2017年上海市恶性肿瘤发病和死亡情况与2002—2017年的变化趋势分析

Analysis of the current status of cancer incidence and mortality in Shanghai,2017 and trends of 2002-2017

目的:上海市疾病预防控制中心每年更新上海市恶性肿瘤发病和死亡及其趋势的统计资料。分析2017年上海市恶性肿瘤发病和死亡的基本情况及其2002—2017年的变化趋势。方法:采用上海市疾病预防控制中心建立的人群基础肿瘤登记管理系统和死因登记系统收集的2002—2017年恶性肿瘤发病和死亡资料,按诊断或死亡年份、部位和年龄组分层,计算数量、构成比、粗率、年龄别率、年龄标化率等指标,分析发病和死亡数量、年龄别率和标化率等变化趋势。应用Joinpoint统计软件分析2002—2017年上海市恶性肿瘤发病和死亡趋势,估算总体和分阶段的年度变化百分比(annual percentage change,APC)及平均年度变化百分比(average annual percent change,AAPC)。采用Segi’s1960年世界标准人口年龄构成进行调整计算标化率。结果:2017年上海市恶性肿瘤新发病例和死亡人数分别为79378例和37186人,粗发病率为546.55/10万,标化发病率为246.31/10万,男性的标化发病率低于女性。粗死亡率为256.04/10万,标化死亡率为88.41/10万,男性的标化死亡率高于女性。年龄别发病和死亡的数量和率值随着年龄的增长而增加,年龄别发病的数量和率值分别在60~64岁组和85岁及以上组达到高峰,男性年龄别死亡的数量和率值分别在80~84岁组和85岁及以上组达到高峰,女性年龄别死亡的数量和率值均在85岁及以上组达到高峰。按发病例数排序,男性前10位常见癌症类型的部位依次为肺癌、结直肠癌、胃癌、前列腺癌、肝癌、甲状腺癌、胰腺癌、膀胱癌、肾癌和食管癌,女性前10位常见癌症类型的部位依次为肺癌、乳腺癌、甲状腺癌、结直肠癌、胃癌、胰腺癌、肝癌、脑和中枢神经系统肿瘤、子宫颈癌和胆囊癌。按死亡人数排序,男性前10位依次为肺癌、胃癌、结直肠癌、肝癌、胰腺癌、前列腺癌、食管癌、膀胱癌、淋巴瘤和胆囊癌,女性前10位依次为肺癌、结直肠癌、乳腺癌、胃癌、胰腺癌、肝癌、胆囊癌、脑和中枢神经系统肿瘤、卵巢癌和淋巴瘤。按性别划分的发病和死亡的前10位常见癌症类型与按常见组合年龄段划分的前5位常见癌症类型差异较大。总体上,标化发病率在2002—2009年维持稳定状态,在2009—2017年以年均2.88%的增速上升;标化死亡率在2002—2011年维持稳定,在2011—2017年以年均2.66%的速度下降。不同性别和癌症类型的变化趋势各不相同。结论:肺癌、结直肠癌、胰腺癌、甲状腺癌、女性乳腺癌、子宫颈癌和男性前列腺癌仍是上海市肿瘤防治的重点,应针对上海市恶性肿瘤流行现状制定适宜筛查技术方案,推进癌症机会性筛查,推广社区肿瘤患者干预管理适宜技术,降低恶性肿瘤疾病负担。

Background and purpose:The Shanghai Municipal Center for Disease Control and Prevention provides annual updates on cancer occurrence and trends in Shanghai.This study aimed to investigate the cancer incidence and mortality in 2017 and their trends from 2002 to 2017 in Shanghai.Methods:Data of new cancer diagnoses and deaths from 2002 to 2017 were obtained from the Shanghai Municipal Center for Disease Control and Prevention population-based cancer registry and Vital Statistics System.Cancer incidence and mortality stratified by year of diagnosis or death,gender and age group were analyzed.Number,proportion,crude rate,age-specific rate,age-standardized rate and others were calculated.The number,proportion and rates of common cancers in different groups were also calculated.Trends in age-standardized rate of incidence and death rates for all cancers combined and for the common cancer types by gender were estimated by joinpoint analysis and characterized by the annual percent change(APC)and average annual percent change(AAPC).Segi’s 1960 world standard population was used for calculating age-standardized incidence and mortality.Results:The new cancer cases and deaths were 79378 and 37186 in Shanghai in 2017.The crude rate of incidence was 546.55/10^(5),and the age-standardized rate was 246.31/10^(5).The age-standardized rate of incidence was higher among females than among males.The crude rate of mortality was 256.04/10^(5),and the age-standardized rate was 88.41/10^(5).The age-standardized rate of mortality was higher among males than among females.The age-specific numbers and rates of incidence and mortality increased with age.The age-specific number and rate of incidence reached the peak at the age groups of 60-64 years and older than 85 years,and those of mortality among males reached the peak at the age groups of 60-64 years and older than 85 years,and those of mortality among females reached the peak at the age groups of older than 85 years,respectively.The sites of top 10 common cancer types sorted by the number of incidence cases among males were lung,colorectum,stomach,prostate,liver,thyroid,pancreas,bladder,kidney and oesophagus,and among females were lung,breast,thyroid,colorectum,stomach,pancreas,liver,brain,central nervous system(CNS),cervix uteri and gallbladder,the sites of those sorted by the number of deaths among males were lung,stomach,colorectum,liver,pancreas,prostate,oesophagus,bladder,lymphoma and gallbladder,among females were lung,colorectum,breast,stomach,pancreas,liver,gallbladder,brain,CNS,ovary and lymphoma.The top 10 common cancer types stratified by gender and the top 5 common cancer types stratified by common age groups merged of incidence and mortality had wide variations.Overall,the age-standardized rates of incidence were stable from 2002 to 2009,and increased 2.88%on average per year from 2009 to 2017.The age-standardized rates of mortality were stable from 2002 to 2011,and decreased 2.66%on average per year from 2011 to 2017.The trends differed by gender and cancer type.Conclusion:Lung cancer,colorectal cancer,pancreatic cancer,thyroid cancer,female breast cancer,cervical cancer and male prostate cancer are the most common cancers in Shanghai,the appropriate screening technical scheme should be formulated according to the current situation of malignant tumors in Shanghai,promote cancer opportunistic screening,promote appropriate technologies for intervention and management of cancer patients in the community,reduce the disease burden of malignant tumors.