Nuklearmedizin 2019; 58(02): 86-92
DOI: 10.1055/a-0859-7454
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Changing trends of incidence and prognosis of thyroid carcinoma

Veränderung der Inzidenz und Prognose des Schilddrüsenkarzinoms
Jamshid Farahati
1   Clinic for Nuclear Medicine, Bethesda, Duisburg, Germany
,
Uwe Mäder
2   Clinic for Nuclear Medicine, University hospital Würzburg, Germany
,
Elena Gilman
1   Clinic for Nuclear Medicine, Bethesda, Duisburg, Germany
,
Rainer Görges
3   Clinic for Nuclear Medicine, University hospital Essen, Germany
,
Ines Maric
1   Clinic for Nuclear Medicine, Bethesda, Duisburg, Germany
,
Ina Binse
3   Clinic for Nuclear Medicine, University hospital Essen, Germany
,
Heribert Hänscheid
2   Clinic for Nuclear Medicine, University hospital Würzburg, Germany
,
Ken Herrmann
3   Clinic for Nuclear Medicine, University hospital Essen, Germany
,
Andreas Buck
2   Clinic for Nuclear Medicine, University hospital Würzburg, Germany
,
Andreas Bockisch
3   Clinic for Nuclear Medicine, University hospital Essen, Germany
› Author Affiliations
Further Information

Publication History

01/22/2019

02/18/2019

Publication Date:
27 March 2019 (online)

Abstract

Aim to evaluate the time trend of epidemiology of follicular cell derived thyroid cancer (TC) based on data from a well documented cancer registry.

Methods Population based data on TC from Lower Franconia (LF), Germany, within 1981 and 2015 were analysed to estimate the regional epidemiology of TC. The incidence was assessed in 5-year-intervals for gender, histology, and tumor stage.

Results Incidence of TC solely attributable to papillary TC (PTC) doubled mainly in T1- and T2-stages within the evaluation period from 4.5 to 8.7/100.000/y in females and 1.7 to 4.1/100.000/y in males. There was no significant change of follicular TC (FTC), whereas anaplastic TC (ATC) decreased in the same interval. The number of lymph-node metastases and T3-cases increased, while the frequency of T4-stage and distant metastases decreased. Increased incidences of T1- and T2-stages suggest an over-diagnosis. In contrast, increasing number of tumors at T3-stage and with lymph node involvement contradict the over-diagnosis as the only reason for rising incidence. Declining of T4-stages in spite of increasing of T3-stages and N1-cases indicates the value of timely detection and treatment of TC. In accordance, reduced incidence of advanced cancers with M1-stage and ATC cases promote our current management of TC.

Conclusion Timely diagnosis and adequate risk-adopted treatment of thyroid cancer reduce the frequency of high-risk cases with distant metastases and the possible protracted dedifferentiation of TC to anaplastic features. Our analyses support the management algorithm in thyroid cancer according to the recent guidelines of German Nuclear Medicine Society.

Zusammenfassung

Ziel Evaluierung des Trends der Epidemiologie von Schilddrüsenkrebs (TC) in Unterfranken (UF).

Methodik Populationsbasierte Daten aus Unterfranken aus den Jahren 1981 bis 2015 wurden analysiert und die Änderung der Inzidenz des TC ermittelt. Die Inzidenz wurde in 5-Jahres-Intervallen in Bezug auf Geschlecht, Histologie, und Tumorstadium berechnet.

Ergebnisse Die TC-Inzidenz verdoppelte sich im Auswertungszeitraum, bei Frauen von 4,5 auf 8,7/100.000/J und von 1,7 auf 4,1/100.000/J bei Männern, was überwiegend den papillären Schilddrüsenkarzinomen (PTC) in T1- und T2-Stadien zuzuschreiben ist. Es gab keine signifikante Änderung beim follikulären TC (FTC), während die Häufigkeit des anaplastische TC (ATC) abnahm. Die Anzahl der Lymphknotenmetastasen und T3-Fälle stieg, während die Frequenz der T4-Fälle und der Fernmetastasen in diesem Intervall abnahm. Eine erhöhte Inzidenz von Karzinomen in T1- und T2-Stadien ließe sich durch Überdiagnostik erklären. Im Gegensatz dazu sprechen die Zunahme der Inzidenz von Tumoren in T3- und N1-Stadien gegen eine Überdiagnose als einzigen Grund für den Anstieg. Die abnehmende Zahl von Patienten mit T4-Stadium bei gleichzeitigem Anstieg der Fälle im T3- und N1-Stadium sprechen vielmehr für eine rechtzeitige Diagnose von Schilddrüsenkarzinomen. Die abnehmende Inzidenz der weit fortgeschnittenen Fälle mit Fernmetastasen und mit ATC im gleichen Zeitraum bestätigen das bei uns verfolgte Konzept.

Schlussfolgerung Die rechtzeitige Diagnose und adäquate risikoadaptierte Behandlung des Schilddrüsenkarzinoms im Frühstadium reduziert die Häufigkeit von Hochrisiko-Fällen mit Fernmetastasen und verhindert die mögliche Entdifferenzierung vom DTC zu anaplastischen Tumoren. Unsere Analysen bestätigen das therapeutische Management von Schilddrüsenkrebs gemäß Leitlinien der Deutschen Gesellschaft für Nuklearmedizin.

 
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