Intracranial tumors in Canary Islands. An epidemiological survey
Transcripción
Intracranial tumors in Canary Islands. An epidemiological survey
Intracranial tumors in Canary Islands. An epidemiological survey (19761985) J.M. Granado Peña and M. Sosa Henríquez* Service of Neurosurgery and Department of General Pathology*. Hospital Insular de Gran Canaria. University of Las Palmas. Las Palmas de Gran Canaria. Canary Islands. Spain. Summary Introduction An epidemiological study on intracranial tumors The incidence of intracranial tumors has been controwas performed on a population of 741,599 residents in versible a 10ngtime31 •35 • Frequently data are not related to Documento http://www.revistaneurocirugia.com Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio the province of Lasdescargado Palmasde (Canary Islands, Spain),el 23/12/2016. specific populations, and sometimes the results obtained over a ten-year period between 1976-1985. During this about surgical series are interpreted as epidemiological. period 441 new intracranial tumors were recorded. The Canary Islands are situated on the 28. o N paraHel The calculated rate of incidence for all the type of tuof latitude, in the Atlantic Ocean, close to the Africa comors was 5.9 per 100,000 population/year (males: 6.4 asto It is our opinion that they have sorne special condiand females 5.4), and 5.2 per 100,000 population/year tions for carrying out reliable epidemiological studies. for the primary ones. A significant correlation between Although sorne features of the primitive pre-hispanic pogeographic latitude and the incidence rates reported in pulation can be nowadays observed in sorne individuals 3.3ó , the literature was found. This feature has not been rethe majority of the population faH into the caucassian tyported previously. pe, and its way of life, its culture, and language is typiKEY WORDS: Brain tumors. Epidemiology. Canary Islands. Spain. Resumen Se realizó un estudio epidemiológico descriptivo sobre tumores intracraneales en la provincia de Las Palmas (Islas Canarias, España). La encuesta comprendió a una población de 741.599 habitantes de derecho, abarcando un período de 10 años (1976-1985). , Durante este período se diagnosticaron un total de 441 nuevos tumores intracraneales en la provincia. La tasa de incidencia calculada para todo~ los tipos de tumor fue de 5,9/100.000 habitantes/año (varones: 6,4 y mujeres: 5,4). Para los tumores considerados primarios la incidencia fue de 5,2/100.000 habitantes/año. La frecuencia e incidencia para los diferentes tipos de tumor fue también calculada. En la revisión de la literatura y comparación con la presente serie, se observó una correlación significativa entre la incidencia referida en las diferentes publicaciones y la latitud geográfica de los distintos países en que las encuestas epidemiológicas fueron realizadas. Este hallazgo no ha sido constatado previamente en la literatura. PALABRAS CLAVE: Tumor cerebral. Epidemiología. Islas Canarias. España. 44 caHy spanish and so, european. Furthermore, the more severe types of pathologies, as happens with intracranial tumors, are handled in just the main two Hospitals where the information concerning to this matter is very easy to obtain because every patient with intracranial tumor is referred to one or another. The purpose of this study was to estimate the actual rate of incidence for intracranial tumorS by sex, group of age, and type of tumor, as well as to compare the results with those previously reported in the literature. There are few studies on the epidemiology of intracranial tumors performed in Spain and none in the Canary Islands. TABLE 1 Distribution of the incidence rate of brain tumors (percent/100.000 population/year) by groups of age and sex in a series of 441 cases. AGE 0-15 16-30 31-45 46-60 >60 TOTAL MALES FEMALES TOTAL 2.6 2.4 6.7 . 17.9 13.6 6.4 1.4 3.5 6.8 11.3 10.7 5.4 2 2.9 6.8 14.6 12.1 5.9 I I Intracranial tumors in Canary Islands. An epidemiological survey(l976-1985) Neurocirugía INCIDENCE (loa.o.oo/TEAR) >60 ;-.1 lZZi M~S 16.,-------------------, . 14 FE+LES~ ...-.. ~ ..•••__.._ . 12 la 46-60 8 " 6 31-45 . . 4 2 Oi--r---,---,--.,--r----,--,--,...--.,,---1 16·30 II TOTAL :IPRIMARY 0-15 0-15 16-30 3t-45 46-60 )60 2.02 2.02 2.95 2.8 6.77 6.19 14.6 11.89 12.01 10.31 GROUPS OF AGE 140 120 100 80 60 40 THOUSAND 20 o 20 40 60 80 THOUSAND 100 120 I -TOTAL --+- PRIMARY I Fig. 2.- Comparative distribution of the incidence rate by Fig. 1.- Distribution of the population in the Province of Las Documento descargado de http://www.revistaneurocirugia.com el 23/12/2016. