2005-2016年中国肝癌发病趋势分析

Analysis on incidence trend of liver cancer in China,2005-2016

目的分析2005-2016年中国肝癌发病情况及变化趋势,并结合乙型肝炎(乙肝)流行的具体变化趋势探究与肝癌发病变化趋势间的相关性。方法根据《中国肿瘤登记年报》中2005-2016年肝癌发病资料,利用Joinpoint回归模型分析肝癌发病世界人口标化率(世标率)变化趋势[以平均年度变化百分比(AAPC)衡量],拟合年龄-时期-队列模型分析2005-2016年≥20岁人群肝癌发病风险的年龄效应、时期效应及队列效应。利用中国公共卫生科学数据中心的乙肝发病资料研究乙肝流行变化趋势,采用Pearson相关系数探究与肝癌发病变化趋势间的相关性。结果2005-2016年中国肝癌粗发病率以2009年为界,呈先上升后趋于稳定的趋势,肝癌发病世标率从19.11/10万降至17.74/10万(AAPC=-0.5%,95%CI:-1.3%~0.3%,P=0.240),男性肝癌发病率下降趋势显著(AAPC=-1.0%,95%CI:-1.5%~-0.5%,P=0.001),女性肝癌发病率在2005-2010年呈上升趋势[年度变化百分比(APC)=1.7%,95%CI:-0.1%~3.4%,P=0.059],在2010-2016年呈显著下降趋势(APC=-1.6%,95%CI:-2.3%~-1.0%,P=0.001)。2005-2016年城市地区(AAPC=-0.3%,95%CI:-0.8%~0.3%,P=0.316)和农村地区(AAPC=-3.9%,95%CI:-4.4%~-3.3%,P<0.001)肝癌发病率呈下降趋势。中国人群肝癌发病风险随年龄增加而增加,年龄效应呈上升趋势,时期效应呈先升后降的趋势,而队列效应呈下降趋势。2009-2016年乙肝与肝癌发病率均呈下降趋势,且存在显著相关性(r=0.71,95%CI:0.01~0.94,P=0.048)。结论2005-2016年中国肝癌发病率呈下降趋势,且存在显著的性别和城乡差异。年龄效应对肝癌发病风险的影响较大,随着中国人口老龄化的加剧,肝癌依然是需要持续关注的公共卫生问题。

Objective To understand the incidence trend of liver cancer in China from 2005 to 2016,and explore the correlation between the incidence trend of liver cancer and the incidence trend of hepatitis B.Methods The incidence data of liver cancer in China from 2005 to 2016 were collected from the Annual Report of Cancer Registry in China.The incidence data of hepatitis B were collected from China Public Health Science Data Center.World standardized incidence rate(WSR)was calculated according to the World Segi's population.Joinpoint regression model was used to analyze the trend of WSR of liver cancer[measured by average annual percentage change(AAPC)].The age-period-cohort model was fitted to analyze the age,period and cohort effects in people aged 20-years and above.Pearson correlation coefficient was used to explore the correlation between the incidence of liver cancer and the incidence of hepatitis B.Results The crude incidence of liver cancer in China showed a trend of first increase before 2009 and then relatively stable.The world standardized morbidity rate of liver cancer in China decreased from 19.11 per 100000 in 2005 to 17.74 per 100000 in 2016(AAPC=-0.5%,95%CI:-1.3%-0.3%,P=0.240).The incidence of liver cancer in male decreased significantly(AAPC=-1.0%,95%CI:-1.5%--0.5%,P=0.001).The incidence of liver cancer in women increased from 2005 to 2010[annual percentage change(APC)=1.7%,95%CI:-0.1%-3.4%,P=0.059]but showed a significant decrease trend from 2010 to 2016(APC=-1.6%,95%CI:-2.3%--1.0%,P=0.001).From 2005 to 2016,the incidence of liver cancer showed a decreasing trend in urban areas(AAPC=-0.3%,95%CI:-0.8%-0.3%,P=0.316)and rural areas(AAPC=-3.9%,95%CI:-4.4%--3.3%,P<0.001).Risk for liver cancer increased with age,while the period effect showed a trend of first increase then decrease and cohort effect showed a decrease trend.The morbidity rates of both hepatitis B and liver cancer showed decrease trends from 2009 to 2016,and there was a significant correlation(r=0.71,95%CI:0.01-0.94,P=0.048).Conclusions From 2005 to 2016,the morbidity rate of liver cancer in China showed a decrease trend,and there were significant gender and urban-rural area specific differences.Age effect had a great impact on the risk for liver cancer.With the progress of population aging in China,liver cancer is still a public health problem,to which close attention needs to be paid.