甲状腺癌的流行病学现状及其影响因素研究进展  

Research progress in epidemiology and risk factors of thyroid cancer

作　　者：张芷悦 何慧婧[1] 单广良[1] 林岩松 ZHANG Zhiyue;HE Huijing;SHAN Guangliang;LIN Yansong(Department of Epidemiology and Statistics,Institute of Basic Medical Sciences,Chinese Academy of Medical Sciences/Peking Union Medical College,Beijing 100005,China;School of Health Humanities,Peking University,Beijing 100191,China;Department of Nuclear Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,State Key Laboratory of Complex Severe and Rare Diseases,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine,Beijing 100730,China)

机构地区：[1]中国医学科学院基础医学研究所/北京协和医学院基础学院流行病与卫生统计学系,北京100005 [2]北京大学医学人文学院,北京100191 [3]中国医学科学院北京协和医学院北京协和医院核医学科,疑难重症及罕见病国家重点实验室,核医学分子靶向诊疗北京市重点实验室,北京100730

出　　处：《中国癌症杂志》2025年第1期21-29,共9页China Oncology

摘　　要：甲状腺癌是内分泌系统和头颈部最常见的恶性肿瘤,包括甲状腺乳头状癌(papillary thyroid cancer,PTC)、甲状腺滤泡癌(follicular thyroid cancer,FTC)、甲状腺髓样癌(medullary thyroid cancer,MTC)和甲状腺未分化癌(anaplastic thyroid cancer,ATC)等类型。近几十年,甲状腺癌的发病率迅速增长。从地区分布看,甲状腺癌的发病率在经济发达地区较高;发病率上升较快的主要是一些高收入国家,但在一些中等收入国家也出现了快速增长;从人群看,女性甲状腺癌的发病率显著高于男性。中国甲状腺癌的发病率近年来也呈明显上升趋势,但死亡率则稳定在较低水平;城市甲状腺癌的发病率高于农村地区,东部沿海地区发病率高于中、西部地区。甲状腺癌的病因复杂多样,主要危险因素包括遗传易感性、辐射暴露、碘摄入水平、内分泌紊乱、环境污染和生活方式等。其中,辐射暴露(尤其是儿童时期暴露于电离辐射)是甲状腺癌公认的重要诱因。此外,碘摄入不足或过量均可影响甲状腺功能,增加癌变风险。在遗传学方面,甲状腺癌的家族聚集性和基因(如BRAF、RET/PTC等)突变在疾病发生中的作用已被广泛研究,而环境污染和现代生活方式的改变也可能在某种程度上促进了疾病的发生、发展。因此,对有甲状腺癌家族史的人群开展早期筛查,减少不必要的医疗辐射暴露,及时干预肥胖等与生活方式密切相关的危险因素,可能对甲状腺癌的预防有积极意义。甲状腺癌患者大多数预后良好,预后影响因素主要有病理学分型(PTC预后较好,而MTC和ATC预后较差)、临床分期(TNM分期Ⅰ、Ⅱ期预后较好,Ⅲ、Ⅳ期较差)、生理因素(女性总体预后优于男性)、遗传学因素和环境因素等。了解甲状腺癌的流行病学现状,探索其发病和预后的影响因素,对于甲状腺癌的预防、治疗和健康管理有重要意义。未来可基于甲状腺癌危�Thyroid cancer is the most common malignant tumor of the endocrine system and head and neck region,mainly including papillary thyroid cancer(PTC),follicular thyroid cancer(FTC),medullary thyroid cancer(MTC)and anaplastic thyroid cancer(ATC).Over the past few decades,the global incidence of thyroid cancer has risen rapidly,nearly doubling in some developed countries.Geographically,thyroid cancer incidence is higher in economically developed regions.Although the fastest increase in incidence has been observed in high-income countries,certain middle-income countries have also reported significant growth.Demographically,the incidence rate is notably higher in women than in men.In China,the incidence of thyroid cancer has increased significantly in recent years,while the mortality rate has remained stable at a low level.Urban areas report higher incidence rates than rural areas,and eastern coastal regions have higher rates compared to central and western regions.The etiology of thyroid cancer is multifaceted,with major risk factors including genetic predisposition,radiation exposure,iodine intake levels,endocrine disruptions,environmental and lifestyle factors.Among these,radiation exposure(particularly ionizing radiation during childhood)is a recognized critical risk factor.In addition,both insufficient and excessive iodine intake can disrupt thyroid function,thereby increasing disease risk.Genetic factors,such as familial clustering and gene(BRAF,RET/PTC,etc.)mutations,have been widely studied,while environmental pollution and modern lifestyles may also contribute to disease onset.Therefore,it is beneficial to conduct early screening for people with a family history of thyroid cancer,reduce unnecessary medical radiation exposure and conduct intervention on lifestyle-related risk factors such as obesity to prevent and control thyroid cancer.Most patients with thyroid cancer have a favorable prognosis.The main factors influencing the prognosis include pathological typing(PTC has a relatively better prognosis,while MTC

关 键 词：甲状腺癌 流行现状 危险因素 早期预防 

分 类 号：R736.1[医药卫生—肿瘤]