中国癌症杂志 ›› 2019, Vol. 29 ›› Issue (2): 81-99.doi: 10.19401/j.cnki.1007-3639.2019.02.001

• 专家述评与论著 • 上一篇    下一篇

2015年上海市恶性肿瘤流行特征分析

鲍萍萍,吴春晓,张敏璐,彭 鹏,王春芳,龚杨明,顾 凯,向詠梅, 施 亮,庞 怡,施 燕,付 晨   

  1. 上海市疾病预防控制中心慢性非传染病与伤害防治所肿瘤防治科,上海 200336
  • 出版日期:2019-02-28 发布日期:2019-03-25
  • 通信作者: FU Chen E-mail: fuchen@scdc.sh.cn
  • 基金资助:
    上海市第四轮公共卫生三年行动计划慢病重点学科项目(15GWZK0801);上海自然人群和大肠癌筛查人群多组学生物特征图谱及大肠癌风险评估研究(18401933403)。

Report of cancer epidemiology in Shanghai, 2015

BAO Pingping, WU Chunxiao, ZHANG Minlu, PENG Peng, WANG Chunfang, GONG Yangming, GU Kai, XIANG Yongmei, SHI Liang, PANG Yi, SHI Yan, FU Chen   

  1. Department of Cancer Prevention and Control, Division of Noncommunicable diseases and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
  • Online:2019-02-28 Published:2019-03-25
  • Contact: 付 晨 E-mail:fuchen@scdc.sh.cn

摘要: 背景与目的:恶性肿瘤严重威胁着居民健康,已成为重大的公共卫生问题。本研究旨在描述和分析2015年上海市恶性肿瘤流行特征。方法:根据上海市恶性肿瘤病例报告登记系统收集的恶性肿瘤发病和死亡资料,按地区、性别分层,分别计算恶性肿瘤发病与死亡粗率、标化率、前10位恶性肿瘤发病与死亡顺位和构成等,并应用Joinpoint统计软件分析2002—2015年上海市肺癌发病和死亡趋势,估算总体和分阶段的年度变化百分比(annual percent change,APC)。采用Segi’s世界标准人口年龄构成计算标化率。结果:2015年上海市共报告恶性肿瘤新发病例71 610例,死亡病例38 445例。病理学诊断比例(percentage of morphologically verified cases,MV%)为78.42%,只有死亡医学证明书比例(percentage of death certifications only,DCO%)为0.21%,死亡发病比(mortality to incidence ratio,M/I)为0.55。上海市恶性肿瘤粗发病率为497.33/10万,标化发病率为228.82/10万,男性标化发病率低于女性,市区低于郊区。恶性肿瘤发病在40岁以后快速上升,在80~84岁年龄组达到高峰。全市发病前10位恶性肿瘤依次为肺癌、结直肠癌、甲状腺癌、胃癌、乳腺癌、肝癌、前列腺癌、胰腺癌、脑和中枢神经系统肿瘤以及膀胱癌,前10位恶性肿瘤占全部恶性肿瘤发病的76.59%。全市恶性肿瘤粗死亡率为267.00/10万,标化死亡率为95.99/10万,男性标化死亡率高于女性,市区和郊区基本持平。死亡率在45岁以后快速上升,在≥85岁年龄组达到高峰。死亡前10位恶性肿瘤依次为肺癌、结直肠癌、胃癌、肝癌、胰腺癌、乳腺癌、食管癌、胆囊癌、前列腺癌以及脑和中枢神经系统肿瘤,前10位恶性肿瘤占全部恶性肿瘤死亡的78.07%。截至2016年12月31日,上海市共有399 027例现患肿瘤病例,现患率为2.77%。市区现患率为3.07%,郊区为2.55%。乳腺癌是现患病例中最常见的恶性肿瘤,占15.33%。现患病例生存达5年的占50.90%。肺癌是上海市发病和死亡均位居第1位的恶性肿瘤。Joinpoint趋势分析显示,2011年男性和女性肺癌发病率均出现拐点。男性肺癌发病率在2002—2011年期间显著下降,APC为-1.34%(P<0.001),自2011年起显著上升,APC为3.30%(P<0.001);女性肺癌发病率在2002—2011年期间无明显变化趋势,较为平稳,2011—2015年期间呈快速上升趋势,APC达15.25%(P<0.001)。与发病率变化不同,2002—2015年间上海市男性肺癌死亡率呈缓慢持续下降趋势,APC为-0.72%(P=0.03),女性无明显变化趋势。与2002年相比,2015年男性和女性肺癌诊断时期别为Ⅰ期的病例比例和腺癌比例均明显上升。男性肺癌诊断时期别Ⅰ期比例由2002年的3.96%上升到2015年的11.08%,女性由3.72%上升至23.57%。男性腺癌比例由2002年的15.81%上升到2015年的34.46%,女性由28.76%上升至66.08%。结论:肺癌、消化系统恶性肿瘤、甲状腺癌和女性乳腺癌仍是威胁上海市居民健康的主要癌种。乳腺癌是现患病例中最常见的恶性肿瘤。自2011年开始,男性和女性肺癌发病率显著上升,提示与低剂量螺旋CT广泛应用有一定关系,但需更多数据和研究支持。

