The rising incidence of adenocarcinoma relative to squamous cell carcinoma of the uterine cervix in the United States - A 24-year population-based study
The rising incidence of adenocarcinoma relative to squamous cell carcinoma of the uterine cervix in the United States - A 24-year population-based study
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DOI：
10.1006/gyno.2000.5826
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发表时间：
2000-08-01
影响因子：
4.7
通讯作者：
Key, CR
中科院分区：
文献类型：
--
作者：
Smith, HO;Tiffany, MF;Key, CR
Objective.本研究的目的是使用基于人群的数据比较宫颈浸润性腺癌和鳞状细胞癌的年龄校正发病率和生存率。SEER数据库用于确定1973年至1996年期间登记的所有宫颈癌病例。阶段被定义为局部的，区域的，或遥远的。使用Jonchkeere-Terpstra精确趋势检验对经统计学校正的发生率进行统计学分析。采用z检验和对数秩检验分别比较相对和观察生存率。所有浸润性宫颈癌的年龄校正发病率每10万人在24年中下降了36.9%[12.35（1973-1977）vs 7.79（1993-1996）]。同样，鳞状细胞癌的年龄校正发病率下降了41.9% [9.45（1973-1977）vs 5.49（1993-1996）]。相反，腺癌的年龄校正发病率增加了29.1% [1.34（1973-1977）vs 1.73（1993-1996）]。腺癌的比例相对于所有宫颈癌增加了107.4%，相对于鳞状细胞癌增加了95.2%，相对于高危女性人群增加了49.3%[10.8% vs 22.4%（P < 0.001）、12.4%对24.0%（P < 0.001）和1.40对2.09/10万妇女（P < 0.001）]。腺癌与鳞状细胞癌的生存率在区域性疾病中比较差（P = 0.04），但在局部或远处疾病中没有差异。在过去24年中，所有宫颈癌和鳞状细胞癌的发病率持续下降。然而，腺癌相对于鳞状细胞癌和所有宫颈癌的比例增加了一倍，每个高危人群的腺癌比例也增加了。这些结果表明，美国目前的筛查实践不足以检测到相当大比例的腺癌前体病变。(C)北京大学出版社.
Objective. The aim of this study was to compare the age-adjusted incidence and survival for invasive adenocarcinoma and squamous cell carcinoma of the uterine cervix using population-based data.Methods. The SEER database was used to identify all cases of cervical cancer registered between 1973 and 1996. Stage was defined as localized, regional, or distant. Age-adjusted incidence rates were analyzed statistically using the Jonchkeere-Terpstra exact test for trends. Relative and observed survival rates, respectively, were compared using z tests and log-rank tests.Results. The age-adjusted incidence rates per 100,000 for all invasive cervical cancers decreased by 36.9% over 24 years [12.35 (1973-1977) vs 7.79 (1993-1996)]. Similarly, the age-adjusted incidence rates for squamous cell carcinoma declined by 41.9% [9.45 (1973-1977) vs 5.49 (1993-1996)]. In contrast, the age-adjusted incidence rates for adenocarcinoma increased by 29.1% [1.34 (1973-1977) vs 1.73 (1993-1996)]. The proportion of adenocarcinoma increased 107.4% relative to all cervical cancer, 95.2% relative to squamous cell carcinoma, and 49.3% relative to the population of women at risk [10.8% vs 22.4% (P < 0.001), 12.4% vs 24.0% (P < 0.001), and 1.40 vs 2.09 per 100,000 women (P < 0.001), respectively]. Observed survival rates for adenocarcinoma vs squamous cell carcinoma were poorer for regional (P = 0.04), but not localized or distant disease.Conclusions. Over the past 24 years, the incidence of all cervical cancer and squamous cell carcinoma has continued to decline. However, the proportion of adenocarcinoma relative to squamous cell carcinoma and to all cervical cancers has doubled, and the rate of adenocarcinoma per population at risk has also increased. These results suggest that current screening practices in the United States are insufficient to detect a significant proportion of adenocarcinoma precursor lesions. (C) 2000 Academic Press.