黑色素瘤发病率增加,死亡率不变:阳光照射更多,治疗更好,诊断活动增加,过度诊断或诊断值降低?
Jesper Bo Nielsen1, Ivar Sønbø Kristiansen1,2, Subash Thapa1,3
1Research Unit of General Practice, University of Southern Denmark, Odense, Denmark.
The British journal of dermatology
|April 24, 2024
概括
由于诊断活动和活检率的增加,丹麦的黑色素瘤发病率大幅上升,但死亡率保持稳定. 这表明过度诊断和较低的诊断值可能解释了增加的发病率而没有相应的死亡人数增加.
科学领域:
- 皮肤病学 皮肤病学
- 在瘤学瘤学.
- 公共卫生 公共卫生
背景情况:
- 黑色素瘤的发病率在全球范围内正在增加,但在许多国家,死亡率并没有按比例上升,这一趋势需要进一步调查.
- 黑色素瘤发病率和死亡率之间的差异尚未得到充分了解,因此需要对促成因素进行全面分析.
研究的目的:
- 调查影响丹麦黑色素瘤发病率和死亡率的因素,包括紫外线辐射 (UVR) 暴露,诊断活动,过度诊断和治疗进展.
- 用国家注册数据分析黑色素瘤发病率,现场黑色素瘤,非典型黑色素细胞病变和死亡率的趋势.
主要方法:
- 一项基于登记的综合性研究,分析了1999-2019年丹麦550万人口的国家病理和死亡数据库.
- 计算侵袭性黑色素瘤,现场黑色素瘤,非典型的黑色素细胞病变和良性naevi的年龄调整发病率,以及黑色素瘤死亡率.
主要成果:
- 从1999年到2011年,黑色素瘤的发病率显著增加,侵袭性黑色素瘤增加了87%,男性的黑色素瘤增加了476%,女性的黑色素瘤增加了357%. 非典型的黑色细胞病变的增加甚至更大 (1928%的男性,1686%的女性).
- 活检率在2011年之前大幅增加,但随后下降. 在研究期间,黑色素瘤死亡率没有显著的趋势. 没有检测到UVR暴露的增加.
- 针对晚期黑色素瘤的免疫疗法于2010年推出,并于2014年普遍使用,但在研究期间与死亡率趋势没有相关性.
结论:
- 丹麦黑色素瘤发病率的增加与活检率和诊断活动的增加密切相关,这表明潜在的过度诊断和诊断值降低.
- 虽然像免疫疗法这样的改善治疗方法可能起到作用,但由于研究的观察性质和多种影响因素,这些数据无法建立因果关系.
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