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Eye (2011) 25, 461–465; doi:10.1038/eye.2011.9; appear online 18 February 2011
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Knowledge of the epidemiology of alternate tumours, can aid the analyst in developing a cogwheel assay back presented with a accommodating with proptosis or eyelid swelling.
The accident of cancerous tumours of all primary sites is rising,1 it is additionally of absorption if alternate tumours appearance this aforementioned ascent trend. Alone one abstraction letters on the accident numbers of cancerous alternate tumours on a population-based level, this abstraction was conducted in the USA and shows a ascent trend.2 These abstracts are not accessible for Europe.
Cancers can appearance bounded differences in their about frequencies, for archetype uveal melanoma is almost added accepted in North America and Europe.3, 4 Bounded differences in alternate tumour frequencies may advance ecology factors are complex in ache development.
The aboriginal ambition of this cardboard is to address on the accident numbers of cancerous alternate tumours in the Netherlands and its development over time, to assay for accessible trends in time. The additional ambition of our abstraction is to actuate the about frequencies of altered histological subtypes of cancerous alternate tumours and analyze these with added genitalia of the world, to see if there are any bounded differences.
All primary cancerous alternate tumours were called from the Netherlands Blight Anthology (NCR) database from 1989 to 2006, bound to association of the Netherlands.
Orbit is authentic as the tissues aural the alternate atrium after to the alternate septum (including the lacrimal gland). In this study, tumours anon extending from aural the globe, the eyelid skin, the conjunctiva, the accent lacrimal glands or the paranasal sinuses to the apogee or abroad alteration to the apogee are excluded.
The NCR annal all blight cases from 1989 onwards. New blight cases are detected through a nation-wide arrangement and anthology of histo- and cytopathology (PALGA).5 Added sources of cases are a civic anthology of hospital acquittal diagnoses (LMR) and haematological laboratories. Specially accomplished NCR agents annal abstracts of new blight cases from the medical files in the hospitals. The all-embracing allocation of diseases for oncology (ICD-O) is acclimated as base for coding of tumours.6
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In this abstraction the topographical armpit codes C69.6 (for orbit) and C69.5 (for breach gland) were acclimated to analyze primary cancerous alternate tumours. The topographical codes C69.3 (for choroid) and C69.4 (for ciliary body) were acclimated to clarify out all uveal tumours. Subsequently, melanomas (morphological codes 8720 through 8790) were selected, to analyze the cardinal of uveal melanomas with the cardinal of primary cancerous alternate tumours.
Tumour types with carefully accompanying morphological characteristics and analytic behaviour, were aggregate in appointment with an eye pathologist (MRD).
To account the awkward incidence, the cardinal of tumours per year was disconnected by the mid-year citizenry provided by the Netherlands Citizenry Statistics.7 To acclimatize for the demographic agency age, the apple standardised arrangement (WSR) was calculated.8 To abate concise fluctuations, we acclimated the centred 3-year affective boilerplate of the WSR.
To appraise time trends in accident ante the estimated anniversary allotment change (EAPC) was affected for the all-embracing tumour incidence, application the statistical software amalgamation Stata (Stata Corporation, College Station, TX, USA). An EAPC with a P-value <0.05 is advised significant.
This abstraction acclimated anonymised abstracts and was accustomed by the aloofness lath of the NCR and is in band with the Dutch aloofness regulations and the acknowledgment of Helsinki.
In the aeon 1989 to 2006, a complete of 3640 alternate and ocular tumours were registered in the Netherlands. The best accepted tumour encountered was a uveal melanoma (n=2193). A complete cardinal of 367 primary cancerous alternate tumours, in 367 patients, were registered. In 89 cases the lacrimal gland was the armpit of agent and all added tumours (n=278) originated in the alternate bendable tissues alfresco the lacrimal gland (Table 1). All-embracing the best accepted tumour blazon was lymphoma (67%), both aural the lacrimal gland (51%) and in the alternate bendable tissues added again the lacrimal gland (72%). The abutting best accepted tumour types were rhabdomyosarcoma (12%), adenocarcinoma (6%), and adenoid cystic blight (5%). All added tumour types had a about abundance of 2% or less. The lacrimal gland was the primary armpit of adenocarcinoma and adenoid cystic blight in 86 and 89%, respectively.
The allotment of macho patients was 53% (n=196) and the boilerplate age was 66 years at the time of diagnosis. The accommodating ages ranged from 0 to 93 years. Two age peaks can be articular (Figure 1), amid 0 and 15 years and amid 60 and 80 years. In the age accumulation beneath 15 years 86% of the tumours was a rhabdomyosarcoma. Amid 60 and 80 years, lymphoma (79%) and blight (14%) predominated.
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Age administration amid the three better histological subgroups and the actual primary cancerous alternate tumours in the Netherlands from 1989 to 2006.
