Levy L F, Auchterlonie W C
Int Surg. 1975 May;60(5):286-92.
In 17 years we have performed 6,505 neurosurgical procedures in the neurosurgical unit of the Salisbury Hospital Group. Only 62% were performed on Africanpatients and 38% on European patients, despite the fact that the African population exceeds the European population by 20 times. This is partly due to the tolerance of rural people towards disease and partly to a number of social factors. The European group has a greater percentage of elderly people than the African group and, although we could not estimate the incidence of tumors among the African group, we would expect their overall incidence per capita to be lower because malignant tumors tend to occur in older people. We do not suspect the existence of a genetic factor in tumor incidence. There were 205 primary intracranial neoplasms in Africans and 244 in Europeans. Histological study shows that 33% of all tumors were meningiomas in the African group compared to 19% in the European group. Gliomas comprised 61.3% of the European series and 48.8% of the African series but the distribution by Kernohan's grading of astrocytomas was the same in both groups. If age was a factor, Grades I and II should have predominated in the African group, but did not. The incidence for each tumor among our European patients followed the patterns reported in various European and USA series. Likewise the pattern emerging from our African series closely paralleled the reports of other workers in Africa. Acoustic neuromas appear to be rather rare among Africans. The average age of all adults with tumors was 15 years lower in the African group than in the European group. However, this is entirely related to the age structure of the population, and not to an earlier age of occurrence. The average ages of medulloblastoma cases were identical. In our European series the occurrence according to age was much the same as that reported by overseas workers. The sex incidence of tumors in the European group seems to be a fair reflection of the situation elsewhere; in the African group it is questionable because men go into the towns to work and leave their families in the country. There was no significant difference in the location of tumors in the two groups. Results of treatment were uniformly inferior in the African group, partly due to the lateness of arrival at the hospital so that the growth was already far advanced and also because many patients suffered poor health from concomitant disease.
17年来，我们在索尔兹伯里医院集团神经外科科室实施了6505例神经外科手术。尽管非洲人口比欧洲人口多20倍，但只有62%的手术是针对非洲患者，38%是针对欧洲患者。这部分是由于农村人口对疾病的耐受，部分是由于一些社会因素。欧洲人群中老年人的比例高于非洲人群，而且，尽管我们无法估算非洲人群中肿瘤的发病率，但我们预计他们的人均总体发病率会更低，因为恶性肿瘤往往发生在老年人中。我们不怀疑肿瘤发病率中存在遗传因素。非洲人中有205例原发性颅内肿瘤，欧洲人中有244例。组织学研究表明，非洲人群中所有肿瘤的33%为脑膜瘤，而欧洲人群中这一比例为19%。神经胶质瘤在欧洲系列中占61.3%，在非洲系列中占48.8%，但两组中星形细胞瘤按克诺汉分级的分布是相同的。如果年龄是一个因素，那么非洲人群中Ⅰ级和Ⅱ级应该占主导，但实际并非如此。我们欧洲患者中每种肿瘤的发病率与欧洲和美国各系列报道的模式一致。同样，我们非洲系列中出现的模式与非洲其他研究人员的报道非常相似。听神经瘤在非洲人当中似乎相当罕见。所有患肿瘤成年人的平均年龄，非洲组比欧洲组低15岁。然而，这完全与人口的年龄结构有关，而不是与发病年龄更早有关。髓母细胞瘤病例的平均年龄相同。在我们的欧洲系列中，按年龄的发病情况与海外研究人员报道的大致相同。欧洲组肿瘤的性别发病率似乎能合理反映其他地方的情况；在非洲组中则存在疑问，因为男性进城务工，把家人留在农村。两组肿瘤的位置没有显著差异。非洲组的治疗结果普遍较差，部分原因是到医院就诊较晚，肿瘤已经长得很大，还因为许多患者因并发疾病健康状况不佳。
