中国食管癌死亡状况和生存分析

Mortality and survival analysis of esophageal cancer in China

目的：通过对中国肿瘤登记地区人群食管癌死亡现状和变化趋势进行分析，为中国食管癌防控提供依据。方法提取全国肿瘤登记中心肿瘤登记数据中的食管癌资料，分城乡、性别、年龄别估计全国食管癌的死亡情况。利用2000—2011年22个有连续数据登记处的食管癌死亡数据计算平均年度变化百分比（ AAPC），分析食管癌死亡变化趋势。对17个肿瘤登记处2003—2005年的食管癌生存数据进行分析。结果2012年全国食管癌死亡约21．09万（其中男性14．90万，女性6．19万），占全部恶性肿瘤死亡的9．65％，食管癌死亡率为15．58／10万，中标率为10．62／10万，世标率为10．67／10万，0～74岁累积死亡率为1．28％，居全部恶性肿瘤死亡的第4位，食管癌死亡率随年龄增加而上升，50岁以后开始快速升高。22个肿瘤登记地区2000—2011年食管癌死亡率略有下降，死亡率的AAPC为－1．1％（95％ CI为－1．8％～－0．5％）。22个肿瘤登记地区食管癌死亡世标率下降明显，AAPC为－4．6％（95％CI为－5．7％～－3．6％），城市地区世标率的AAPC为－3．8％，农村地区为－2．4％。食管癌的5年相对生存率为20．9％（95％CI为20．2％～21．7％），1年、3年和5年观察生存率分别为54．0％、25．5％和18．4％。结论中国食管癌死亡负担依然十分严重，在食管癌重点高发地区开展早诊早治工作十分必要。

Objective To estimate the nationwide mortality of esophageal cancer in China in 2012, to investigate the trends of the disease, and to provide support data for esophageal cancer prevention and control in China. Methods Data of population-based cancer registry of China were extracted by sex and geographical area. Joinpoint software was used to analyze the trends of esophageal cancer from 2000 to 2011 using the continuous data of 22 cancer registries. Average annual percentage change rates （ AAPC） were calculated,and 17 cancer registries data during 2003？2005 were analyzed. Results In 2012, there were estimated 210.9 thousand new cases of esophageal cancer death in China, with 149 thousand in males and 61.9 thousand in females, accounting for 9. 65% of overall cancer death. The crude mortality rate of esophageal cancer in 2012 was 15.58 per 100 000, accounting for the fourth-leading cause of overall cancer deaths. The age-standardized mortality rates by world population and China population were 10. 67 per 100 000 and 10.62 per 100 000, respectively. The cumulative mortality rate for age 0？74 was 1.28%. The age-specific mortality rates were increasing with age, and there was a sharp increase after 50 years of age. From 2000 to 2011, there was a slight decreasing trend for crude mortality rate, with the AAPC of -1.1%（95% CI： -1.8% to -0.5%）. However, the age standardized mortality rates were decreasing significantly with the AAPC of-4.6% （95% CI：-5.7% to-3.6%）. The AAPCs for age-standardized esophageal cancer mortality were -3. 8% in urban areas and -2. 4% in rural areas. For combined 5-year age standardized relative survival was 20.9% （95%CI：20.2% to 21.7%） and the 1-, 3- and 5-year observed survival rates were 54.0%, 25.5%, 18.4%, respectively. Conclusion There is still a heavy burden of esophageal cancer in China. Prevention and early diagnosis of the disease in esophageal cancer high？risk areas is very essential.