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio group of age, for the whole of the tumors and the primary ones Palmas by group ofage and sexo in a series of 441 intracranial tumors. Material and methods This study is based on a population of 741,599 people living in the province of Las Palmas de Gran Canaria (Spain). The distribution of the population by sex and age group is showed in Figure l. In a ten year period, between 1976-1985,441 new intracranial neoplasms were recorded. The cases were obtained from the records of the Services of Neurosurgery (98%) and Pathology (2% of the tumors in this series comes from autopsy material) from the two main reference Hospitals in the province, in which the most impotant intracranial disorders are managed. The private consulting of aH the neurosurgeons practising in the province were taken into account and investigated, but no one tumor was found because aH of them were referred to the main Hospitals when diagnosed. All the vascular malformations as weH as intracranial tumor occurring among no resident population were exeluded of this study. The parameters to evaluate were recorded as follow: Age: The patients were divided into groups separated by a 15 year interval (0-15, 16-30,31-45,45-60, and older than 60). Diagnostic features: Seven diagnostic groups were defined according to Rubinstein 33, as follow: Glioma (it ineludes all the tumors arising from glial cells, with all types and grades, and mixed tumors). Meningioma. Schwanoma (ineluding Neurofibroma). Pituitary Adenoma. Metástasis. ather tumors (This group ineludes mainly tumors of the TABLE2 Comparison betwen relevant data about intracranial tumors of different series reported in the literature. TABLE3 Comparison betwen relevant data about .intracranial tumors of diffetent series reported in the literature. Author Kurland" G. Ferial' Brewis4 Gudmundson l5 City/Country Rochester Sweden Carlisle Iceland Year 1957 1964 1966 1970 Heshmat 17 Schoemberg34 Author Leibowitz25 Percy3l City/Country Israel Rochester Washington Connetticut Year 1971 1972 1976 1976 No Cases Incidence Gliomas Meningiomas Neurinomas Pito Adenom. Metastasis ather tumors No verified 50 9.2 16% 16% 4% 14% 32% 8% 10% 172 11.4 50% 17% 6% 20% 5% Pit. Adenom.= Pituitary Adenomas. 60 6 25% 6.6% 45% 234 7.8 32% 15.8% 6.4% 5.1% 20.5% 20% No Cases Incidence Gliomas Meningiomas Neurinomas Pito Adenom. Metastasis ather tumors Not verified 1034 9.8 33% 20% 4% 6.7% 160 14.4 33% 38% 5.6% 10.6% 990 4.3 68% 9.3% 0.6% 9% 3210 4.9 47% 12.5% 1.5% 9% 7% 29% 9.4% 3.1% 12% 9% 24.5% Pit. Adenom.= Pituitary Adenomas. 45 IntracraniaI tumors in Canary IsIands. An epidemiologicaI survey (1976- 1985) Neurocirugía % 70 60 so 40 30 20 Documento descargado de http://www.revistaneurocirugia.com el 23/12/2016. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio 10 o • MALES l7J FEMALES D TOTAL N.V.T.=NO VERIFIED TUMORS Fig. 3.- Distribution by type oftumor and sex in a serie of 441 intracranial tumors. infancy and childhood, such as M~dulloblastoma and Prirnitive Neuroectodermal Tumors 30 as well as some rare tumors of adults such as Chondrosarcoma of the skull base, Osteosarcoma of the cranial vault and others, and no verified tumors (those diagnosed by clinical and radiological tests, whose were not histologically verified because of several reasons). The Incidence rate (100,000 people/year) for ea~h sex, age and type of tumor was calculated and the results were compar~d with those reported in the literature. The statistical study was performed in a PC-compatible computer with the Statistical Package for the ~Social Sciences (SPSS) software. We consider significant at the level of confidence of 95% (P<0.05). Results The mean age, at the time of the diagnosis, in this series was 43· years (SD 18). There were no differences between both sexes. Tumors were significantly more frequent in men (55.4%) than in women (44.6%), (P<0.05). The Incídence rate for all the tumors was 5.9/100,000 population/year, and for the primary intracranial tumors was 5.2/100,000 population/year. The relevant data are showed on Table 1 and Figures 2 to 5. 46 Discussion In Tables 2 to 4 are represented the relevant data reported previously in the literature in a comparative fashion. TABLE4 Comparison betwen relevant data about intracranial tumors of different series reported in the literature. Author City/Country Year No Cases Incidence Gliomas Meningiomas Neurinomas Pito Adenom. Metastasis Other tumors Not verified Abuh-Salih l Fohelholm 1o Kepes 21 Sudan Finland Taiwan 1984 1988 1984 123 27.9% 45.5% 0.8% 10.6% 6.5% 3.2% 0% 326 12.3 15.6% 17.2% 6.1% 16.5% 20% 12.8% 17% Pit. Adenom.= Pituitary Adenomas. 