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Skjaldkirtilskrabbamein á Íslandi tímabilið 1955-2004 : klínísk og meinafræðileg faraldsfræðirannsókn

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Authors
Jón Gunnlaugur Jónasson
Jón Hrafnkelsson
Elínborg Ólafsdóttir
Issue Date
2011-02

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Other Titles
Thyroid cancer in Iceland in the period 1955-2004 : a clinico-pathological and epidemiological study
Citation
Læknablaðið 2011, 97(2):83-9
Abstract
Introduction: Thyroid cancer has been unusually common in Iceland. Histological classification and TNM-staging has altered somewhat in the last decades. The aim of this study was to investigate the epidemiology of thyroid cancer in Iceland over half a century and identify factors affecting survival. Material and methods: Information on all thyroid cancers diagnosed in Iceland from 1955 to 2004 was obtained from the Icelandic Cancer Registry. Tumours diagnosed post-mortem were excluded. The date of diagnosis, sex and age at diagnosis was registered. All histopathology material was re-evaluated to reclassify tumours and TNM-stage was determined. The effect of registered parameters on prognosis was determined both in uni- and multivariate analysis. Results: Out of 805 thyroid cancer cases in the study 588 were in women. The mean age was 51 years in women and 58 years in men. The oscillation of incidence was marked in the study period although it did not increase in the last decades of the study. The overall proportion of papillary carcinoma was around 80% and the proportion of T0-T2 tumours was 66%. Neither number has changed significantly in the last 40 years of the study. The overall disease specific 5 year survival was 88% and increased significantly in the study period. In a multivariate analysis patient's age, year of diagnosis, tumour type and TNM-stage were independent significant prognostic variables. Conclusion: Thyroid cancer incidence in Iceland is no longer different to that in many neighbouring countries. Sex was not an independent prognostic parameter. The year of diagnosis was an independent prognostic factor which might indicate a more efficient treatment in later years. Key words: thyroid cancer, histological classification, TNM-staging, incidence, epidemiology. Correspondence: Jon Gunnlaugur Jonasson, jongj@landspitali.is.
Inngangur: Krabbamein í skjaldkirtli eru fremur sjaldgæf æxli þó þau hafi verið óvenju algeng á Íslandi. Meinafræðiflokkun og TNM-stigun æxlanna hefur breyst á undanförnum áratugum. Tilgangur rannsóknarinnar var að endurskoða öll skjaldkirtilskrabbamein á 50 ára tímabili, meta horfur sjúklinga og kanna breytingar. Efniviður og aðferðir: Upplýsingar fengust hjá Krabbameinsskrá Íslands um skjaldkirtilskrabbamein greind á Íslandi 1955-2004. Greiningardagur, kyn og aldur sjúklinga var skráð. Öll vefjasýni voru endurmetin, æxlin endurflokkuð og TNM-stig ákvarðað. Einungis æxli greind í lifandi sjúklingum komu inn í þessa rannsókn. Athugað var hvaða þættir höfðu áhrif á lifun sjúklinga og hverjir þeirra reyndust sjálfstætt marktækir. Niðurstöður: Alls greindust 805 skjaldkirtilskrabbamein á tímabilinu, þar af 588 í konum. Meðalaldur kvenna var 51 ár en karla 58 ár. Marktækar sveiflur á nýgengi komu fram en nýgengið jókst þó lítið á síðustu áratugum rannsóknartímans. Hlutfall totumyndandi krabbameins var í heild um 80% og T0-T2 stig æxla um 66%. Þessi hlutföll breyttust lítið, einkum síðustu fjóra áratugina. Æxli í konum greindust almennt á lægra TNM-stigi. Sjúkdómssértæk fimm ára lifun var 88% og jókst marktækt á rannsóknartímanum. Við fjölbreytugreiningu var aldur við greiningu, greiningarár, vefjagerð og TNM-stig allt sjálfstæðir þættir sem höfðu áhrif á horfur sjúklinga. Ályktun: Nýgengi skjaldkirtilskrabbameins hérlendis er ekki lengur hátt miðað við ýmis nágrannalönd. Kyn reyndist ekki sjálfstætt marktækur áhættuþáttur varðandi lifun. Hins vegar var greiningarár sjálfstæður þáttur sem getur bent til að meðferð hafi orðið árangursríkari.
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