Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen.
Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Int J Cancer. 2022 Aug 15;151(4):510-517. doi: 10.1002/ijc.34031. Epub 2022 Apr 29.
We analyzed long-term incidence trends in liver cancer (including hepatocellular carcinoma and intrahepatic cholangiocarcinoma) with an aim to interpret the changes in terms of known risk factors and hypothesize that historical exposure to Thorotrast, a radiographic contrast medium emitting alpha particles, has changed population rates. The NORDCAN database was used to collect cancer registry data from Denmark (DK), Finland (FI), Norway (NO) and Sweden (SE), which we used from 1953 (DK, FI and NO) and 1960 (SE) through 2019. Thorotrast, which caused a 100-fold risk of liver cancer was used in DK and SE, and probably also in FI between 1930 and 1950, but not in NO. The incidence trend for liver cancer showed a broad maximum at around 1980, most prominent and statistically significant in SE and DK men and women, and in all countries, a steadily increasing trend towards the end of follow-up. Incidence for NO was lower than for the other countries and the rates showed no peaking at around 1980. Birth cohort analysis identified a transient risk which could be dated to a period between 1930 and 1950 in countries other than NO. Considering a lag time between Thorotrast use and liver cancer appearance, the large incidence peak around 1980 in DK and DE was probably contributed by Thorotrast but considering the ecological nature of the findings, the association should be considered cautiously as hypothesis generating. The late increase in liver cancer risk is most likely lifestyle related and largely preventable.
我们分析了肝癌（包括肝细胞癌和肝内胆管癌）的长期发病率趋势，旨在根据已知的危险因素来解释这些变化，并假设历史上接触 Thorotrast（一种发射阿尔法粒子的放射造影剂）已经改变了人群的发病率。我们使用了 NORDCAN 数据库来收集丹麦（DK）、芬兰（FI）、挪威（NO）和瑞典（SE）的癌症登记数据，这些数据来自 1953 年（DK、FI 和 NO）和 1960 年（SE）至 2019 年。Thorotrast 曾导致肝癌的风险增加 100 倍，在 DK 和 SE 中使用，可能在 FI 中也在 1930 年至 1950 年之间使用，但在 NO 中没有使用。肝癌的发病率趋势在 1980 年左右出现了一个广泛的高峰，在 SE 和 DK 的男女中最为明显和具有统计学意义，在所有国家，随着随访的结束，发病率呈稳步上升趋势。NO 的发病率低于其他国家，而且发病率在 1980 年左右没有出现高峰。出生队列分析确定了一个短暂的风险，这个风险可以追溯到 1930 年至 1950 年期间除 NO 以外的国家。考虑到 Thorotrast 使用和肝癌出现之间的潜伏期，DK 和 DE 大约在 1980 年左右出现的高发病率高峰可能是由 Thorotrast 引起的，但考虑到这些发现的生态性质，应该谨慎地将这种关联视为产生假设的依据。肝癌风险的晚期增加很可能与生活方式有关，而且在很大程度上是可以预防的。
