青岛地区1306例甲状腺癌的临床病理特征分析

Analysis of the clinicopathological characteristics for 1 306 cases of thyroid cancer in Qingdao

背景与目的：甲状腺癌（thyroidcancer，TC）发病率在全球范围不断攀升，但存在地区差异。该研究旨在探讨青岛这一典型东部沿海城市的TC发病情况和临床病理特点，以及该地区近年来甲状腺手术疾病谱的变化。方法：回顾性分析青岛大学附属医院2014年行甲状腺切除术的2251例甲状腺结节患者，对其中1306例TC患者的临床病理特征进一步统计分析，并与该院前期数据及美国SurveillanceEpidemiologyEndResults（-SEER）数据库比较。结果：随着该院甲状腺手术例数的逐年上升，其中TC的比例亦由2010年的34．8％上升至2014年的59．0％。TC高发于20。54岁年龄段，较SEER数据库前移（U=2289，P=0．000），男女比例为1：2．80，其中超重和肥胖者占50．2％。78．2％的TC患者初诊时无明显l临床症状或体征，16．6％已有可看到或摸到的甲状腺结节，仅有5．2％因声音嘶哑或其他压迫症状就诊。2014年微小癌占该院TC的61．7％，较2010年（37．7％）明显增多。该院TC伴有颈部淋巴结转移者比例明显高于SEER数据库（49．5％坩26％，x2=11．806，P=0．001），且微小癌伴有颈部淋巴结转移率亦高达31．3％。TC各病理类型所占比例分别为：乳头状癌97．5％、滤泡癌1．1％、髓样癌1．0％、未分化癌0．5％，乳头状癌比例略高于SEER数据库（U=4654．5，P=0．055）。结论：青岛地区甲状腺手术逐年增多，TC术前诊断准确率逐年提高。该地区Tc发病呈相对年轻化、超重化及高淋巴结转移趋势。微小癌比率增高提示该地区筛查及体检等预防意识的普及，微小癌中较高的淋巴结转移率提示该地区微小癌的侵袭性不容忽视。

Background and purpose： The incidence of thyroid cancer （TC） is increasing worldwide. However, there were some differences among different regions. The purpose of this study was to investigate the incidence trends and clinicopathological characteristics of TC in Qingdao, a typical eastern coastal city, and to analyze the change in etiological spectrum of surgical thyroid diseases in recent years. Methods： A total of 2 251 patients who underwent thyroidectomy in 2014 due to thyroid nodules at the Affiliated Hospital of Qingdao University were retrospectively reviewed. The clinico- pathological characteristics were further analyzed among 1 306 patients with TC and compared with the corresponding data from the Surveillance Epidemiology and End Results （SEER） database as well as previous data from this hospital. Results： With the increasing number of thyroidectomy in Qingdao, there was also an increase in the proportion of TC in patients after thyroidectomy, from 34.8% in 2010 to 59.0% in 2014. Among those with TC, the male-to-female ratio was 1 ： 2.80, with a relatively high incidence among 20-54 year-old adults, who were younger than those reported in terms of distribution of age in SEER database （U=2 289, P=0.000）. About 50.2% of the TC patients were overweight or obese, 78.2% TC patients had only asymptomatic nodules detected by ultrasound at initial diagnosis, while 16.6% had visible or palpable thyroid nodules. Only 5.2% presented hoarseness or other repression symptoms. Micro-carcinoma accounted for 61.7% of TC in 2014 at this hospital, which was significantly higher than the proportion in 2010 （37.7%）. Lymph node involvement was significantly more frequent at this hospital than in SEER database （49.5% vs 26.0%,x2=11.806, P=0.001）. Even among patients with micro-carcinoma, 31.3% already presented lymph node metastases. The proportions of papillary, follicular, medullary and anaplastic carcinoma were 97.5%, 1.1%, 1.0% and 0.5%, respectively, among which the percentage of papillary carcinoma was higher than that in SEER database （U=4 654.5, P=0.055）. Conclusion： There was an increase in the number of thyroidectomy in Qingdao, and the preoperative diagnostic accuracy of TC in this area kept rising. The in- cidence of TC was relatively high in a younger population, with more common lymph node involvements and an overweight trend. The increasing proportion of micro-carcinoma might be related to the popularization of health examination. However, the frequent lymph node metastasis in patients with micro-carcinoma is an important indicator of the invasive behavior of micro-carcinoma, which should not be overlooked.