1990年至2020年间全球及我国肺癌的发病流行趋势及防控措施

Lung cancer worldwide and in China from 1990 to 2020:prevalence and prevention measures

1990年至2020年间,全球肺癌新发病例数不断增长,其间发病率保持稳定,但全球肺癌发病呈现性别、地区、年龄、组织学类型分布变化趋势。男、女发病率数据差异不断缩小,男性世界人口年龄标化发病率(世标发病率)下降12.5%,女性世标发病率上升22.3%。1998年至2012年,肺癌的发病具有明显的地区差异,欧洲、亚洲和北美洲的男性肺癌世标发病率均有下降趋势,平均年度变化百分比分别为-1.6%、-0.6%和-2.5%;而女性肺癌发病率,除了北美洲表现出下降趋势,其他地区则呈现出上升趋势。1998年至2012年,全球各地区的肺癌平均发病年龄均呈现逐年递增的趋势,亚洲男性的肺癌平均发病年龄增幅最大,从1998年的67.21岁增加到2012年的69.14岁。20世纪80年代初期开始,鳞状细胞癌占肺癌的构成比就呈现下降趋势,2004年起,腺癌已成为世界上最常见的肺癌组织学类型。2020年,我国是全球每年新发肺癌病例数最多的国家,达539181例。1989年至2008年,我国城乡肺癌发病率比由2.07降至1.14,城乡间的肺癌发病水平差异已明显缩小;我国经济欠发达地区,肺癌的发病率在上升,而一些肺癌高发地区则得到了控制。我国作为全球最大的烟草生产国和消费国,烟草的控制形势严峻,控制职业暴露也是我国预防肺癌发生的关键,环境污染造成肺癌的风险逐步走低,建立肺癌危险因素的监测网络是未来发展的方向。

From 1990 to 2020,the number of newly diagnosed cases of lung cancer in the world continued to grow,but the prevalence remained stable.As time went,the incidence(world standard incidence,adjusted with age structure of world population)of lung cancer changed in gender,region,age,and histological type.The difference between male and female in incidence continued to narrow,with male incidence declining by 12.5%and female incidence rising by 22.3%.There were obvious regional differences in the incidence of lung cancer.From 1998 to 2012,the incidence of male lung cancer in Europe,Asia and North America showed a downward trend(the average annual change percentages were-1.6%,-0.6%and-2.5%,respectively),while the incidence of female lung cancer showed a upward trend except North America.From 1998 to 2012,the average age of lung cancer patients in all regions of the world showed a trend of increasing year by year.The average age at diagnosis of lung cancer in Asian men increased from 67.21 years in 1998 to 69.14 years in 2012.Patterns of histological types of lung cancer have also changed.Since the early 1980s,the proportion of squamous cell lung cancer has declined.Since 2004,adenocarcinoma has become the most common histological type of lung cancer in the world.In 2020,China had the largest cases of newly diagnosed lung cancer in the world.From 1989 to 2008,urban-rural ratio of lung cancer incidence dropped from 2.07 to 1.14.In economically underdeveloped areas,the incidence of lung cancer was also rising,and the situation in some areas with high incidence of lung cancer had been controlled.China,as the largest tobacco producer and consumer country,has to be serious with the control of tobacco.Risk of lung cancer caused by environmental pollution is gradually lower.Controlling occupational exposure is also the key to preventing lung cancer in China,and establishing a mornitoring network for risk factors is the direction in future.