基于2004—2017年中国肿瘤登记年报数据的我国子宫内膜癌发病和死亡分析

Incidence and mortality of endometrial cancer in China,data from China Cancer Registry Annual Report,2004-2017

目的基于2004—2017年中国肿瘤登记年报数据分析我国子宫内膜癌(EC)发病和死亡情况。方法提取中国肿瘤登记年报2004—2017年中EC的发病率及死亡率数据,按照地区(全国、城市、农村,东、中、西部)和年龄别的发病率、死亡率、发病例数、死亡例数,及分地区的人口学数据分别进行提取计算,估计全国的EC的发病及死亡情况。使用2000年全国人口普查的标准人口年龄构成及Segi′s标准人口年龄构成数据计算中国人口标化率(中标率)和世界人口标化率(世标率)。使用Join Point回归计算发病率的年度变化百分比,Cochran-Armitage趋势检验分析变化趋势。结果2004—2017年,我国肿瘤登记报告地区覆盖女性人口数由35571657名增长至215201995名,覆盖地区总人口数量占全国总人口数量的比例由5.53%提升至31.39%,EC粗发病率由6.20/10万增长至10.06/10万,粗发病率随时间增加呈上升趋势(P_(趋势)<0.001);调整年龄后,发病率的中标率由2004年的5.75/10万增长至2017年的6.79/10万,世标率由2004年的5.60/10万增长至2017年的6.56/10万,均呈逐年上升趋势(均P_(趋势)<0.001)。2017年城市与农村地区粗发病率分别为10.89/10万、9.25/10万,调整年龄后,发病率的中标率分别为7.14/10万、6.43/10万;世标发病率东部地区高于中部及西部地区(7.16/10万、6.44/10万、5.60/10万);发病率农村地区增长较城市地区年度变化百分比(APC)更为显著(3.2%比0.7%,P<0.001)。年龄别发病率随年龄增长而升高,50~54岁年龄组达高峰(25.70/10万)。40岁以下年龄组粗发病率农村地区增长幅度高于城市地区(69.84%比-7.09%)。2004—2017年间子宫内膜肿瘤标化死亡率呈下降趋势,中标率由1.83/10万下降至1.47/10万,世标率由1.81/10万下降至1.46/10万。年龄别死亡率随年龄增长而增高,≥85岁年龄组达高峰(13.16/10万)。结论近年来我国EC发病率整体呈上升趋势,特别是在农村地区40岁以下年轻女性EC发病率快速增长。全国EC发病率存在城乡差异及地区差异。部分城市地区EC发病率已居我国女性生殖系统恶性肿瘤发病率之首。EC标化死亡率呈下降趋势。

Objective To analysis the incidence rate and mortality rate of endometrial cancer in China from 2004 to 2017 according to the data from China Cancer Registry Annual Report.Methods The incidence and mortality data of endometrial cancer were extracted from the China Cancer Registry Annual Report 2004 to 2017,and the incidence,mortality,number of new cases,number of deaths were extracted according to the region(national,urban,rural and eastern,middle and western areas)and the age composition of population to estimate the incidence and mortality of endometrial cancer nationwide.The age-standardized incidence rate and mortality rate were calculated based on the Chinese standard population in 2000(ASIRC,ASIRW)and Segi′s world population(ASMRC,ASMRW).Join Point regression was used to calculate the annual percentage change of morbidity rate,and Cochran-Armitage trend test was used to analyze the changing trend of morbidity and mortality.Results From 2004 to 2017,the number of women covered by the China Cancer Registry Annual Report has increased from 35571657 to 215201995,and the total population of the covered areas has increased from 5.53%to 31.39%.The crude incidence rate of endometrial cancer increased from 6.20/100000 to 10.06/100000,and showed an upward trend over time(P<0.001).After adjusting for age,ASIRC increased from 5.75/100000 in 2004 to 6.79/100000 in 2017,and ASIRW increased from 5.60/100000 in 2004 to 6.56/100000 in 2017,both showing an upward trend over time(all P<0.001).The crude incidence rates in urban area and rural area were respectively 10.89/100000 and 9.25/100000 in 2017,and the ASIRC was higher in urban than rural areas(7.14/100000 vs 6.43/100000)after adjusting for age.The ASIRW was higher in eastern areas than middle areas and western areas(7.16/100000 vs 6.44/100000 vs 5.60/100000).The incidence rate in rural areas showed more significant growth than urban areas[annual percent change(APC):3.2%vs 0.7%,P<0.001].The age-specific incidence rate increased with age and reached a peak in the age group of 50-54 years(25.70/100000).Incidence rate in the under-40 age group increased more in rural areas than in urban areas(69.84%vs-7.09%).From 2004 to 2017,the age-standardized mortality rate shows a decreasing trend,with the ASMRC from 1.83/100000 to 1.47/100000,and the ASMRW from 1.81/100,000 to 1.46/100,000.There was no significant difference between urban and rural areas in mortality of endometrial cancer.Age-specific mortality rates increased with age,reaching a peak in the age group 85 years and older(13.16/100000).Conclusions Recent years,there was an increasing incidence rate of endometrial cancer in China.Especially in rural areas,the incidence rate of endometrial cancer is increasing rapidly in young women under 40 years of age.There were differences between urban and rural areas and regions in the incidence rate of endometrial cancer.The incidence rates of endometrial cancer in some high-income cities have occupied the first place of female reproductive system malignant cancers.The age-standardized mortality rate of endometrial cancer shows a decreasing trend.