Objective: To assess racial and sex variances in second primary thyroid malignancy (SPTM) cumulative incidence and temporal trends and the radiation exposure effect in pediatric SPTM. Materials and Methods: A retrospective cohort study, a non-experimental epidemiologic design, was used to assess the cumulative incidence (CmI) and temporal trends as well as the exposure effect of radiation in SPTM among children, 0–19 years, in the Surveillance, Epidemiology, and End Results (SEER) registry, National Cancer Institute (NCI), USA. Percent change (PC) and annual percent change (APC) were used to examine CmI rates and temporal trends, while chi-square statistics and binomial regression models were used to examine variable distribution by race and to determine the exposure effect of radiation on SPTM as well as mortality, respectively. Results: The frequency of pediatric thyroid cancer was (n= 3457) between 1973 and 2013/14, while the PC was 151.2 for all races but 99.8 among whites. Of all pediatric thyroid cancers diagnosed during this period, SPTM accounted for 3% (n= 99). Compared to whites, blacks/AA were 60% less likely to present with SPTM, adjusted risk ratio, aRR = 0.40, 99% CI 0.06–2.47, while other races were 18% more likely to develop SPTM, aRR = 1.18, 99% CI 0.48–2.87. Additionally, females relative to males were 63% less likely to be diagnosed with SPTM, aRR = 0.37, 99% CI 0.22–0.61. With respect to urbanicity, compared to children in rural areas, those in urban areas were 21% less likely to develop SPTM, aRR = 0.79, 99% CI, 0.12–5.35, while children in metropolitan areas were 40% less likely to develop SPTM, aRR = 0.60, 99% CI, 0.10–3.59. Although imprecise, there was a 5% increased risk of SPTM, with radiation as an exposure effect, aRR = 1.05, 99% CI 1.01–1.75. Conclusions: There are increasing temporal trends in pediatric SPTM with blacks relative to whites having observed lower incidence, despite an increasing percent change among blacks/AA, indicative of the disproportionate burden of this malignant neoplasm. SPTM risk was higher among males and in rural areas, while radiation as a risk for SPTM was clinically and biologically meaningful, albeit an observed statistically insignificant inference due to sampling variability, requiring intervention mapping in radiation exposure margination among children.
目的：评估儿童第二原发甲状腺恶性肿瘤（SPTM）累积发病率及时间趋势的种族与性别差异，以及辐射暴露对儿童SPTM的影响。材料与方法：本研究采用回顾性队列研究（一种非实验性流行病学设计），基于美国国家癌症研究所（NCI）的监测、流行病学和最终结果（SEER）登记数据，评估1973年至2013/14年间0-19岁儿童SPTM的累积发病率（CmI）、时间趋势及辐射暴露效应。采用百分比变化（PC）和年度百分比变化（APC）分析累积发病率及其时间趋势；使用卡方统计量和二项回归模型分别检验变量在不同种族间的分布，并评估辐射暴露对SPTM发生及死亡率的影响。结果：1973年至2013/14年间，儿童甲状腺癌病例数为3457例，所有种族的PC为151.2，而白人为99.8。在此期间诊断的所有儿童甲状腺癌中，SPTM占3%（99例）。与白人相比，黑人/非裔美国人患SPTM的可能性低60%（校正风险比aRR = 0.40，99% CI 0.06–2.47），而其他种族患SPTM的可能性高18%（aRR = 1.18，99% CI 0.48–2.87）。此外，女性相对于男性被诊断为SPTM的可能性低63%（aRR = 0.37，99% CI 0.22–0.61）。在城乡分布方面，与农村地区儿童相比，城市地区儿童患SPTM的可能性低21%（aRR = 0.79，99% CI 0.12–5.35），而大都市地区儿童患SPTM的可能性低40%（aRR = 0.60，99% CI 0.10–3.59）。尽管结果不精确，但辐射暴露使SPTM风险增加5%（aRR = 1.05，99% CI 1.01–1.75）。结论：儿童SPTM的时间趋势呈上升态势，尽管黑人/非裔美国人的百分比变化增长显著，但其发病率仍低于白人，表明该恶性肿瘤的疾病负担存在不均衡性。男性和农村地区儿童的SPTM风险更高；辐射作为SPTM的风险因素具有临床和生物学意义，尽管因样本变异性导致统计学推断不显著，但仍需针对儿童辐射暴露边界制定干预规划。
肿瘤(癌症)患者之家