Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy.
Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy.
Gynecol Oncol. 2020 Jun;157(3):656-663. doi: 10.1016/j.ygyno.2020.03.013. Epub 2020 Apr 7.
The incidence of vulvar squamous cell carcinoma has increased for decades in most Western countries - a trend virtually restricted to women aged <50 or 60 years. In southern Europe, conversely, the trends have been insufficiently studied. This article reports a study from Italy.
Thirty-eight local cancer registries, currently covering 15,274,070 women, equivalent to 49.2% of the Italian national female population, participated. Invasive cancers registered between 1990 and 2015 with an International Classification of Diseases for Oncology, 3rd revision, topography code C51 and morphology codes compatible with vulvar squamous cell carcinoma (n = 6294) were eligible. Incidence trends were analysed using joinpoint regression models, with calculation of the estimated annual percent change (EAPC), and age-period-cohort models.
Total incidence showed a regular and significant decreasing trend (EAPC, -0.96; 95% confidence interval (CI), -1.43 to -0.48). This was entirely accounted for by women aged ≥60 years (EAPC, -1.34; 95% CI, -1.86 to -0.81). For younger women, the EAPC between 1990 and 2012 was 1.20 (95% CI, 0.34 to 2.06) with a non-significant acceleration thereafter. This pattern did not vary substantially in a sensitivity analysis for the effect of geographic area and duration of the registry. The age-period-cohort analysis revealed a risk decrease in cohorts born between 1905 and 1940 and a new increase in cohorts born since 1945.
The decreasing trend observed among older women and the resulting decrease in total rate are at variance with reports from most Western countries. Age-period-cohort analysis confirmed a decreasing trend for earliest birth cohorts and an opposite one for recent ones.
几十年来，大多数西方国家的外阴鳞状细胞癌发病率一直在上升——这种趋势几乎仅限于年龄<50 或 60 岁的女性。相比之下，在南欧，这些趋势研究得还不够充分。本文报告了一项来自意大利的研究。
38 个地方癌症登记处，目前覆盖了 15274070 名女性，相当于意大利全国女性人口的 49.2%，参与了这项研究。符合国际肿瘤疾病分类第 3 版，解剖学编码 C51 和形态学编码与外阴鳞状细胞癌相匹配（n=6294）的 1990 年至 2015 年登记的浸润性癌症被认为是合格的。使用 joinpoint 回归模型分析发病率趋势，计算估计的年平均百分比变化（EAPC）和年龄-时期-队列模型。
总发病率呈规则且显著的下降趋势（EAPC，-0.96；95%置信区间（CI），-1.43 至-0.48）。这完全归因于年龄≥60 岁的女性（EAPC，-1.34；95% CI，-1.86 至-0.81）。对于年轻女性，1990 年至 2012 年期间的 EAPC 为 1.20（95% CI，0.34 至 2.06），此后加速趋势不明显。在对地理区域和登记时间的影响进行敏感性分析后，这种模式并没有发生太大变化。年龄-时期-队列分析显示，出生于 1905 年至 1940 年的队列的风险降低，而自 1945 年以来出生的队列的风险增加。
观察到的老年女性发病率下降趋势以及由此导致的总发病率下降与大多数西方国家的报告不一致。年龄-时期-队列分析证实了最早出生队列的下降趋势和最近出生队列的相反趋势。