关键词: 恶性肿瘤, 发病率, 死亡率, 趋势, 肺癌

Abstract: Background and Purpose: Cancer has become a serious public health problem that threatens the health of Shanghai residents. This study aimed to investigate the cancer incidence and mortality in Shanghai in 2015. Methods: The data were collected from Shanghai Cancer Registry. Cancer incidence and mortality stratified by gender and region were analyzed. Crude rate, agestandardized rate (ASR), age-specific and region-specific rates, cumulative rate and truncated rate were calculated. The proportion and rates of 10 common cancers in different groups were also calculated. Joinpoint software was used to analyze the incidence and mortality trends of lung cancer during 2002-2015, and the annual percent change (APC) for the whole period and the time segments were estimated. Segi’s population was used for calculating age-standardized incidence and mortality. Results: The total reported new cancer cases and deaths were 71 610 and 38 445, respectively. The percentage of morphologically verified cases (MV%) accounted for 78.42%, and 0.21% of cases were identified through the percentage of death certifications only (DCO%) with mortality to incidence ratio (M/I ratio) of 0.55. The crude incidence in Shanghai Cancer Registry was 497.33/105, and the ASR was 228.82/105. The cancer incidence in female was higher than that in male, and the incidence in suburban areas was higher than that in urban areas. Cancer incidence increased rapidly after the age of 40 years and reached the peak at the age group of 80-84 years. The top 10 incidence of cancers were lung cancer, colorectal cancer, thyroid cancer, stomach cancer, breast cancer, liver cancer, prostate cancer, pancreatic cancer, central nervous system (CNS) tumor and bladder cancer. The incidence cases for top 10 cancers accounted for 76.59% of total cases. The crude mortality in Shanghai Cancer Registry was 267.00/105, and the ASR was 95.99/105. The cancer mortality in male was higher than that in female, and the mortality in urban areas was similar to that in suburban areas. Cancer mortality increased rapidly after the age of 45 years and reached the peak at the age group of 85+ years. The top 10 mortality of cancers were lung cancer, colorectal cancer, stomach cancer, liver cancer, pancreatic cancer, breast cancer, esophageal cancer, gallbladder cancer, prostate cancer and CNS tumor. The mortality cases for top 10 cancers accounted for 78.07 % of total cases. Up to Dec.31, 2016, there were 399 027 survivors with cancer in Shanghai. The prevalence rate of cancer was 2.77%. The rates in urban areas and suburb were 3.07% and 2.55%, respectively. Breast cancer was the most common malignancy in all cancer survivors, accounting for 15.33%. One half of the cases with cancer survivied for five years. Joinpoint analysis showed that 2011 was the joinpoint for incidence of lung cancer in both genders. For males, the incidence rates of lung cancer decreased significantly during 2002-2011 (APC=-1.34%; P<0.001), but increased significantly during 2011-2015 (APC=3.30%; P<0.001). For females, the incidence rates were stable during 2002-2011, while they increased substantially during 2011-2015 (APC=15.25%, P<0.001). In contrast, the mortality rates decreased significantly from 2002 to 2015 for males (APC= -0.72%, P=0.030), and no significant trend was found for females. The proportion of cases with stage I lung cancer or adenocarcinoma of newly diagnosed cases increased during this period in both genders. Conclusion: Lung cancer, digestive system malignancies, thyroid cancer and breast cancer are the most common cancers in Shanghai. Breast cancer is the most common malignancy in all cancer survivors. There has been a steady increase in the incidence of lung cancer in both genders since 2011.

Key words: Cancer, Incidence, Mortality, Trends, Lung cancer