Sharp G B, Cologne J B, Fukuhara T, Itakura H, Yamamoto M, Tokuoka S
Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan.
Int J Cancer. 2001 Sep 1;93(5):751-8. doi: 10.1002/ijc.1390.
Primary liver cancer (PLC) rates have risen dramatically during the past few decades in some regions, particularly in Japan, where PLC is now the third major cause of cancer death. PLC is one of the most difficult tumors to diagnose correctly, because (i) the liver is a frequent site of cancer metastasis and (ii) death from PLC is often attributed to cirrhosis or chronic hepatitis. Also, because the disease is often rapidly fatal, a large proportion of liver cancer cases are identified based on death certificates alone without confirmation by clinical records. Thus, worldwide differences in published incidence rates for this disease reflect regional or national differences in both the accuracy of death certificates and the sensitivity of diagnostic methods. By comparing death certificate causes of death with those based on pathology review, we were able to adjust 1958--1994 incidence rates for a large Japanese cohort for these errors. Although the death certificate false-positive error rate declined, the false-negative error rate remained high throughout the study. The introduction of improved liver cancer diagnostic methods in Japan in the early 1980s was associated with a sharp increase in PLC incidence. We conclude that errors in death certificate causes of death and changes in liver cancer diagnostic techniques have had an important impact on the reported incidence of this disease. Taking these factors into account, rates of hepatocellular carcinoma rose between 2.4- and 4.3-fold in our Japanese cohort from 1960 to 1985, peaked about 1993 and declined thereafter. Incidence rates of cholangiocarcinoma remained stable through 1987.
在过去几十年中，某些地区的原发性肝癌（PLC）发病率急剧上升，尤其是在日本，如今PLC已成为癌症死亡的第三大主要原因。PLC是最难正确诊断的肿瘤之一，原因如下：（i）肝脏是癌症转移的常见部位；（ii）PLC导致的死亡常归因于肝硬化或慢性肝炎。此外，由于该疾病往往迅速致命，很大一部分肝癌病例仅根据死亡证明确诊，未经临床记录证实。因此，全球该疾病公布的发病率差异反映了死亡证明准确性和诊断方法敏感性在地区或国家层面的差异。通过比较死亡证明上的死因与病理检查确定的死因，我们能够对日本一个大型队列1958 - 1994年的发病率进行这些误差调整。尽管死亡证明的假阳性错误率有所下降，但在整个研究过程中，假阴性错误率仍然很高。20世纪80年代初日本引入改进的肝癌诊断方法后，PLC发病率急剧上升。我们得出结论，死亡证明死因的误差以及肝癌诊断技术的变化对该疾病报告的发病率产生了重要影响。考虑到这些因素，我们日本队列中肝细胞癌的发病率在1960年至1985年间上升了2.4至4.3倍，在1 about 1993年左右达到峰值，此后下降。胆管癌的发病率在1987年之前保持稳定。
