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(95% CI \u2212\u00a00.9; 0.5). EBV testing became routine only in the last decade, the incidence of EBV-positive tumors remained stable over this period (APC 1.2, 95% CI \u2212\u00a01.3; 3.8). An increase in EBV-negative tumors (APC: 7.1, 95% CI 2.5; 11.9) and a decrease in untested tumors were found (APC: \u2212\u00a010.7, 95% CI \u2212\u00a015.7; \u2212\u00a05.7). The incidence of non-keratinizing, differentiated tumors increased (APC: 3.8, (95% CI 2.2; 5.5) while the incidence of other histological subtypes remained stable. Overall survival was better in patients diagnosed after 1998 (hazard ratio 0.8, 95% CI 0.6; 0.9). EBV status, histology, stage, and age were independently associated with relative excess risk of dying, but period of diagnosis was not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Testing for EBV increased over time, and a stable incidence of EBV-positive NPC over the last 10\u00a0years. The rising incidence of non-keratinizing, differentiated NPC mirrors data from the US and suggests a shift in non-endemic regions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00432-023-05547-8","type":"journal-article","created":{"date-parts":[[2024,1,29]],"date-time":"2024-01-29T11:02:16Z","timestamp":1706526136000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Nasopharyngeal carcinoma: nationwide trends in subtype-specific incidence and survival over 3 decades in a non-endemic area"],"prefix":"10.1007","volume":"150","author":[{"given":"Jort S.","family":"van Velsen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bert","family":"van der Vegt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boudewijn E. 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B.v.d.V. reports honoraria received by the University Medical Center Groningen for expertise or scientific advisory board\/consultancy from Visiopharm, Philips, MSD\/Merck, Daiichi-Sankyo\/AstraZenica; Speaker\u2019s fee from Visiopharm, Diaceutics, MSD\/Merck. B.E.C.P. reports research grants, consultancy fees and honoraria from Olympus EU. J.A.L. reports consultancy fees from IBA and RaySearch laboratories, and collaborative research contracts with IBA, RaySearch laboratories, Elekta, Mirada and Siemens. All other authors have no potential conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Since the data were anonymized, ethics approval was not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}}],"article-number":"49"}}