Miller R W, Young J L, Novakovic B
Clinical Epidemiology Branch, National Cancer Institute, Bethesda, Maryland 20892-7360.
Cancer. 1995 Jan 1;75(1 Suppl):395-405. doi: 10.1002/1097-0142(19950101)75:1+<395::aid-cncr2820751321>3.0.co;2-w.
Cancers of individual organs generally are composed of various histologic types, each with its own frequency and demographic patterns. For childhood cancers in particular, a classification of cancers by histologic type is important for understanding the etiology and progression of the disease.
Data from the Surveillance, Epidemiology, and End Results (SEER) Program on 9308 microscopically confirmed malignant neoplasms in children younger than age 15, newly diagnosed during 1973-1987, were made available for analysis. Tumors were grouped histologically according to a classification previously utilized in an international volume of childhood cancer incidence.
The most frequent histologic types were acute lymphocytic leukemia (23.6%), astrocytoma (9.6%), neuroblastoma (6.6%), and Wilms' tumor (6.4%). Acute lymphocytic leukemia accounted for 75% of childhood leukemia. The most common form of Hodgkin's disease was the nodular sclerosing subtype, which was diagnosed in 56% of all cases. Burkitt's and Burkitt-like disease accounted for approximately one third of non-Hodgkin's lymphoma, the sex ratio (male to female) being unusually high (5.7). Among the brain tumors, glioma was of interest because 198 cases (excluded from this analysis) were diagnosed without histologic confirmation--due, no doubt, to their inaccessibility for biopsy because they were located in the brain stem. The most common histologic type of soft tissue sarcoma was rhabdomyosarcoma, which accounted for 51% of the total, more than half of which were of the embryonal type. To the authors' knowledge, this report offers for the first time the relative frequencies of rare types of leukemias, such as megakaryoblastic leukemia, in childhood. This report also includes the frequencies of 21 rarer forms of soft tissue sarcoma. Five forms of childhood cancer had a 5-year relative survival rate of 85% or better. Of the cancers with the poorest outcome, three had relative survival rates of 46.5-49%; the relative survival rate of acute myelogenous leukemia was only 26.4%. The trends in survival over time for 21 types of childhood cancer also are included in this report.
Further refinements in classification now are available through laboratory techniques utilizing molecular biology, immunology, and cytogenetics, which are of importance in etiologic studies, diagnosis, treatment, and prognosis. It would be important in the future for cancer registries to record the results of relevant laboratory tests for further analysis by subtype.
单个器官的癌症通常由多种组织学类型组成，每种类型都有其自身的发病率和人口统计学模式。特别是对于儿童癌症，按组织学类型对癌症进行分类对于理解疾病的病因和进展非常重要。
提供了监测、流行病学和最终结果（SEER）计划中1973 - 1987年期间新诊断的9308例15岁以下儿童经显微镜确诊的恶性肿瘤数据用于分析。根据先前在一本国际儿童癌症发病率书籍中使用的分类方法，将肿瘤按组织学进行分组。
最常见的组织学类型为急性淋巴细胞白血病（23.6%）、星形细胞瘤（9.6%）、神经母细胞瘤（6.6%）和肾母细胞瘤（6.4%）。急性淋巴细胞白血病占儿童白血病的75%。霍奇金病最常见的形式是结节硬化亚型，在所有病例中占56%。伯基特淋巴瘤和伯基特样疾病约占非霍奇金淋巴瘤的三分之一，其性别比（男至女）异常高（5.7）。在脑肿瘤中，胶质瘤值得关注，因为有198例（本分析中排除）在未进行组织学确诊的情况下被诊断出来——无疑是因为它们位于脑干，难以进行活检。软组织肉瘤最常见的组织学类型是横纹肌肉瘤，占总数的51%，其中一半以上是胚胎型。据作者所知，本报告首次提供了儿童期罕见白血病类型（如巨核细胞白血病）的相对发病率。本报告还包括21种较罕见的软组织肉瘤的发病率。五种儿童癌症的5年相对生存率为85%或更高。在预后最差的癌症中，三种癌症的相对生存率为46.5% - 49%；急性髓细胞白血病的相对生存率仅为26.4%。本报告还包括21种儿童癌症随时间的生存趋势。
现在可以通过利用分子生物学、免疫学和细胞遗传学的实验室技术对分类进行进一步细化，这在病因学研究、诊断、治疗和预后方面都很重要。未来癌症登记处记录相关实验室检测结果以便按亚型进行进一步分析将很重要。
