Department of Pathology, Maastricht University Medical Centre+, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands.
Department of Epidemiology, GROW-School for Oncology and Reproduction, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
Virchows Arch. 2023 Dec;483(6):865-872. doi: 10.1007/s00428-023-03571-0. Epub 2023 Jun 3.
Autopsy rates are declining, while major discrepancies between autopsies and clinical diagnoses remain. Still, little is known about the impact of suspected underlying diseases, for example, a diagnosis of cancer, on the autopsy rate. The aim of this study was to investigate the relation between the clinical cause of death, a history of cancer, and the medical autopsy rate using data from the Netherlands Cohort Study on Diet and Cancer (NLCS), a large prospective cohort study with a long follow-up. The NLCS is a prospective study initiated in 1986 and includes 120,852 persons (58,279 males and 62,573 females), 55-69 years of age at the time of enrollment. The NLCS was linked with the Dutch Nationwide Pathology Databank (PALGA), the Dutch Population Register (GBA), the Netherlands Cancer Registry, and the causes of death registry (Statistics Netherlands). If applicable, the 95% confidence intervals were calculated. During the follow-up of the NLCS, 59,760 deaths were recorded by linkage with the GBA from 1991 until 2009. Of these, a medical autopsy was performed on 3736 deceased according to linkage with PALGA, resulting in an overall autopsy rate of 6.3%. Major variations in the autopsy rate were observed according to the cause of death. The autopsy rate increased according to the number of contributing causes of death. Lastly, a diagnosis of cancer affected the autopsy rate. The clinical cause of death and a history of cancer both influenced the medical autopsy rate in a large national cohort. The insight this study provides may help clinicians and pathologists counteracting the further downfall of the medical autopsy.
尸检率正在下降，而尸检与临床诊断之间仍存在重大差异。尽管如此，人们对疑似潜在疾病（例如癌症诊断）对尸检率的影响知之甚少。本研究旨在使用荷兰饮食与癌症队列研究（NLCS）的数据调查临床死因、癌症病史与医疗尸检率之间的关系，NLCS 是一项大型前瞻性队列研究，随访时间较长。NLCS 于 1986 年启动，包括 120852 人（58279 名男性和 62573 名女性），入组时年龄为 55-69 岁。NLCS 与荷兰全国病理数据库（PALGA）、荷兰人口登记处（GBA）、荷兰癌症登记处和死因登记处（荷兰统计局）相链接。如果适用，计算了 95%置信区间。在 NLCS 的随访期间，通过与 GBA 的链接，从 1991 年到 2009 年记录了 59760 例死亡。其中，根据与 PALGA 的链接，对 3736 名死者进行了医疗尸检，尸检率总体为 6.3%。根据死因的不同，尸检率存在较大差异。尸检率随着死因的数量而增加。最后，癌症诊断影响尸检率。临床死因和癌症病史都影响了大型国家队列的医疗尸检率。本研究提供的见解可能有助于临床医生和病理学家对抗医疗尸检率的进一步下降。
