Radhakrishnan K, Mokri B, Parisi J E, O'Fallon W M, Sunku J, Kurland L T
Department of Neurology, Mayo Clinic, Rochester, MN 55905.
Ann Neurol. 1995 Jan;37(1):67-73. doi: 10.1002/ana.410370113.
A number of reports have suggested an increasing incidence of primary brain tumors, especially malignant astrocytomas, in the elderly population. To investigate this issue, we analyzed the incidence and temporal trends of primary intracranial neoplasms diagnosed in the population of Rochester, Minnesota, over the 40 years between 1950 and 1990. The incidence of symptomatic primary brain tumors (excluding patients diagnosed incidentally at autopsy and by neuroimaging studies) increased from 9.5 per 100,000 population per year in 1950 to 1969 to 12.5 per 100,000 per year in 1970 to 1989; this change was not statistically significant (chi 2 trend, 1.89; p = 0.17). While the incidence of pituitary adenomas increased significantly between the two periods (chi 2 trend, 4.44; p = 0.04), the incidence trends of all gliomas, malignant astrocytomas, and meningiomas showed no change among persons younger than 65 years as well as those 65 years and older. The number of patients incidentally found to have neoplasms by neuroimaging studies increased in the recent 20-year period (chi 2 trend, 4.08; p = 0.04). The average age- and sex-adjusted incidence rates per 100,000 per year during the study period in the population of Rochester, Minnesota, for symptomatic tumors were 5.0 for all gliomas, 3.3 for malignant astrocytomas, 2.0 for meningiomas, and 2.4 for pituitary adenomas. In conclusion, our data indicate that the reported increase in the incidence of primary brain tumors is an artifact of improvement in diagnostic technology and practice.
多项报告表明，原发性脑肿瘤尤其是恶性星形细胞瘤在老年人群中的发病率呈上升趋势。为研究此问题，我们分析了1950年至1990年这40年间明尼苏达州罗切斯特市人群中诊断出的原发性颅内肿瘤的发病率及时间趋势。有症状的原发性脑肿瘤（不包括尸检和神经影像学检查偶然诊断出的患者）的发病率从1950年至1969年的每年每10万人9.5例增至1970年至1989年的每年每10万人12.5例；这一变化无统计学意义（卡方趋势检验，1.89；p = 0.17）。虽然两个时期垂体腺瘤的发病率显著增加（卡方趋势检验，4.44；p = 0.04），但在65岁及以下人群以及65岁及以上人群中，所有胶质瘤、恶性星形细胞瘤和脑膜瘤的发病率趋势均无变化。在最近20年期间，通过神经影像学检查偶然发现肿瘤的患者数量有所增加（卡方趋势检验，4.08；p = 0.04）。在研究期间，明尼苏达州罗切斯特市人群中有症状肿瘤的年龄和性别调整后的年发病率为：所有胶质瘤每10万人5.0例，恶性星形细胞瘤每10万人3.3例，脑膜瘤每10万人2.0例，垂体腺瘤每10万人2.4例。总之，我们的数据表明，报告的原发性脑肿瘤发病率增加是诊断技术和实践改进的假象。
