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  • Analysis of Chinese Literature Citations in the 2025 ATA Guidelines: Evaluating the Progress of Thyroidology in China from an International Perspective

    ObjectiveTo compare the citations of Chinese literature in the 2015 and 2025 editions of the American Thyroid Association (ATA) guidelines, thereby evaluating the progress in the field of differentiated thyroid cancer (DTC) in China. MethodsChinese literature cited in the 2015 and 2025 ATA guidelines was collected and cataloged. Comparisons were made between the two editions regarding the number of citations, source journals, affiliated institutions, regional distribution, research types, and research foci. Results① Changes in the quantity and regional distribution of Chinese citations: The proportion of Chinese literature cited in the 2025 ATA guidelines increased nearly threefold compared to the 2015 edition (8.8% vs. 3.3%, P<0.001). The number of source journals increased nearly fourfold, the number of contributing cities more than doubled, and the number of involved hospital institutions quadrupled. Compared to the 2015 edition, where cited institutions were primarily located in Taiwan (11 publications), Hong Kong (11 publications), and coastal cities in Mainland China (12 publications), the 2025 edition showed a broader distribution encompassing medical centers in the Beijing-Tianjin-Hebei region, Yangtze River Delta, Pearl River Delta, Chengdu, Changchun, among others. West China Hospital of Sichuan University led the nation with the most citations (20 publications). The proportion of citations from Mainland Chinese institutions increased significantly compared to those from Taiwan and Hong Kong (accounting for 84.5%).② Changes in research types of cited literature: Clinical research constituted the majority (>95%) of cited Chinese literature in both editions. However, three basic research studies appeared in the 2025 edition. Single-center studies predominated in both guidelines.③ Changes in research foci of cited literature: The number of research foci covered increased nearly twofold in the 2025 edition (20 foci) compared to the 2015 edition (11 foci). Radioactive Iodine (RAI-131) therapy was the most frequently cited focus in both editions. Among research foci with ≥5 citations, traditional areas like tumor staging & prognosis and surgical methods & extent remained prominent, while the focus on recurrent laryngeal nerve protection rose in rank. Some traditional foci declined in ranking. Notable newly prominent or significantly changed foci included ablation therapy (12 publications, ranked 2nd), comprehensive treatment (11 publications), lymph node metastasis (10 publications), parathyroid protection (7 publications), thyroid cancer & pregnancy risks (5 publications), and active surveillance (5 publications). ConclusionCompared to the 2015 ATA guidelines, the 2025 edition cited a higher proportion of Chinese literature, demonstrated a wider geographical distribution of publications (expanding from Taiwan, Hong Kong, and coastal developed areas to major regional centers across China), and covered broader and more in-depth research foci. This indicates significant growth in China's DTC field in recent years, with a gradual shift from traditional concerns like cure and recurrence rates towards improving long-term quality of life and developing personalized, precise comprehensive management models. China is playing an increasingly important role in shaping global DTC standards. However, high-quality prospective, multicenter, randomized clinical trials remain an area for future enhancement.

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