Usher Institute, University of Edinburgh, Edinburgh, UK.
Brain Tumour Centre of Excellence, Cancer Research UK Edinburgh Centre, University of Edinburgh, Edinburgh, UK.
Neuro Oncol. 2021 Jun 1;23(6):979-989. doi: 10.1093/neuonc/noaa282.
Increasing incidence of central nervous system (CNS) tumors has been noted in some populations. However, the influence of changing surgical and imaging practices has not been consistently accounted for.
We evaluated average annual percentage change (AAPC) in age- and gender-stratified incidence of CNS tumors by tumor subtypes and histological confirmation in Wales, United Kingdom (1997-2015) and the United States (2004-2015) using joinpoint regression.
In Wales, the incidence of histologically confirmed CNS tumors increased more than all CNS tumors (AAPC 3.62% vs 1.63%), indicating an increasing proportion undergoing surgery. Grade II and III glioma incidence declined significantly (AAPC -3.09% and -1.85%, respectively) but remained stable for those with histological confirmation. Grade IV glioma incidence increased overall (AAPC 3.99%), more markedly for those with histological confirmation (AAPC 5.36%), suggesting reduced glioma subtype misclassification due to increased surgery. In the United States, the incidence of CNS tumors increased overall but was stable for histologically confirmed tumors (AAPC 1.86% vs 0.09%) indicating an increase in patients diagnosed without surgery. An increase in grade IV gliomas (AAPC 0.28%) and a decline in grade II gliomas (AAPC -3.41%) were accompanied by similar changes in those with histological confirmation, indicating the overall trends in glioma subtypes were unlikely to be caused by changing diagnostic and clinical management.
Changes in clinical practice have influenced the incidence of CNS tumors in the United Kingdom and the United States. These should be considered when evaluating trends and in epidemiological studies of putative risk factors for CNS tumors.
一些人群中枢神经系统（CNS）肿瘤的发病率不断上升。然而，手术和影像学实践改变的影响尚未得到一致解释。
我们使用 joinpoint 回归评估了英国威尔士（1997-2015 年）和美国（2004-2015 年）按年龄和性别分层的 CNS 肿瘤亚型和组织学确诊发病率的年均百分比变化（AAPC）。
在威尔士，组织学确诊的 CNS 肿瘤发病率增长超过所有 CNS 肿瘤（AAPC 分别为 3.62%和 1.63%），表明接受手术的比例不断增加。II 级和 III 级神经胶质瘤的发病率显著下降（AAPC 分别为-3.09%和-1.85%），但经组织学确诊的肿瘤发病率保持稳定。IV 级神经胶质瘤的发病率总体增加（AAPC 为 3.99%），经组织学确诊的肿瘤发病率增加更为明显（AAPC 为 5.36%），表明由于手术增加，神经胶质瘤亚型分类错误减少。在美国，CNS 肿瘤的发病率总体增加，但经组织学确诊的肿瘤发病率保持稳定（AAPC 分别为 1.86%和 0.09%），表明未经手术诊断的患者数量增加。IV 级神经胶质瘤的发病率增加（AAPC 为 0.28%）和 II 级神经胶质瘤的发病率下降（AAPC 为-3.41%），与经组织学确诊的肿瘤相似，表明神经胶质瘤亚型的总体趋势不太可能是由改变的诊断和临床管理引起的。
临床实践的变化影响了英国和美国 CNS 肿瘤的发病率。在评估 CNS 肿瘤的趋势和疑似危险因素的流行病学研究中，应考虑这些变化。
