Sikora Andrew G, Toniolo Paolo, DeLacure Mark D
Department of Otolaryngology, New York University School of Medicine, New York, New York, USA.
Laryngoscope. 2004 Nov;114(11):1915-23. doi: 10.1097/01.mlg.0000147920.66486.bc.
OBJECTIVES/HYPOTHESIS: Head and neck squamous cell carcinoma (HNSCCA) has declined in the United States since the late 1970s. During this time, substantial immigration from other countries has occurred, and the average lifespan has increased. We tested the hypothesis that these trends have altered the HNSCCA patient population.
Retrospective analysis was made of population-based data from the SEER database, a national registry capturing roughly 10% of all U.S. cancer diagnoses.
We examined all unique diagnoses of HNSCCA in the database from 1976 to 1999 and determined the breakdown of cases by age, sex, and race.
The absolute number of new HNSCCA diagnoses per year declined overall by 5% during the time period of the study, whereas new diagnoses in patients older than 74 years of age increased by more than 20%. The rate of HNSCCA per 100,000 person-years in elderly women did not change, and the rate in elderly men decreased, indicating that the observed increase in cases is explained by a growing population of elderly persons at risk. An increase in the absolute number of cases, but not the incidence rate, was also seen among persons younger than 50 years of age. Although both the absolute number of new cases and the incidence rates of HNSCCA in white male patients declined substantially, the percentage of HNSCCA patients classified as minorities increased from 14.5% to more than 20% of all cases. During the time period of the study, the overall number of HNSCCA cases in nonwhite and Hispanic patients increased by 36%.
Increasing numbers of elderly and minority patients with HNSCCA are likely to alter patterns of disease and utilization of health care resources.
目的/假设：自20世纪70年代末以来，美国头颈部鳞状细胞癌（HNSCCA）的发病率呈下降趋势。在此期间，大量移民涌入美国，且平均寿命有所延长。我们检验了这样一个假设，即这些趋势改变了HNSCCA患者群体。
对来自监测、流行病学和最终结果（SEER）数据库的基于人群的数据进行回顾性分析，该数据库是一个全国性登记处，记录了约10%的美国癌症诊断病例。
我们检查了数据库中1976年至1999年所有HNSCCA的独特诊断，并按年龄、性别和种族对病例进行了分类。
在研究期间，每年新诊断的HNSCCA病例绝对数总体下降了5%，而74岁以上患者的新诊断病例增加了20%以上。老年女性每10万人年的HNSCCA发病率没有变化，老年男性的发病率下降，这表明观察到的病例增加是由处于风险中的老年人群体增加所解释的。50岁以下人群中病例的绝对数也有所增加，但发病率没有增加。虽然白人男性患者中新病例的绝对数和HNSCCA的发病率都大幅下降，但被归类为少数族裔的HNSCCA患者比例从所有病例的14.5%增加到了20%以上。在研究期间，非白人和西班牙裔患者中HNSCCA病例的总数增加了36%。
HNSCCA老年患者和少数族裔患者数量的增加可能会改变疾病模式和医疗资源的利用情况。
