Int J Thyroidol.  2024 Nov;17(2):277-285. 10.11106/ijt.2024.17.2.277.

Changing Trends of Thyroid Cancer Clinical Characteristics and Treatment Pattern in South Korea: Insights from an Institutional Database and the Korean Cancer Center Registry Database

• Kang YJ
• Choi N
• Seok J
• Kim SW
• Kim TH
• Chung JH
• Son YI
• Chung MK

• KMID: 2561608
• DOI: http://doi.org/10.11106/ijt.2024.17.2.277

Abstract

Background and Objectives
To analyze the clinical trends and treatment patterns of thyroid cancer in the recent decade in South Korea.
Materials and Methods
Two distinctive datasets, a single institutional database from 2009 to 2021 of differentiated thyroid cancer (DTC) patients (n=3145) and a nationwide database of the Korean Cancer Center Registry (KCCR) from 2005 to 2019 for patients (n=414,828) with all types of thyroid cancer, were analyzed. Annual incidence, the extent of thyroidectomy and neck dissection, T and N stages, and postoperative radioactive iodine (RAI) were investigated and descriptively presented.
Results
The institutional database demonstrated that the annual cases of DTC surgeries suddenly dropped in 2014, coinciding with a social debate on overdiagnosis in South Korea. Due to changes in the staging manual and management guidelines during the study period, lobectomy has been preferred more than total thyroidectomy and the number of anterior compartment neck dissections has decreased. However, cases with lateral neck dissection and T4 stage gradually increased, suggesting that social issue did not influence the incidence of advanced thyroid diseases. The KCCR database also supported a similar phenomenon that showed a recent increase in localized and regional disease after a shock from social controversy.
Conclusion
Our institutional and KCCR data findings collectively indicate a steady incidence in localized and regional thyroid cancer after the initial drop triggered by the 2014 controversy in South Korea.

Keyword

Thyroid neoplasms; Incidence; Surgery; Treatment; Database

Figure

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  Fig. 1 Annual cases of DTC surgery based on the database of a single institution from 2009 to 2021. The number of DTC surgeries showed a sudden dropped in 2014 with a gradual recent increase.

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  Fig. 2 Annual changes of surgical extent and T classification from 2009 to 2021 in DTC. (A) Annual changes of the extent of thyroidectomy, showing a gradual decrease in total thyroidectomy and an increase in lobectomy. (B) Annual changes in proportion of T classification. While T3 stage was notably decreased in 2018, incidence of T4 stage was suddenly increased in 2021.

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  Fig. 3 Annual changes of N classification and surgical extent from 2009 to 2021 in DTC. (A) Annual changes in proportion of N classification. There was no definite difference in N0 or N1 frequency. (B) Annual changes in the extent of neck management. Frequency of ACND decreased since 2015, while frequency of LND sharply increased.

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  Fig. 4 Annual number of postoperative RAI from 2009 to 2021. Postoperative RAI incidence steadily decreased over that period.

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  Fig. 5 Thyroid cancer registration data from the Korea National Cancer Center. (A) Changes of total number in both differentiated and undifferentiated thyroid cancer surgery from 2005 to 2018. Thyroid cancer incidence continuously increased until 2012, with a sudden decrease in 2014 and 2015. Its incidence remained stable until 2018. (B) Incidence of thyroid cancer according to localized, regional, distant metastasis and is unknown. Localized and regional disease decreased after 2012 with a recent increase until 2018.

Reference

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