上海市白血病主要亚型发病特征和趋势分析

Epidemiological features of major subtypes of leukemia and its incidence trends in Shanghai

目的:分析2008年至2012年上海市白血病及其主要亚型的流行病学特征和上海市市区1973年至2012年的白血病发病趋势,为探寻病因学研究线索,制定和评估白血病预防、研究与控制的规划和措施提供依据。方法:根据上海市恶性肿瘤病例报告登记系统收集的白血病发病资料,描述患者的发病概况及性别、年龄和各亚型分布,并应用Joinpoint统计软件进行趋势分析,估算总体和分阶段的年度变化百分比(annual percent change,APC)。标化率采用世界人口构成为标准。结果:2008年至2012年,上海全市共新诊断白血病病例4 404例,占所有部位恶性肿瘤的1.53%。男、女性的白血病粗发病率分别为6.78/10万和5.75/10万,标化发病率为5.14/10万和4.11/10万,男性标化发病率高于女性(X=3.16,P<0.01)。急性髓细胞白血病(acute myelogenous leukemia,AML)是最常见的白血病亚型,占18.30%,其次为急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)、慢性髓细胞白血病(chronic myelocytic leukemia,CML)和慢性淋巴细胞白血病(chronic lymphocytic leukemia,CLL)。除ALL外,各亚型白血病的年龄别发病率均随着年龄的增长而升高;ALL的发病年龄相对较早,年龄别发病率表现出随年龄的增长发病率下降,0~5岁组是发病高峰。1973年至2012年期间的总白血病标化发病率,男性无明显变化趋势,而女性标化发病率则明显下降,APC为-0.39%;不同亚型的发病趋势不同,男性ALL的发病率上升(APC为1.12%),男性和女性CLL的发病率均呈明显上升趋势,而男、女性AML的发病率则在这40年间均显著下降,平均APC分别为-2.04%和-2.00%。结论:上海白血病发病率接近全球平均水平,男性比女性多发,AML是最常见的亚型,ALL的发病年龄相对较早。1973年至2012年期间,男性白血病发病率无明显变化,女性则显著下降,不同亚型变化趋势不同。

Objective： To describe the patterns of leukemia incidence in Shanghai during 2008-2012 and investigate the trends of leukemia incidence in Shanghai urban area during 1973-2012 in Order to provide references for designing prevention programs, research spots and control strategies on leukemia. Methods： Data of leukemia cases were collected by the Shanghai Cancer Registry. The patterns of leukemia incidence according to gender, age, and subtypes during 2008- 2012 were described. Joinpoint software was used to analyze the incidence trends, and the annual percentage changes （APCs） for the whole period and time segments were estimated. The world standard population 1960 was used for calcula- ting the age-standardized incidence （ASR）. Results： During 2008-2012, 4 404 new leukemia cases were diagnosed in Shanghai, accounted for 1.53% of the total cancer cases. The crude rate of leukemia was 6.78 per 100 000 for male and 5.75 per 100 000 for female, and the ASRs were 5.14 per 100 000 and 4.11 per 100 000, respectively. ASR for total leukemia in male were higher than that in female（X=3.16, P〈0.01 ）. Acute myeloid leukemia （AML） was the major subtype of leukemia, accounted for 18.30% of the total cases, then were the acute lymphoblastie leukemia （ALL）, chronic myelocy- tic leukemia （CML） and chronic lymphocytic leukemia （CML）. Differed from other subtypes, acute lymphoblastic leukemia （ALL） usually occurred among young population, with the highest incidence in 0-5 age group. The incidence of other types of leukemia increased with the increase in age. During the period of 1973-2012, leukemia incidence among males was stable, while the incidence significantly decreased among females with an APC-0.39%. Incidence of ALL increased signi- ficantly among males （APC 1.12%） and remained stable among females. Incidence of CLL increased significantly in both sex, and incidence of AML decreased significantly in females. Conclusions： The incidence of leukemia in Shanghai during 2008-2012 is similar to the average level in the world, and incidence in male is higher than that in female. AML is the major subtype of leukemia. The incidence trends varies with different subtypes. During 1973-2012, incidence of leukemia in male is stable, while decreases significantly in female. The trends differ between different subtypes.