Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, Thailand.
Cancer Unit, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand.
Asian Pac J Cancer Prev. 2020 Nov 1;21(11):3291-3299. doi: 10.31557/APJCP.2020.21.11.3291.
While nasopharyngeal carcinoma (NPC) is rare in non-endemic regions such as the North America, endemic countries, such as Thailand, continue to struggle with high incidence and mortality rates. NPC has a complex etiology that varies by histological subtype.
NPC cases (1990-2014) were identified using the International Classification of Diseases for Oncology (ICD-O) code C11 from the Chiang Mai, Khon Kaen, Lampang, and Songkhla cancer registries and compared to Asian/Pacific Islanders (A/PI) from the US SEER program. Age-standardized incidence rates and changes in annual percent change (APC) for overall and subtype specific NPC were assessed using R and Joinpoint. Kaplan Meier curves were generated in SAS to evaluate differences in survival by sex, year of diagnosis and histological subtype. Five-year relative survival estimates were calculated between 2000-2014.
Non-keratinizing NPC predominated across all registries except Songkhla, where the keretinizing subtype made up ~60% of all reported cases. Incidence of keratinizing NPC significantly decreased among Chiang Mai males between 1996 and 2014 (APC:-13.0 [95%CI:-16.2, -9.6]), Songkhla females (APC:-4.0 [95%CI: -7.4, -0.5]) and males between 2006 and 2014 (APC:-15.5 [95%CI:-25.0, -4.7]), as well as A/PI females (APC:-5.1 [95%CI:-6,7, -3.4]) and males (APC: -4.8 [95%CI:-5.9, -3.7]). Non-keratinizing NPC increased among Songkhla males (APC:4.3 [95%CI:1.8, 6.9]). The keratinizing subtype exhibited the worst survival, while the non-keratinizing undifferentiated subtype had the best survival. Although US A/PI had the highest 5-year relative survival estimates, among the Thai registries Chiang Mai had the best and Lampang the worst survival.
Although US A/PIs exhibited similar rates of NPC as seen in the endemic Thai population, improved tobacco control has led to a decrease in keratinizing NPC incidence irrespective of geography. Additionally, while challenges associate with access to care may still exist among rural Thais, chemoradiation was shown to confer a survival benefit in non-keratinizing NPC treatment.
尽管鼻咽癌（NPC）在北美的非流行地区（如北美）较为罕见，但像泰国这样的流行地区，仍在与高发病率和死亡率作斗争。NPC 的病因复杂，其组织学亚型不同。
从清迈、孔敬、廊开和宋卡癌症登记处，使用国际肿瘤疾病分类（ICD-O）代码 C11 识别 NPC 病例（1990-2014 年），并与美国 SEER 计划中的亚洲/太平洋岛民（A/PI）进行比较。使用 R 和 Joinpoint 评估总体和亚型特异性 NPC 的年龄标准化发病率和年度百分比变化（APC）的变化。在 SAS 中生成 Kaplan-Meier 曲线，以评估性别、诊断年份和组织学亚型对生存的影响。计算 2000-2014 年期间的 5 年相对生存率估计值。
除了宋卡，所有登记处都以非角化 NPC 为主，非角化 NPC 在那里占所有报告病例的~60%。在清迈男性中，角化 NPC 的发病率在 1996 年至 2014 年间显著下降（APC：-13.0[95%CI：-16.2，-9.6]），在宋卡女性（APC：-4.0[95%CI：-7.4，-0.5]）和 2006 年至 2014 年期间的男性中（APC：-15.5[95%CI：-25.0，-4.7]），以及 A/PI 女性（APC：-5.1[95%CI：-6，7，-3.4]）和男性（APC：-4.8[95%CI：-5.9，-3.7]）。在宋卡男性中，非角化 NPC 有所增加（APC：4.3[95%CI：1.8，6.9]）。角化 NPC 亚型的生存率最差，而非角化未分化亚型的生存率最好。尽管美国 A/PI 的 5 年相对生存率估计值最高，但在泰国登记处中，清迈的生存率最高，而廊开的生存率最低。
尽管美国 A/PI 与泰国流行地区所见 NPC 发病率相似，但烟草控制的改善导致无论地理位置如何，角化 NPC 的发病率都有所下降。此外，尽管农村泰国人可能仍然面临获得医疗服务的挑战，但在非角化 NPC 治疗中，化疗放疗可带来生存获益。
