Spix Claudia, Eletr Dina, Blettner Maria, Kaatsch Peter
German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University of Mainz, Germany.
Int J Cancer. 2008 Apr 15;122(8):1859-67. doi: 10.1002/ijc.23281.
The German Childhood Cancer Registry regularly presents graphs of childhood cancer incidence rates by period, but no systematic analysis. The Automated Childhood Cancer Information System-project found an increasing trend in Europe. Against this background we present the first detailed trend analysis of childhood (aged under 15) malignancies in Germany. We examined incidence rates separately in western Germany 1987-2004 and eastern Germany 1991-2004. We analyzed all malignancies, all main diagnostic groups and relevant subsets using an age-period-cohort model. Additionally we fitted fractional polynomials to assess the linearity of the drift. All malignancies combined (excluding Central Nervous System-tumors and neuroblastoma) show a significant trend: +0.7% in western and +1.1% per year in eastern Germany. The overall trend in Germany is mostly due to the significant increase in lymphoid leukemia, which increased significantly in western Germany (+0.7% per year) and significantly nonlinearly in eastern Germany (+3.3% per year until 1998, +0.8% since 1998), catching up from a level 20% below western Germany. This could be due to life style changes since the reunification in eastern Germany influencing early immune system training. We found no trends for acute non-lymphocytic leukemia and non-Hodgkin lymphoma. Hodgkin's disease shows a cohort effect in western Germany after reunification. Improved registration of CNS tumors led to an increase. Neuroblastoma yielded a period effect in western Germany due to screening. With the exception of germ cell tumors, further observations for solid tumor entities are in agreement with those reported for Europe.
德国儿童癌症登记处定期公布各时期儿童癌症发病率的图表，但未进行系统分析。自动化儿童癌症信息系统项目发现欧洲呈现上升趋势。在此背景下，我们对德国15岁以下儿童恶性肿瘤进行了首次详细的趋势分析。我们分别研究了1987 - 2004年西德和1991 - 2004年东德的发病率。我们使用年龄 - 时期 - 队列模型分析了所有恶性肿瘤、所有主要诊断组及相关亚组。此外，我们拟合了分数多项式以评估趋势的线性。所有恶性肿瘤合并（不包括中枢神经系统肿瘤和神经母细胞瘤）呈现显著趋势：西德每年上升0.7%，东德每年上升1.1%。德国的总体趋势主要归因于淋巴细胞白血病的显著增加，其在西德显著上升（每年0.7%），在东德显著非线性上升（1998年前每年3.3%，1998年后每年0.8%），从低于西德20%的水平追赶上来。这可能是由于东德统一后生活方式的改变影响了早期免疫系统训练。我们未发现急性非淋巴细胞白血病和非霍奇金淋巴瘤的趋势。霍奇金病在统一后的西德呈现队列效应。中枢神经系统肿瘤登记的改善导致发病率上升。由于筛查，神经母细胞瘤在西德呈现时期效应。除生殖细胞肿瘤外，实体瘤的进一步观察结果与欧洲报道的一致。