The all-embracing boilerplate awkward accident was 13 per 10 000 000 per year and the WSR was 10 per 10 000 000 per year (Table 1). Amount 2 shows the WSR for males and females over time. The EAPC for the WSR in the years 1989 to 2006 was 2.5% (P=0.089) for men, 3.0% (P=0.006) for women, and 2.8% (P=0.001) for men and women combined.
The advance of primary cancerous alternate tumour accident (centred 3-year affective average) standardised to the apple citizenry (WSR) from 1989 to 2006.
The best accepted cancerous alternate tumours begin in the citizenry of the Netherlands from 1989 to 2006 were lymphoma followed by rhabdomyosarcoma, adenocarcinoma, and adenoid cystic carcinoma. In the 18-year abstraction period, the cardinal of alternate tumours was baby compared with the cardinal of uveal melanoma.
Other studies based on blight registries, performed in Asia and in the USA, appearance agnate about frequencies of tumour types (Table 2) and all achieve that the complete primary cancerous alternate tumour is lymphoma.2, 3, 4
The third and fourth best accepted tumours, adenocarcinomas and adenoid cystic carcinomas, additionally analyze with the blow of the world.2, 3, 4 This suggests there are no bounded differences in about frequencies of alternate tumour types (see Table 2), as there are for uveal melanoma and retinoblastoma.2, 3, 4
Other studies address squamous corpuscle blight (SCC) as the additional best accepted tumour type, instead of rhabdomyosarcoma in our study.2, 3, 4 As is mentioned by Margo and Mulla,2 this aerial abundance of SCC's is apparently in allotment the aftereffect of coding errors. Their account is that it is added acceptable that these tumours represent a accessory advance from structures surrounding the orbit, such as the eyelids and the paranasal sinuses. Our abstraction includes eight SCC's, two Ewing sarcomas, and three melanomas that are attenuate primary tumours of the orbit. In retrospect, some of these registrations may represent coding errors but all-embracing the cardinal of coding errors is still actual low.
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The boilerplate awkward accident of alternate tumours in the Netherlands is lower compared with the accident in Florida (13 vs 20 per 10 000 000 bodies per year). As age is one of the best important factors in developing cancer, we absitively to actual for age application the WSR. The boilerplate apple standardised accident in our abstraction is 10, which is lower again the boilerplate awkward incidence. This can be explained by the almost earlier citizenry in the Netherlands as compared with the apple citizenry and the actuality that best alternate tumours action at earlier ages.
The majority of the epidemiological advice on primary cancerous alternate tumours is based on studies performed in tertiary affliction centres.9, 10, 11, 12, 13, 14 These tertiary centres can accept a appropriate absorption or ability in specific tumour types. This accordingly leads to an overrepresentation of these tumour types and accordingly the about frequencies cannot be activated to the accepted population. Without a accepted citizenry size, as is the case in a tertiary centermost study, it is additionally absurd to compute accident numbers.
Epidemiological characteristics can advice the analyst in formulating a cogwheel diagnosis. As can been apparent from our data, age can advice accomplish several kinds of alternate malignancies added or beneath likely, bounded accomplishments on the added duke seems to accept no role in acute amid altered tumour types because about frequencies of alternate tumours are commensurable in altered genitalia of the world. The accident of alternate tumours shows a slight about access in time, the complete accident numbers, however, are still actual low, so we do not accede this ascent trend to be of analytic importance. The access of immunocompromised patients may explain this ascent trend, for archetype patients with HIV and solid agency displace recipients.15 In addition, as mentioned by Margo and Mulla added lymphoid hyperplastic lesions are now actuality diagnosed as lymphoma.
In our abstraction we alone acclimated the topographical codes C69.5 and C69.6 to analyze alternate tumours. Added codes that can analyze tumours amid in the apogee are C41.0 for cartilage tumours of the face and skull and C72.3 for optic assumption tumours. These codes, however, are aggregate by added cranial basic and optic chiasm or optic amplitude tumours, respectively, and do not accommodate abundant advice to analyze primary alternate tumours and were excluded. These ancillary codes, however, were additionally not acclimated in the accident studies that are compared with our abstraction in Table 2.
The believability of the abstracts in our abstraction depends on the abyss of the blight registration. Estimates of the abyss in registrating blight cases by the NCR are 96.2 and 98.7%.16, 17 Specially accomplished NCR agents assay the abounding medical almanac of all patients to minimise the adventitious of an alternate tumour actuality allotment of systemic tumour captivation and appropriately actuality non-primary.
In summary, the about frequencies of histopathological subtypes begin in the Netherlands do not alter abundantly from the frequencies begin in added genitalia of the world. We additionally achieve that lymphoma is the best accepted blight of the apogee in the Netherlands. This blight is followed by rhabdomyosarcoma, adenocarcinoma, and adenoid cystic carcinoma. The all-embracing average, age standardised incidence, of alternate malignancies is 10 per 10 000 000 per year and this abstraction shows a apathetic rise.
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The authors acknowledge no battle of interest.
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