1973—2013年上海市徐汇区甲状腺癌发病趋势和生存分析

Temporal trends in the incidence and survival analysis of thyroid cancer in Xuhui District, Shanghai,1973—2013

背景与目的：近年来甲状腺癌发病率的迅速上升引起了广泛关注,可能与生活方式、老龄化和诊断技术水平提高等相关。本研究采用41年的甲状腺癌发病和随访资料,描述和分析上海市徐汇区居民甲状腺癌发病趋势及生存情况。方法：甲状腺癌发病资料来自上海市肿瘤登记报告系统,发病时间覆盖1973—2013年,用1973年人口构成计算标化发病率,采用自然样条回归模型分析甲状腺癌发病趋势,平均年度变化百分比（annual percentage change,APC）计算采用美国国立癌症研究所Jointpoint软件,生存率估计采用Kaplan-Meier法。结果：甲状腺癌的病理类型以乳头状癌为主（69.8%）,1973—1978年和2009—2013年女性标化发病率分别是男性的2.51倍和2.70倍,男性发病年龄为（50.04±14.71）岁,女性发病年龄为（48.57±13.65）岁。去除老龄化因素,1981年以来甲状腺癌标化发病率呈上升趋势,1981—2004年平均每年上升8.46%（95%CI：5.9%-11.1%）,2004—2013年快速增长,平均每年上升20.30%（95%CI：9.8%-31.7%）。甲状腺癌总体预后较好,2003—2013年5年生存率达95.21%,10年生存率89.09%;41年生存分析显示,女性生存率高于男性（χ^2=15.43,P=0.000 1）。结论：甲状腺癌在徐汇区的增长趋势与上海市及其他发达国家情况相似,虽然死亡率低,但发病率增长迅速,提示进一步研究相关危险因素,为制定防治策略打下基础。

Background and purpose： Increasing thyroid cancer （TC） incidence has caused wide public concern. It is typically interpreted as an increase in the true occurrence of TC but may also reflect changing life style or aging of population or increased diagnostic scrutiny. This study describes the temporal trend for incidence of TC and survival rate of patients by summarizing the 41 years TC incidences and follow-up data in Xuhui District, Shanghai.. Methods： Annual TC incidence data of Xuhui District from 1973 to 2013 were provided by Shanghai Cancer Registry System. The calculation of age-standardized incidence rates （ASIR） was based on the population of the year 1973. Temporal trends in TC incidence were analyzed based on the natural spline regression model. Annual percentage change （APC） was estimated by Jointpoint software from US National Cancer Institute, as well as survival rates were estimated using Kaplan-Meier method by Stata software. Results： During the period from 1973 to 2013, papillary cancer was the dominant type with proportion 69.8%. The ASIRs for female TC were 2.51-2.70 times as high as those for male TC. The average age of TC incidence for male was 50.04±14.71 while for female was 48.57±13.65. When aging factors were removed, incidence rate of TC was on the rise since 1981 with the APC of 8.46% （95%CI：5.9%-11.1%）, and on a rapid growth from 2004 to 2013 with the APC of 20.30% （95%CI： 9.8%-31.7%）. The study showed that the 5-year TC survival rate was 95.21%, and the 10-year TC survival rate was 89.09%. In addition, survival rate of female was higher than that of male （χ^2=15.43, P=0.000 1）. Conclusion： The rising trend of TC in Xuhui District is similar to those in Shanghai and some developed countries. Although the mortality rate of TC is low, it has a rapid increase in incidence. Studies on factors associated with TC will help to clarify the epidemiological features about TC and promote more efficient prevention and control strategies.