1012 26.6% 22.4% 10.4% 4.5% Huang l9 China 1982 22454 1.14 42.8% 16.6% 9.5% 9.5% 6.8% 13% Intracranial tumors in Canary Islands. Ari epidemiological survey (1976-1985) Neurocirugía Meningiomas were the second most frequent tumors in this series. ¡he incidence rate for this group increases ste4 adly with age (Fig. 4). Females were significantly more 3 -GUOMA affected than males(P<Ü.05) with a ratio 2: 1 (Fig. 3). This 2 - MENINGIOMA feature has been largely reported in the literature6.22 , and *-ADENOMA probably an hormonal factor is involved8.1!.27. Although O -NEURINOMA these tumors are uncommon during infancy and 0-15 16-30 31-45 45-60 >60 *- METASTASIS 3 4 chilhood Z, in this series 1,5% of them were diagnosed in 2,6 4,5 GUOMA 1 1 -OTHERS 2,1 1,9 0,4 1,7 MENINGIOMA 0,05 patients below 15 years, becoming 2.3% of the whole of 0,3 0,6 1 ADENOMA 0,4 ~NVT tumors in this group of age. This figure is slightly higher ° 0,1 0,5 0,2 0,1 0,1 NEURINOMA 2,7 1,7 0,1 0,6 METASTASIS than the one previously reportedI3.27.29. ° 0,5 0,5 1,3 0,4 0,5 OTHERS In the group of patients with Metastases are only in3,4 0,5 0,3 0,3 2,7 NVT cluded those patients who were evaluated for neurosurgiNVT = NO VERIFIED TUMORS cal treatment. Therefore, it is not representative for the troe incidence of Metastases, because many patients with Fig. 4.- Comparative distribution of incidence rate for diffethis pathology are not referred to the neurosurgical serviintracranial tumor by groups of age in a serieselof rent kinds of Documento descargado de http://www.revistaneurocirugia.com 23/12/2016. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio ces, when the physicians decide that a surgical procedure 441 intracranial tumors. is not worthwhile. Pituitary Adenomas in this series were significantly In our series the incidence rate for aH the tumors incremore frequent in men than in women (P<0.05) (Fig. 3). ases along with age until a maximum of 60 years old, and This figure differs from those published in other reports 38 . decreases slightly aboye this age (Fig. 2). This distribution 2 In the group of Neurinomas both sexes were affected agrees with most of the reports in the literature .28.34. in the same way. Nevertheless, it seems to be a low freThe type of tumor was studied. Glioma was the comquency figure. monest type of tumor in our series and its frequency was As much as 16.8% of the tumors were histologicaHy significantly higher in men than in women, (P<0.05) (Fig. not verified. More or less 40% of them showed antece3) as it has been pointed out by other authors l8 . The rate of dents of another previous neoplasm and most of them weincidence for this tumor is significantly lower than those re multiple, suggesting a metastatic disorder. The remaifigures reported in North Europe I6 .20. An increase with age ning 60% were diagnosed in elderly patients, and its inciwas observed (Fig. 4) until the 60 years limit was reached dence rate increased steadily with advancing age (Fig. 4). for slightly decreasing thereafter. They could be meningiomas too. Although racial factors are involved in the developTABLE5 ment of the intracranial neoplasms 5.l7·'5, no significant difGeographic latitude and incidence rate of brain tuferences in ratios of several types of tumor were found mors in different series reported in the literature. between the present series and those carried out on caucasian populations (Tables 2, 3 and 4). Latitude Incidence Citr/Country FinaHy, the geographic latitude was calculated for different places in which the incidence rate for intracranial Iceland (1963)15 65°N 7.8 tumors was previously reported in the literature (Tab. 5). Goteborg (1964)12 57°N 11.4 Statistically significant relationships between latitude and Carlisle (1966)4 54°N 6 incidence rate were found (r=0.57, p<0.05) (Fig. 5). SeveIsrael (1971)25 31°N 9.8 ral hypothesis might be argued to explain this finding, aH Rochester (USA) (1971)31 44°N 14.4 of them hazardous. On one hand it is possible that the Mexico (1976)30 19°N 3 amount of diagnosis is higher in the countries situated in Connetticut (1976)34 41°N 4.9 the northem hemisphere because their better socio-econoWashington (1976)17 38°N 4.3 mical conditions, which affords better health care and Shangai (1982)19 3l o N 1.1 highly sophisticated technology. Nevertheless, we have Central Finland (1984)10 65°N 12.3 compared the results at this time with those obtained on Trento (1986)9 46°N 8.5 the same population, reported twelve years ago 14 and sigBolzano (1988)26 46°N 8.4 nificant differences were not found in spite of the conside28°N 5.2 Las Palmas GC (1994)* rable technological and social advances that have taken place meantime. A dramatic increase of the incidence of * = This series. brain tumors in elderly people, in United States and in INCIDENCf 100,000 PEap~ElYE.AR 5 47 Intracranial tumors in Canary Islands. An epidemiological survey (1976-1985) Neurocirugía 9. FERRARI. 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