中国肿瘤登记地区2008年恶性肿瘤发病和死亡分析

Report of Incidence and Mortality from China Cancer Registries in 2008

[目的]利用全国肿瘤登记中心2011年收集的各登记处肿瘤登记资料,分析2008年全国肿瘤登记覆盖地区癌症的发病与死亡水平。[方法]通过对全国56个登记处上报的2008年肿瘤登记数据进行全面审核与评价,选取其中41个登记处的数据进行合并,按地级以上城市和县（县级市）划分城市和农村,分别计算发病（死亡）率、年龄别发病（死亡）率、标化发病（死亡）率、构成比、累积发病（死亡）率。[结果]2008年中国肿瘤登记地区的41个登记处合计覆盖登记人口66 138 784人（城市52 158 495人,农村13 980 289人）,共报告新发病例197 833例,死亡病例122 136例,病理诊断比例为69.33%,只有死亡证明书比例为2.23%,死亡/发病比为0.62。中国肿瘤登记地区恶性肿瘤发病率为299.12/10万（男性330.16/10万,女性267.56/10万）,中标发病率148.75/10万,世标发病率194.99/10万,累积发病率（0~74岁）为22.27%。城市地区发病率为307.04/10万,中标发病率148.64/10万,农村地区发病率为269.57/10万,中标发病率151.02/10万。恶性肿瘤死亡率为184.67/10万（男性228.14/10万,女性140.48/10万）,中标死亡率84.36/10万,世标死亡率114.32/10万,累积死亡率（0~74岁）为12.89%。城市地区恶性肿瘤死亡率为181.54/10万,中标死亡率79.21/10万。农村地区恶性肿瘤死亡率为196.34/10万,中标死亡率106.05/10万。中国肿瘤登记地区无论城市还是农村,恶性肿瘤发病占前几位的主要是肺癌、胃癌、结直肠癌、肝癌、食管癌、胰腺癌、脑瘤、淋巴瘤、女性乳腺癌和宫颈癌等,占全部恶性肿瘤发病的75%左右。恶性肿瘤死亡前几位的主要是肺癌、胃癌、肝癌、食管癌、结直肠癌、胰腺癌、乳腺癌、脑瘤、白血病和淋巴瘤,约占全部恶性肿瘤死亡的80%左右。农村地区发病、死亡是以食管癌、胃癌为主的消化系统恶性肿瘤较高,其次为肺癌、肝癌、结直肠癌,而城市地区发病、死亡以肺癌位居第一位,女性以乳腺癌位居女性发病第一位,其次是肝癌、胃癌、结直肠癌较高。[结论]肺癌、胃癌、结直肠癌、肝癌、食管癌、女性乳腺癌为威胁我国居民健康的主要恶性肿瘤,为我国今后恶性肿瘤的防控重点,同时,肿瘤的防控工作还应考虑癌谱在地区和性别上的差异。

[Purpose] To investigate the cancer incidence and mortality in cancer registration areas in 2008.[Methods] After checking and evaluating the cancer registry data in 2008 from 56 cancer registries,of them 41 registries’ data were selected for this analysis.We classified cancer registries into two categories： urban and rural.Incidence and mortality rates,age-specific rates,age-standardized rates,proportions,cumulative rates were calculated.[Results] The population coverage of all 41 registries were 66 138 784（52 158 495 in urban areas and 13 980 289 in rural areas）.The total cancer incident cases and deaths were 197 833 and 122 136,respectively with mortality to incidence rate ratio of 0.62.The morphological verified rate was 69.33% and 2.23% of cases were identified by death certificate only.The crude cancer incidence in registration areas was 299.12/10 5（330.16/10 5 in male and 267.56/10 5 in female） and age-standardized incidence rates by Chinese standard population（ASIRC） and by world standard population（ASIRW） were 148.75/10 5 and 194.99/10 5,respectively with cumulative incidence rate（0～74 age years old） of 22.27%.Both of crude and adjusted incidence rates in urban areas were higher than that in rural areas.The crude cancer mortality was 184.67/10 5（228.14/10 5 in male,140.48/10 5 in female）,and age-standardized mortality rates by Chinese standard population（ASMRC） and by world population were 84.36/10 5 and 114.32/10 5 respectively with cumulative mortality rate（0～74 age years old） of 12.89%.Age-adjusted mortality rates in urban areas were lower than that in rural areas.The top ten commonest cancer types were lung,stomach,colorectum,liver,esophagus,pancreas,brain,lymphoma,breast and cervix,accounting for 75% of all cancer incidence in registration areas.Lung cancer was the leading cause of cancer death,followed by gastric cancer,liver cancer,esophageal cancer,colorectum cancer and pancreas cancer.The mortality of top ten cancers accounted for 80% of all cancer deaths.The cancer spectrum was quite different in different locations and sexes.In rural areas,cancers from digestive system were still common,such as esophageal cancer,gastric cancer and liver cancer.However,common cancers,such as lung cancer,colorectal cancer and breast cancer were the main cancer types in urban areas.[Conclusions] Lung cancer,gastric cancer,colon and rectum cancer,liver cancer and esophageal cancer are the major cancer burden in China,which should be focused on for national cancer prevention and control program in the future.Different cancer control strategies should be carried out due to the different cancer spectrum in urban and rural areas.