Department of Public Health, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Oral Oncol. 2013 Mar;49(3):237-43. doi: 10.1016/j.oraloncology.2012.09.016. Epub 2012 Oct 22.
Nasopharyngeal carcinoma (NPC) is rare in western countries albeit affected by common and unrelated phenomena: smoking less in men, more in women and immigration from China and North Africa. We studied trends in NPC incidence, tumour morphology, survival and mortality in order to assess progress against this cancer.
A trend analysis was performed with nationwide incidence and survival data (from The Netherlands Cancer registry in 1989-2009), followed by analysis of mortality (data from Statistics Netherlands) covering the period 1970-2009, and calculating estimated percentages of change (EAPC) in both. According to the WHO classification we distinguished keratinizing SCC (WHO-I), differentiated (WHO-IIA) and undifferentiated (WHO-IIB) non-keratinizing carcinoma.
NPC incidence significantly decreased since 1989, especially in males (EAPC 1989-2009: -1.3; 95% CI: -2.5, -0.2) and in patients with keratinizing SCC (WHO-I) (EAPC: -3.6; 95% CI: -5.3, -1.8). By contrast, the incidence of differentiated non-keratinizing tumours (WHO-IIA) significantly increased in the same period (EAPC: 9.6; 95% CI: 5.6, 13.5). One- and three-year relative survival, as an indicator of disease-specific survival increased slightly from 79% to 81% and from 57% to 65% since 1989. NPC mortality significantly decreased since 1970 (EAPC: -1.2; 95% CI: -1.8, -0.5) and more pronounced since 1989 (EAPC: -3.0; 95% CI: -4.3, -1.6).
During the past two decades, the incidence of NPC in The Netherlands decreased mainly by less keratinizing, supposedly smoking-related NPC (WHO-I). However, the incidence of non-keratinizing NPC (WHO-IIA, B) increased, most likely due to EBV infection and thus related to higher immigration levels of people from high-incidence areas.
尽管鼻咽癌（NPC）在西方国家较为罕见，但仍存在一些共同且不相关的现象：男性吸烟减少，女性吸烟增加，以及来自中国和北非的移民。我们研究了 NPC 发病率、肿瘤形态、生存和死亡率的趋势，以评估针对这种癌症的进展情况。
对全国范围内的发病率和生存率数据（1989-2009 年来自荷兰癌症登记处）进行趋势分析，然后分析死亡率（1970-2009 年来自荷兰统计局的数据），并计算两者的估计百分比变化（EAPC）。根据世界卫生组织（WHO）分类，我们区分了角化性鳞状细胞癌（WHO-I）、分化型（WHO-IIA）和未分化型（WHO-IIB）非角化性癌。
自 1989 年以来，NPC 的发病率显著下降，尤其是男性（1989-2009 年的 EAPC：-1.3；95%CI：-2.5，-0.2）和角化性鳞状细胞癌（WHO-I）患者（EAPC：-3.6；95%CI：-5.3，-1.8）。相比之下，同期分化型非角化性肿瘤（WHO-IIA）的发病率显著增加（EAPC：9.6；95%CI：5.6，13.5）。自 1989 年以来，作为疾病特异性生存率的指标，一年和三年相对生存率略有增加，从 79%增加到 81%，从 57%增加到 65%。自 1970 年以来，NPC 的死亡率显著下降（EAPC：-1.2；95%CI：-1.8，-0.5），自 1989 年以来下降更为明显（EAPC：-3.0；95%CI：-4.3，-1.6）。
在过去的二十年中，荷兰 NPC 的发病率下降主要是由于角化程度降低，推测与吸烟有关的 NPC（WHO-I）减少。然而，非角化 NPC（WHO-IIA，B）的发病率增加，可能与 EBV 感染有关，因此与高发病率地区移民人数的增加有关。
