TY - JOUR

T1 - Incidental and Non-incidental Papillary Thyroid Microcarcinoma in Denmark 1996–2015

T2 - A national study on incidence, outcome and thoughts on active surveillance

AU - Reinke, Rasmus

AU - Mathiesen, Jes Sloth

AU - Larsen, Stine Rosenkilde

AU - Hahn, Christoffer Holst

AU - Pedersen, Henrik Baymler

AU - Bentzen, Jens

AU - Schytte, Sten

AU - Godballe, Christian

AU - Londero, Stefano Christian

AU - A study from The Danish Thyroid Cancer Group – DATHYRCA (part of the DAHANCA organization)

PY - 2019/6

Y1 - 2019/6

N2 - Background: Incidental and non-incidental papillary microcarcinomas (PMC) are associated with different outcomes and treatment options may vary. The least favourable outcome is typically seen when carcinoma is suspected prior to surgery. Only a few studies have addressed the prognosis based on the way of detection for PMC, and they have been limited to retrospective single-center studies. We hypothesize that the “way of detection” may predict prognosis. The aim was to calculate the incidence and outcome of PMC based on the way of detection and to identify patients that may be suitable for active surveillance. Method: This national cohort study consists of 803 patients diagnosed with PMC in Denmark from 1996 to 2015. Patients were identified from the DATHYRCA database and allocated into groups according to the way of detection leading to surgery: Incidental at surgery (n = 527), non-incidental with symptoms suspected from the index tumor (n = 134) and non-incidental with symptoms suspected from a metastasis (n = 142). Results: Age-standardized incidence rates increased from 0.35 per 100,000 per year in 1996 to 1.19 per 100,000 per year in 2015. A significant rise in incidence was found for both the incidental group and non-incidental group with symptoms suspected from a metastasis. Recurrence free survival was significantly worse for patients with suspicion of metastasis prior to surgery than patient groups without. No difference in mortality was found between groups. Conclusion: PMC patients without suspicion of metastasis have the same low risk of recurrence as incidental cases and may be candidates for active surveillance.

AB - Background: Incidental and non-incidental papillary microcarcinomas (PMC) are associated with different outcomes and treatment options may vary. The least favourable outcome is typically seen when carcinoma is suspected prior to surgery. Only a few studies have addressed the prognosis based on the way of detection for PMC, and they have been limited to retrospective single-center studies. We hypothesize that the “way of detection” may predict prognosis. The aim was to calculate the incidence and outcome of PMC based on the way of detection and to identify patients that may be suitable for active surveillance. Method: This national cohort study consists of 803 patients diagnosed with PMC in Denmark from 1996 to 2015. Patients were identified from the DATHYRCA database and allocated into groups according to the way of detection leading to surgery: Incidental at surgery (n = 527), non-incidental with symptoms suspected from the index tumor (n = 134) and non-incidental with symptoms suspected from a metastasis (n = 142). Results: Age-standardized incidence rates increased from 0.35 per 100,000 per year in 1996 to 1.19 per 100,000 per year in 2015. A significant rise in incidence was found for both the incidental group and non-incidental group with symptoms suspected from a metastasis. Recurrence free survival was significantly worse for patients with suspicion of metastasis prior to surgery than patient groups without. No difference in mortality was found between groups. Conclusion: PMC patients without suspicion of metastasis have the same low risk of recurrence as incidental cases and may be candidates for active surveillance.

KW - Active surveillance

KW - Incidental

KW - Microcarcinoma

KW - Non-incidental

KW - Papillary thyroid carcinoma

KW - Thyroid cancer

UR - http://www.scopus.com/inward/record.url?scp=85063113576&partnerID=8YFLogxK

U2 - 10.1016/j.canep.2019.03.011

DO - 10.1016/j.canep.2019.03.011

M3 - Journal article

C2 - 30909152

AN - SCOPUS:85063113576

VL - 60

SP - 46

EP - 50

JO - Cancer Epidemiology

JF - Cancer Epidemiology

SN - 1877-7821

ER -