临床上检测到的胃肠胰神经内分泌肿瘤正在增加：德国的流行病学变化。
Clinically detected gastroenteropancreatic neuroendocrine tumors are on the rise: epidemiological changes in Germany.
机构信息
Hans Scherübl, Christoph Schwertner, Joachim Steinberg, Jan Eick, Wanda Ring, Krishna Tiwari, Klinik für Gastroenterologie, GI Onkologie und Infektiologie, Vivantes Klinikum Am Urban, 10967 Berlin, Germany.
出版信息
World J Gastroenterol. 2013 Dec 21;19(47):9012-9. doi: 10.3748/wjg.v19.i47.9012.
AIM
To study the epidemiologic changes of gastroenteropancreatic neuroendocrine tumors (GEP-NET) in Germany, we analyzed two time periods 1976-1988 and 1998-2006.
METHODS
We evaluated epidemiological data of GEP-NET from the former East German National Cancer Registry (DDR Krebsregister, 1976-1988) and its successor, the Joint Cancer Registry (GKR, 1998-2006), which was founded after German reunification. Due to a particularly substantial database the epidemiological data from the federal states of Mecklenburg-Western Pomerania, Saxony, Brandenburg and Thuringia, covering a population of more than 10.8 million people, were analyzed. Survival probabilities were calculated using life table analysis. In addition, GEP-NET patients were evaluated for one or more second (non-GEP-NET) primary malignancies.
RESULTS
A total of 2821 GEP neuroendocrine neoplasms were identified in the two registries. The overall incidence increased significantly between 1976 and 2006 from 0.31 (per 100.000 inhabitants per year) to 2.27 for men and from 0.57 to 2.38 for women. In the later period studied (2004-2006), the small intestine was the most common site. Neuroendocrine (NE) neoplasms of the small intestine showed the largest absolute increase in incidence, while rectal NE neoplasms exhibited the greatest relative increase. Only the incidence of appendiceal NET in women showed little change between 1976 and 2006. Overall survival of patients varied for sex, tumor site and the two periods studied but improved significantly over time. Interestingly, about 20% of the GEP-NET patients developed one or more second malignancies. Their most common location was the gastrointestinal tract. GEP-NET patients without second malignancies fared better than those with one or more of them.
CONCLUSION
The number of detected GEP-NET increased about 5-fold in Germany between 1976 and 2006. At the same time, their anatomic distribution changed, and the survival of GEP-NET patients improved significantly. Second malignancies are common and influence the overall survival of GEP-NET patients. Thus, GEP-NET warrant our attention as well as intensive research on their tumorigenesis.
目的
为了研究德国胃肠胰神经内分泌肿瘤（GEP-NET）的流行病学变化，我们分析了两个时间段，分别为 1976-1988 年和 1998-2006 年。
方法
我们评估了前东德国家癌症登记处（DDR Krebsregister，1976-1988 年）及其后继机构联合癌症登记处（GKR，1998-2006 年）的 GEP-NET 流行病学数据，该登记处是在德国统一后成立的。由于数据库特别庞大，我们分析了来自梅克伦堡-前波美拉尼亚、萨克森、勃兰登堡和图林根联邦州的流行病学数据，这些联邦州的人口超过 1080 万人。使用寿命表分析计算了生存概率。此外，我们还评估了 GEP-NET 患者是否患有一种或多种第二（非 GEP-NET）原发性恶性肿瘤。
结果
在这两个登记处共发现 2821 例 GEP 神经内分泌肿瘤。1976 年至 2006 年期间，男性的总体发病率从 0.31（每 10 万居民每年）显著上升至 2.27，女性的发病率从 0.57 上升至 2.38。在研究的后期（2004-2006 年），小肠是最常见的部位。小肠神经内分泌（NE）肿瘤的发病率增长最大，而直肠 NE 肿瘤的发病率增长最大。只有女性阑尾 NET 的发病率在 1976 年至 2006 年间变化不大。患者的总体生存率因性别、肿瘤部位和研究的两个时期而有所不同，但随着时间的推移显著提高。有趣的是，约 20%的 GEP-NET 患者患有一种或多种第二恶性肿瘤。它们最常见的部位是胃肠道。没有第二恶性肿瘤的 GEP-NET 患者比有一个或多个第二恶性肿瘤的患者预后更好。
结论
1976 年至 2006 年间，德国检测到的 GEP-NET 数量增加了约 5 倍。与此同时，它们的解剖分布发生了变化，GEP-NET 患者的生存率显著提高。第二恶性肿瘤很常见，影响 GEP-NET 患者的总体生存率。因此，GEP-NET 需要我们的关注，以及对其肿瘤发生的深入研究。
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