2014年上海市恶性肿瘤发病和死亡特征分析

Analysis of cancer incidence and mortality in Shanghai, 2014

背景与目的:恶性肿瘤已成为严重威胁上海市居民健康的重大公共卫生问题。该研究旨在描述和分析2014年上海市恶性肿瘤发病与死亡情况。方法:根据上海市恶性肿瘤病例报告登记系统收集的恶性肿瘤发病资料,按地区、性别分层,分别计算恶性肿瘤发病与死亡粗率、标化率、前10位恶性肿瘤发病与死亡顺位和构成等,应用Joinpoint统计软件分析2002—2014年上海市恶性肿瘤发病和死亡趋势,估算总体和分阶段的年度变化百分比(annual percentage change,APC)。采用Segi’s世界标准人口年龄构成计算标化率。结果:2014年上海市共报告恶性肿瘤新发病例68 541例,死亡病例37 242例。病理学诊断比例为79.49%,只有死亡医学证明书比例为0.04%,死亡发病比为0.54。上海市恶性肿瘤粗发病率为477.79/10万,标化发病率为223.57/10万,男性标化发病率低于女性,市区低于郊区。恶性肿瘤发病在40岁以后快速上升,在80~84岁年龄组达到高峰。全市发病前10位恶性肿瘤依次为肺癌、结直肠癌、甲状腺癌、胃癌、乳腺癌、肝癌、前列腺癌、胰腺癌、脑和中枢神经系统肿瘤以及膀胱癌,前10位恶性肿瘤占全部恶性肿瘤发病的75.89%。全市恶性肿瘤粗死亡率为259.61/10万,标化死亡率为95.73/10万,男性标化死亡率高于女性,市区和郊区基本持平。死亡率在45岁以后快速上升,在≥85岁年龄组达到高峰。死亡前10位恶性肿瘤依次为肺癌、结直肠癌、胃癌、肝癌、胰腺癌、乳腺癌、食管癌、胆囊癌、前列腺癌以及脑和中枢神经系统肿瘤,前10位恶性肿瘤占全部恶性肿瘤死亡的78.12%。2002—2014年,上海市女性所有部位的恶性肿瘤标化发病率呈明显上升趋势(APC为2.17%,P<0.001),男性标化发病率则较为稳定。男性和女性所有部位的恶性肿瘤标化死亡率均呈明显下降趋势(APC分别为-0.82%和-0.76%,P<0.05)。结论:肺癌、消化系统恶性肿瘤、甲状腺癌和女性乳腺癌是威胁上海市居民健康的主要恶性肿瘤,仍是肿瘤防治工作的重点。同时,2002—2014年女性恶性肿瘤发病率有上升趋势,男性和女性恶性肿瘤死亡率均持续下降。

Background and purpose： Cancer has become a serious public health problem that threatens the health of Shanghai residents. This study aimed to investigate the cancer incidence and mortality in Shanghai in 2014. Methods： The data were collected from Shanghai Cancer Registry. Cancer incidence and mortality stratified by gender and region were analyzed. Crude rate, age-standardized rate, age-specific and region-specific rates, cumulative rate and truncated rate were calculated. The proportion and rates of 10 common cancers in different groups were also calculated. Joinpoint software was used to analyze the incidence and mortality trend during 2002-2014, and the annual percentage changes（APC） for whole period and for the time segments were estimated. Segi＇s population was used for calculating age-standardized incidence and mortality. Results： Shanghai Cancer Registry covered the total residential population with 14.50 million in 2014. The total reported new cancer cases and deaths were 68 541 and 37 242, respectively. The pathologically verified cases accounted for 79.49%, and 0.04% of cases were identified through death certifications only with mortality to incidence ratio of 0.54. The crude incidence in Shanghai Cancer Registry was 477.79 per 100 000. The age-standardized incidence by world standard population was 223.57 per 100 000. The incidence was higher in females than that in males, and the incidence in suburban areas was higher than that in urban areas. Cancer incidence increased rapidly after the age of 40 years and reached the peak in the age group of 80-84 years. The top 10 incidences of cancers were lung cancer, colorectal cancer, thyroid cancer, gastric cancer, breast cancer, liver cancer, prostate cancer, pancreatic cancer, brain and central nervous system tumor, and bladder cancer. The incidence cases for top 10 cancers accounted for 75.89% of total cases. The crude mortality in Shanghai Cancer Registry was 259.61 per 100 000. The age-standardized mortality rates by world standard population was 95.73 per 100 000. The mortality of males was higher than that of females, and the mortality in urban areas was similar to that in suburban areas. Cancer mortality increased rapidly after the age of 45 years and reached the peak in the age group of ≥85 years. The top 10 causes of cancer death were lung cancer, colorectal cancer, gastric cancer, liver cancer, pancreatic cancer, breast cancer, esophageal cancer, gallbladder cancer, prostate cancer, and brain and central nervous system tumor. The top 10 types of cancer accounted for 78.12% of all cancer deaths. For all cancers combined, the incidence rates were stable from 2002 to 2014 among males, whereas they increased significantly（APC=2.17%; P〈0.001） among females. By contrast, the mortality rates decreased significantly among both males（APC=-0.82%; P〈0.05） and females（APC=-0.76%; P〈0.05）. Conclusion： Lung cancer, digestive system malignancies, thyroid cancer and female breast cancer are the most common cancers in Shanghai. These cancers should be focused on. The incidence rates increased among females and the mortality rates decreased among both genders during 2002-2014.