基于文献计量学的甲状腺癌诊疗进展历程的循证可视化研究

Evidence-based visualization study on the progress of diagnosis and treatment for thyroid cancer based on bibliometrics

背景与目的:甲状腺癌是全球最常见的内分泌系统恶性肿瘤,其发病率逐年剧增,已位居女性恶性肿瘤的第四位,其卫生负担逐年加重。近年来,随着医疗技术的发展及甲状腺癌诊疗模式的转变,甲状腺癌患者的生存预后得到明显改善。本文通过结合本研究团队既往针对甲状腺癌的文献计量学研究的基础,运用聚类分析和主题挖掘的方法,以不同时间范围作为研究对象,分析世界范围内甲状腺癌的发展历程与诊治模式的动态演进过程,以期预测未来甲状腺癌研究热点,以及为后续甲状腺癌诊疗的发展方向提供参考。方法:回顾性收集Web of Science Core Collection(WoSCC)数据库中甲状腺癌相关的研究,应用VOSviewer 1.6.18软件对纳入文献的研究主题、关键词、作者信息、发表年份等变量提取后进行聚类及时序分析和主题挖掘,通过文献计量学的方法探索已发表甲状腺癌相关的研究主题,以及不同时间范围内甲状腺癌诊疗模式的动态演变过程,并预测未来研究热点。结果:最终共纳入甲状腺癌相关研究主题的文献32074篇,其中,最早的文献发表于1955年。随着时间的推移,发文量迅速增加。世界范围内,基于已发表文献的甲状腺癌发展聚类分析大致可分为3个阶段。其中包括:⑴经验医学指导下的探索治疗阶段(1955—1990年,第一阶段),该阶段共发表符合要求的文献2713篇。在甲状腺癌领域最开始被关注的是其流行病学特征、与抗甲状腺球蛋白指标间的关系、随访预后等方面,但在该阶段各个关键词之间并未形成较理想的聚类。⑵循证医学理念下的规范治疗阶段(1991—2000年,第二阶段),该阶段共发表符合要求的文献2845篇。该阶段研究热点主要为甲状腺癌的治疗与预后,包括了放射碘治疗、消融治疗以及远处转移等方面,且自1996年以后甲状腺癌的流行病学、诊疗、基础研究及预后等各个领域逐渐受到了业界的关注。⑶精准医学主导下的个体化治疗阶段(2001—2022年,第三阶段),该阶段共发表符合要求的文献26516篇。该阶段研究热点主要为甲状腺癌的基础研究,包括BRAF突变、mRNA、信号通路等,此阶段中甲状腺癌的分子机制研究(如非编码RNA及寻找更理想的协助诊断监测预后的生物标志物)及甲状腺癌治疗新型药物研究是当前研究者关注重点领域。结论:甲状腺癌的相关基础研究逐渐成为研究领域内的主要热点,预测未来研究热点将更加集中于甲状腺癌新型靶向药物研发及更理想生物标志物的探索方向。

Background and Aims:Thyroid cancer is the most common malignancy of the endocrine system globally,with its incidence increasing each year.It ranks fourth among malignant tumors in females,contributing to a growing healthcare burden.In recent years,advancements in medical technology and changes in thyroid cancer diagnosis and treatment approaches have significantly improved the survival prognosis for patients.Based on the previous bibliometric research conducted by our team on thyroid cancer,this study was performed to analyze the dynamic evolution of the development as well as diagnostic and treatment patterns of thyroid cancer worldwide by utilizing clustering analysis and theme mining techniques,with different time horizons as the research object,in order to predict future research trends in thyroid cancer and provide valuable insights for the future direction of thyroid cancer diagnosis and treatment.Methods:The thyroid cancer-related studies from the Web of Science database were retrospectively collected.The VOSviewer 1.6.18 software was used to extract variables such as research topics,keywords,author information,and publication years from the included literature.Clustering analysis,temporal analysis,and topic mining were performed to explore the research themes of published studies on thyroid cancer using bibliometric methods.The dynamic evolution process of thyroid cancer diagnosis and treatment patterns within different time periods was examined,and future research hotspots were predicted.Results:A total of 32074 publications on thyroid cancer-related research topics were included in the analysis,with the earliest publication dating back to 1955.Over time,the number of publications increased rapidly.Globally,based on the published literature,the development of thyroid cancer can be roughly divided into three stages through clustering analysis.These stages were as follows:1.Exploratory treatment stage under empirical medicine guidance(1955-1990,Stage 1):A total of 2713 eligible publications were published during this stage.Initially,the focus in the field of thyroid cancer was on its epidemiological characteristics,the relationship with antithyroglobulin indicators,follow-up prognosis,etc.However,during this stage,ideal clustering among various key terms was not yet established.2.Standardized treatment stage under evidence-based medicine principles(1991-2000,Stage 2):A total of 2845 eligible publications were published during this stage.The research focus shifted to the treatment and prognosis of thyroid cancer,including topics such as radioactive iodine therapy,ablation therapy,distant metastasis,etc.Since 1996,there has been increasing attention from the industry on the epidemiology,diagnosis,treatment,basic research,and prognosis of thyroid cancer.3.Individualized treatment stage under the guidance of precision medicine(2001-2022,Stage 3):A total of 26516 eligible publications were published during this stage.The research focus primarily revolved around the basic research of thyroid cancer,including BRAF mutations,mRNA,signaling pathways,etc.Molecular mechanism studies of thyroid cancer(such as non-coding RNA and the search for more ideal biomarkers to assist in diagnosis,monitoring,and prognosis)and the development of novel drugs for thyroid cancer treatment were the current key areas of interest for researchers in this stage.Conclusion:The field of thyroid cancer research has seen a growing emphasis on related basic studies.It is predicted that future research hotspots will predominantly concentrate on the development of new targeted drugs for thyroid cancer and the exploration of more ideal biomarkers.