimmunity was positive in 71.6% of patients. Lymph node metastases were present in 28% of cases, with no reported distant metastases. Overall, the outcomes were favorable.

Conclusion

WLPTC shares similar clinical and radiological presentations as classic PTC. The hallmark histological features of WLPTC are papillae lined with oncocytic tumor cells with papillary nuclear changes and lymphoid stroma. WLPTC is almost constantly associated with CLT. The management of WLPTC aligns with that of classic PTC with comparable stage and risk category, often resulting in favorable outcomes.

Ultrasound, laboratory and histopathological insights in diagnosing papillary thyroid carcinoma in a paediatric population: a single centre follow-up study between 2000-2022

Background

Papillary thyroid carcinoma (PTC) often coincides with autoimmune thyroiditis (AIT); whether this association is incidental or causal remains debated.

Objective

To evaluate the ultrasonographic, laboratory, and histopathological features of PTC in paediatric patients with and without AIT and its relationship to puberty.

Design

A retrospective cohort study.

Patients and methods

A retrospective analysis of medical records of 90 patients (69; 76.7% females). The mean age at PTC diagnosis was 13.8 years [range 6-18]. All patients were evaluated ultrasonographically before thyroid surgery. Thyroid nodules were categorised using the European Thyroid Imaging Reporting and Data System (EU-TIRADS PL), and cytopathology was assessed using Bethesda criteria. Neck ultrasound results and thyroid and autoimmune status were correlated with histopathological PTC assessment.

Results

The coexistence of PTC and AIT was found in 48.9% (44/90) of patients. The percentage of AIT was increasing with age; AIT was present only in 1/3 of prepubertal, close to 50% in pubertal, and over 60% in adolescent patients. The youngest patients (aged <10 years old) presented more often with goitre and lymphadenopathy and less often with AIT than adolescents (15-18 years of age). There were no differences in TPOAb, TgAb, and TSH levels between the age subgroups. Presurgical TgAb levels were higher than those of TPOAb in the youngest patients. Histopathological analysis revealed that the solid subtype was observed more often in prepubertal children and diffuse sclerosing in children below 14 years of age, whereas the classic subtype dominated in late pubertal. Univariate and multivariate analyses revealed that lymph nodes metastases (LNM) were associated with PTC diameter and fT4 level, whereas extrathyroidal extension with age and angioinvasion with PTC diameter and age. The correlations between age and fibrosis, and the presence of psammoma bodies in malignant tissues were close to significant. We did not observe an association between TSH levels and the presence of autoimmunity and PTC variables.

Conclusions

In paediatric patients the natural course of PTC may be less aggressive in adolescent patients than in younger children (especially < 10 years of age). We suggest that pre-operative evaluation of paediatric patients with thyroid nodules could include apart from assessment of thyroid hormones, evaluation of TPOAb, TgAb, and TRAb together with comprehensive neck ultrasonography.

Ultrasound evolution of parenchymal changes in the thyroid gland with autoimmune thyroiditis in children prior to the development of papillary thyroid carcinoma - a follow-up study

Background

Follicular cell-derived thyroid carcinoma represents the vast majority of paediatric thyroid cancers (TCs). Papillary thyroid carcinoma (PTC) accounts for over 90% of all childhood TC cases, and its incidence in paediatric patients is increasing. The objective of this follow-up study was to present the outcome of ultrasound (US) and laboratory monitoring of paediatric patients with autoimmune thyroiditis (AIT) prior to the development of PTC.

Patients and methods

This prospective study included 180 children and adolescents (132 females; 73.3%) with a suspicion of thyroid disorder referred to the Outpatient Endocrine Department. The patients were divided into four groups: 1) 28 patients with a mean age of 10.7 [standard deviation (SD), 3.1] y, in whom PTC was detected during the active surveillance of AIT [AIT(+), PTC(+) follow up (F)]; 2) 18 patients with a mean age of 12.8 (SD, 3.4) y, in whom PTC and AIT were detected upon admission (A) [AIT(+), PTC(+) A]; 3) 45 patients with a mean age of 13.0 (SD, 3.4) y, in whom PTC was detected upon admission and AIT was excluded [AIT(-), PTC(+) A]; and 4) an age- and sex-matched control group of 89 patients with AIT and with a mean age of 9.4 (SD, 3.0) y. The analysis included clinical, US, and laboratory assessment results of children on admission (groups 1-4) and during follow-up (groups 1 and 4) in the Paediatric Endocrine Outpatient Department.

Results

Upon admission of those in group 1, the US evaluation revealed a hypoechogenic thyroid gland in 12 and an irregular normoechogenic gland in 16 patients. US monitoring revealed an increase in thyroid echogenicity and an increased irregularity of the thyroid structure during the follow-up period of all of the patients from group 1. Such changes were not noticed in group 4. PTC was diagnosed at the mean time of 3.6 y (3 mo-9 y) since AIT confirmation in group 1. The mean maximum PTC diameter as per the US was significantly smaller in group 1 than in groups 2 and 3 [13.2 (10.8) mm vs. 22.2 (12.8) and 22.05 (15.4) mm]. Fewer patients in group 1 were referred to 131I than in groups 2 and 3 (71.4% vs. 94.4 and 93.3%). Interestingly, significant differences were observed in the thyroglobulin antibody (TgAb)/thyroid peroxidase antibody (TPOAb) ratio between groups 2 and 3, as opposed to group 4, at the beginning of observation [15.3 (27.6) and 3.5 (8.8] vs. 0.77 (1.9)]. In group 1, after the follow-up, an increase in the TgAb/TPOAb ratio was observed [1.2 (9.8) to 5.2 (13.5)]. There were no significant differences between groups 1-3 in labeling index Ki67, lymph nodes metastasis, extrathyroidal extension, and angioinvasion. There were no associations between thyroid-stimulating hormone, TgAb, and the extent of the disease.

Conclusion

The use of thyroid US focused on the search for developing tumours in the routine follow-up of patients with AIT may not only help in the early detection of thyroid malignancies that are not clinically apparent but may also influence the invasiveness of oncological therapy and reduce the future side effects of 131I therapy. We propose that the repeat evaluation of TPOAb and TgAb warrants further exploration as a strategy to determine TC susceptibility in paediatric patients with AIT in larger multicentre studies.