Journal List > J Korean Thyroid Assoc > v.7(2) > 1056559

Jung, Jeon, Song, Hong, Kim, Kim, Shong, and Kim: Time Trends Analysis of Characteristics of Patients with Thyroid Cancer in a Single Medical Center

Abstract

Background and Objectives

The incidence of thyroid cancer is increasing worldwide. The increase in the frequency of screening tests may have led to an over-detection of small thyroid cancers. The Korean Thyroid Association (KTA) discourages the find needle aspiration of thyroid nodules ≤0.5 cm. The aim of this study was to evaluate time trends of characteristics of thyroid cancer patients in a single medical center.

Materials and Methods

This study included 15,465 patients who underwent operation due to thyroid cancer from 1995 to 2012. Data on age, gender of patients and histology, clinical stage of the thyroid cancer were reviewed retrospectively.

Results

New thyroid cancer cases have dramatically increased and papillary thyroid carcinoma (PTC) accounted for a major part of this increase. PTCs were accounted for 98% of all thyroid cancer surgeries in 2012 and 79% in 1995. The proportion of PTCs ≤0.5 cm has increased from 1% in 1995 to 32% in 2009 and then slightly decreased afterward. The peak age of patients with PTC has increased from 40 years in 1995-2000 to 55 years in 2006-2012. The proportion of small follicular thyroid carcinomas and medullary thyroid carcinomas (≤1.0 cm) also steadily increased during study periods.

Conclusion

Thyroid cancers became smaller but, increase of very small PTCs stopped after 2010, in which the KTA guidelines were introduced. These findings suggest that the increasing incidence of thyroid cancer in Korea might be due to the over-detection of small thyroid cancers.

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Fig. 1.
Time trends of the thyroid cancers. (A) Changes in the number of thyroid cancer patients according to their pathology type. (B) Changes in the number of papillary thyroid carcinoma patients according to their primary tumor size. (C) Changes in the proportion of papillary thyroid carcinoma patients according to their primary tumor size. The number in this table presented the percentage of patients in each year.
jkta-7-159f1.tif
Fig. 2.
Time trends in the number of thyroid cancer patients except papillary thyroid carcinoma. (A) Changes in the number of thyroid cancer patients except papillary thyroid carcinoma according to their pathology type. (B) Changes in the number of follicular thyroid carcinoma patients according to their primary tumor size. (C) Changes in the number of medullary thyroid carcinoma patients according to their primary tumor size.
jkta-7-159f2.tif
Fig. 3.
Time trends in the age of thyroid cancer patients. The X axis represents the age of patients and the Y axis represents the percentage of patients. Patients were classified into 3 groups according to their year of operation; 1995-2000, 2001-2005 and 2006-2012. (A) Overall patients. (B) Female. (C) Male.
jkta-7-159f3.tif
Table 1.
Time trends in surgical extent and stage of papillary thyroid carcinoma
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Extent of surgery
Total thyroidectomy 57.1 85.0 93.5 94.4 86.5 77.1 73.6 75.8 68.0 73.7 77.8 78.1 78.6 73.0 66.7 62.1 59.5 54.0
Partial thyroidectomy 42.9 15.0 6.5 5.6 13.5 22.9 26.0 24.2 32.0 26.3 22.1 21.9 21.3 27.0 33.3 37.7 40.5 46.0
Other 0.0 0.0 0.0 0.0 0.0 0.0 0.4 0.0 0.0 0.0 0.1 0.0 0.1 0.0 0.1 0.2 0.0 0.0
Extent of invasion
No perlthyroldal extension 58.6 44.1 52.2 49.5 48.3 40.7 43.8 45.2 52.6 51.0 45.9 37.4 38.5 41.8 40.7 37.7 46.2 52.7
Microscopic Invasion 35.7 52.8 43.5 48.0 49.8 57.9 54.3 53.7 46.0 48.4 53.9 62.2 60.5 57.5 59.1 61.8 53.7 47.3
Macroscopic Invasion 5.7 3.1 4.3 2.6 1.9 1.4 1.9 1.1 1.4 0.6 0.3 0.3 0.5 0.5 0.2 0.3 0.2 0.0
T stage
pT1 35.7 25.2 32.6 30.6 31.4 30.8 30.6 37.4 42.2 44.4 40.1 35.1 37.0 39.0 39.5 36.5 43.7 51.0
pT2 20.0 18.1 15.2 15.3 12.6 8.9 10.2 5.7 9.8 5.6 5.0 2.0 1.3 2.5 1.1 1.0 2.2 1.6
pT3 38.6 53.5 47.8 51.0 54.1 58.9 57.4 55.9 46.7 49.4 54.6 62.6 61.0 57.9 59.2 62.2 54.0 47.4
pT4a 5.7 3.1 4.3 3.1 1.9 1.4 1.9 1.1 1.4 0.6 0.4 0.3 0.5 0.5 0.2 0.3 0.1 0.0
N stage
pNO/Nx 67.1 33.9 33.3 33.2 38.6 42.5 50.2 46.3 57.1 55.6 55.0 52.8 54.8 61.5 62.7 59.6 56.7 59.1
pN1a 21.4 46.5 52.2 52.0 47.3 46.7 38.1 43.4 35.4 36.1 35.5 36.7 34.6 31.0 30.1 32.8 35.9 31.9
pN1b 11.4 19.7 14.5 14.8 14.0 10.7 11.7 10.3 7.5 8.3 9.6 10.6 10.6 7.5 7.2 7.6 7.4 9.1
M Stage
M0 97.1 96.1 94.9 95.4 95.7 96.3 98.1 97.5 98.6 99.4 98.7 98.3 99.3 99.6 99.7 99.6 99.8 99.6
M1 2.9 3.9 5.1 4.6 4.3 3.7 1.9 2.5 1.4 0.6 1.4 1.7 0.7 0.4 0.3 0.4 0.3 0.4
TNM stages
I 74.3 63.8 59.4 59.7 57.5 57.5 57.0 59.1 61.9 60.6 57.6 57.9 50.5 51.9 54.1 55.3 59.5 62.3
II 7.1 4.7 2.9 4.1 5.3 2.3 3.4 1.4 2.5 1.1 1.7 1.4 0.4 1.3 0.4 0.5 0.5 0.4
III 15.7 22.0 26.8 26.5 30.9 34.6 34.0 33.5 32.0 33.5 36.6 35.4 41.7 42.3 41.2 40.1 36.0 32.7
IVA 2.9 6.3 8.0 7.1 3.9 3.7 4.5 4.6 2.9 4.5 3.6 4.5 6.7 4.3 4.2 4.0 3.9 4.3
IVC 0.0 3.1 2.9 2.6 2.4 1.9 1.1 1.4 0.7 0.3 0.7 0.8 0.5 0.2 0.1 0.2 0.2 0.3

Values are presented as the proportion of patients in each year according to the categories

Other: completion thyroidectomy 3 or more months after initial partial thyroidectomy T/N/M stages by TNM (Tumor Node Metastasis) staging system

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