国际睾丸癌发病率趋势：35 年和 41 个国家的经验教训。
International Trends in the Incidence of Testicular Cancer: Lessons from 35 Years and 41 Countries.
机构信息
Cancer and Chronic Conditions Research Group, Department of Public Health, University of Otago, Wellington, New Zealand.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
出版信息
Eur Urol. 2019 Nov;76(5):615-623. doi: 10.1016/j.eururo.2019.07.002. Epub 2019 Jul 17.
BACKGROUND
Incidence rates of testicular cancer (TC) have been increasing in many countries since, at least, the mid-20th century without clear explanation. Examining the varying trends across countries and time provides clues to understanding the causes of TC.
OBJECTIVE
We have presented incidence data from 41 countries and evaluated incidence trends for the 35-yr period from 1978 to 2012.
DESIGN, SETTING, AND PARTICIPANTS: Cancer registry data from Cancer Incidence in Five Continents (CI5) volumes V-XI, CI5plus, and the NORDCAN database were analysed.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Age-standardised rates of TC overall and by histological type were calculated. A joinpoint regression model of the natural log-transformed rates was used to calculate the average annual percent change (AAPC) in incidence. Age-period-cohort modelling was used to examine the effect of birth cohort on rates.
RESULTS AND LIMITATIONS
While the highest incidence of TC remains in Northern Europe, the gap is closing between higher- and lower-incidence regions. Age-period-cohort modelling found flattening of risk among recent cohorts in Denmark and the UK, a steady increase in risk in the USA (particularly for seminomas), and an increase in risk among more recent cohorts in Costa Rica, Croatia, and Slovakia.
CONCLUSIONS
The gap between low- and high-incidence countries is closing due to increases in the former and stabilisation in the latter. Understanding the causes of these and other differences in incidence rates between, and within, countries may help further our understanding of the aetiology of this cancer.
PATIENT SUMMARY
We examined the rates of testicular cancer in different countries over time. These rates have been increasing, although the rates in high-incidence countries seem to be slowing down, while rates in low-incidence countries are catching up. These trends might help us understand what is causing testicular cancer in general.
背景
自 20 世纪中叶以来，许多国家的睾丸癌（TC）发病率一直在上升，但原因尚不清楚。研究各国和不同时期的变化趋势为了解 TC 的病因提供了线索。
目的
我们展示了 41 个国家的发病率数据，并评估了 1978 年至 2012 年 35 年间的发病率趋势。
设计、地点和参与者：分析了《五大洲癌症发病率》（CI5）第五至第十一卷、CI5plus 和 NORDCAN 数据库中的癌症登记数据。
观察指标和统计分析
计算了 TC 总体和组织学类型的年龄标准化发病率。采用自然对数转换率的联合回归模型计算发病率的年均百分比变化（AAPC）。采用年龄-时期-队列模型检查出生队列对发病率的影响。
结果和局限性
虽然 TC 的最高发病率仍在北欧，但高发病率和低发病率地区之间的差距正在缩小。年龄-时期-队列模型发现丹麦和英国最近的队列风险趋于平稳，美国（尤其是精原细胞瘤）的风险稳步上升，哥斯达黎加、克罗地亚和斯洛伐克最近的队列风险上升。
结论
由于高发病率国家发病率的增加和低发病率国家发病率的稳定，低发病率国家和高发病率国家之间的差距正在缩小。了解这些国家和国家内部发病率差异的原因，可能有助于进一步了解这种癌症的病因。
患者总结
我们研究了不同国家在不同时间的睾丸癌发病率。这些比率一直在上升，尽管高发病率国家的比率似乎在放缓，而低发病率国家的比率在上升。这些趋势可能有助于我们了解一般导致睾丸癌的原因。
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