2018年湖南省长沙市恶性肿瘤发病与死亡及2014-2018年变化趋势分析

Incidence and Mortality of Cancer in 2018 and Trend from 2014 to 2018 in Changsha Cancer Registration Areas of Hunan Province

[目的]分析长沙市2018年及2014-2018年恶性肿瘤发病与死亡数据,以期为长沙市恶性肿瘤防治工作提供参考依据.[方法]收集和整理2014-2018年长沙市肿瘤登记地区上报的肿瘤新发与死亡资料.使用SAS9.4软件按城乡、性别分层,分别计算恶性肿瘤的发病和死亡相关指标,中标率和世标率分别采用2000年中国标准人口年龄构成和Segi世界标准人口年龄构成为标准进行计算.采用Joinpoint 4.9软件分析恶性肿瘤发病与死亡趋势,采用对数直线回归模型估计率的年度变化百分比(APC),采用t检验进行统计检验,检验水准为α=0.05.[结果]2018年长沙市肿瘤登记地区恶性肿瘤发病率为277.46/10万,其中男性(304.94/10万)高于女性(249.69/10万),城市地区(294.42/10万)高于农村地区(251.63/10万);中标发病率为192.10/10万,世标发病率为188.88/10万,累积率(0~74岁)为22.53%.男性发病前5位分别为肺癌、结直肠肛门癌、肝癌、食管癌、口腔和咽喉癌;女性发病前5位分别为乳腺癌、肺癌、结直肠肛门癌、宫颈癌和甲状腺癌.2018年长沙市肿瘤登记地区恶性肿瘤死亡率为169.48/10万,其中男性(222.02/10万)高于女性(116.40/10万),城市地区(176.01/10万)高于农村地区(159.54/10万);中标死亡率为107.54/10万,世标死亡率为107.40/10万,累积率(0~74岁)为12.77%.男性死亡前5位分别为肺癌、肝癌、结直肠肛门癌、食管癌和胃癌;女性死亡前5位分别为肺癌、结直肠肛门癌、肝癌、乳腺癌、宫颈癌.2014-2018年发病呈上升趋势,中标发病率APC为7.37%(95%CI:2.62%~12.33%),男性中标发病率上升幅度略低于女性[APC:5.97%(95%CI:0.66%~11.56%)vs 9.03%(95%CI:4.28%~14.01%)],城市上升幅度略低于农村[APC:6.55%(95%CI:0.26%~13.23%)vs 9.61%(95%CI:8.07%~11.18%)].2014-2018年死亡率变化趋势较平稳,但农村地区恶性肿瘤中标死亡率呈上升趋势,APC为7.21%(95%CI:0.32%~14.57%).[结论]2018年长沙市恶性肿瘤发病率和死亡率较高,特别是男性和城市地区,2014-2018年恶性肿瘤疾病负担逐年增加,农村尤为明显.肺癌、乳腺癌、结直肠肛门癌、肝癌、宫颈癌、食管癌和胃癌等是常见癌种,口腔和咽喉癌是长沙市特色癌种,应采取综合措施加强恶性肿瘤防治工作.

[Purpose]To analyze the cancer incidence and mortality in Changsha City in 2018 and trends from 2014 to 2018.[Methods]The data of new cancer cases and deaths were collected from Changsha cancer registration areas.The data were stratified by areas and gender,and the incidence and mortality were calculated.The population composition of China in 2000 and Segi’s population structure were used to calculate age-standardized rate(ASR).Joinpoint 4.9 software was used to analyze the incidence and mortality trends of cancer.The annual percentage change(APC)of the rate was estimated by log-linear regression model,and t test was used for statistical test,with test levelα=0.05.[Results]The crude cancer incidence in Changsha cancer registration areas in 2018 was 277.46/105,which was higher in male(304.94/105)than that in female(249.69/105),and higher in urban areas(294.42/105)than that in rural areas(251.63/105).The age-standardized incidence rate by Chinese standard population in 2000(ASIRC)and by Segi’s world standard population(ASIRW)were 192.10/105 and 188.88/105,respectively.The cumulative incidence rate(0~74 years old)was 22.53%.The top five cancers in male were lung cancer,colorectal and anal cancer,liver cancer,esophageal cancer,oral and pharyngeal cancer;while the top five cancers in female were breast cancer,lung cancer,and colorectal and anal cancer,cervical cancer and thyroid cancer.The crude cancer mortality in Changsha cancer registration areas in 2018 was 169.48/105,which was higher in male(222.02/105)than that in female(116.40/105),and higher in urban areas(176.01/105)than that in rural areas(159.54/105).The age-standardized mortality rate by Chinese standard population in 2000(ASMRC)and by Segi’s world standard population(ASMRW)were 107.54/105 and 107.40/105,respectively.The cumulative incidence rate(0~74 years)was 12.77%.The top five cancer deaths in male were lung cancer,liver cancer,colorectal and anal cancer,esophageal cancer and gastric cancer;while the top five cancer deaths in female were lung cancer,colorectal and anal cancer,liver cancer,breast cancer and cervical cancer.The trend of incidence was increasing from 2014 to 2018,with the APC of ASIRC 7.37%(95%CI:2.62%~12.33%).The APC was lower in male(5.97%,95%CI:2.62%~12.33%)than that in female(9.03%,95%CI:4.28%~14.01%),and lower in urban areas(6.55%,95%CI:0.26%~13.23%)than that in rural areas(9.61%,95%CI:8.07%~11.18%).The trend of mortality from 2014 to 2018 was relatively stable,while it was increasing in rural areas with the APC of ASMRC 7.21%(95%CI:0.32%~14.57%).[Conclusion]The incidence and mortality of cancer in Changsha City were high in 2018,especially in male and in urban areas.The burden of cancer was increasing from 2014 to 2018,especially in rural areas.Lung cancer,breast cancer,colorectal and anal cancer,liver cancer,cervical cancer,esophageal cancer and stomach cancer were the most common cancers,and oral cavity and pharynx cancer were the characteristic cancer in Changsha City.The comprehensive measures should be taken to strengthen cancer prevention and treatment.