江苏省启东市育龄女性恶性肿瘤患者生存率变化趋势分析

Trend analysis of survival rate of female patients with malignant tumors of childbearing age in Qidong,Jiangsu Province

目的探讨江苏省启东市过去45年内15~49岁育龄女性恶性肿瘤(MTCF)患者生存率及其变化趋势。方法选择1972年1月1日至2016年12月31日"启东市肿瘤登记系统、全死因登记系统"(隶属于启东肝癌防治研究所)登记的15~49岁MTCF(含脑和中枢神经系统良性肿瘤)患者10014例为研究对象。计算MTCF患者1、5、10年观察生存率(OSR)和相对生存率(RSR),并采用Hakulinen似然比检验法,对45年内的9个时间段(1972—1976年、1977—1981年、1982—1986年、1987—1991年、1992—1996年、1997—2001年、2002—2006年、2007—2011年、2012—2016年,5年间隔,分别为第1~9个5年)与患者7个年龄段(15~19岁、20~24岁、25~29岁、30~34岁、35~39岁、40~44岁、45~49岁,5岁间隔,分别为第1~7个5岁)的RSR进行比较。分析MTCF患者1、5、10年OSR、RSR的平均年度变化百分比(AAPC)。本研究遵循的程序符合启东市人民医院伦理委员会规定,并通过该伦理委员会审查及批准(审批文号:ER-XXM-LWTG-2021-051)。结果①MTCF患者1、5、10年OSR与RSR分别为53.23%、36.54%、32.54%与53.34%、36.98%、33.45%,1、5年RSR从第1个5年的44.04%、25.06%上升至第9个5年的83.24%、68.04%,10年RSR从第1个5年的21.14%上升至第8个5年的47.24%。9个时间段中,MTCF患者的1、5、10年RSR总体比较,差异有统计学意义(χ^(2)=1291.19,P<0.001)。MTCF患者1、5、10年OSR的AAPC分别为2.18%、3.30%、3.66%,1、5、10年RSR的AAPC分别为2.18%、3.28%、3.61%,其1、5、10年OSR和RSR在9个时间段中的上升趋势比较,差异均有统计学意义(1、5、10年OSR:t=5.62、P=0.001,t=6.47、P<0.001,t=6.45、P<0.001;1、5、10年RSR:t=5.63、P=0.001,t=6.50、P<0.001,t=6.48、P<0.001)。②过去45年内第1~7个5岁MTCF患者5年RSR分别27.47%、32.29%、33.21%、34.76%、34.87%、36.00%、40.60%,7个年龄段患者5年RSR总体比较,差异有统计学意义(χ^(2)=90.66、P<0.001)。第1~7个5岁MTCF患者5年RSR的AAPC分别为3.56%、2.48%、3.47%、3.18%、3.02%、3.54%、3.32%,7个年龄段患者5年RSR在9个时间段中的上升趋势比较,差异均有统计学意义(t=5.03、P=0.002,t=6.34、P<0.001,t=10.80、P<0.001,t=5.24、P=0.001,t=5.66、P=0.001,t=5.09、P=0.001,t=6.66,P<0.001)。③启东市发病数前10位的MTCF患者中,5年RSR最高的为甲状腺癌(97.05%),最低的为肝癌(6.86%)。结论启东市过去45年内MTCF患者总体生存率呈上升趋势,应继续关注育龄女性健康,加强肝癌等重点癌症筛查策略,早发现、早诊断、早治疗,以进一步提高MTCF患者整体生存率。

Objective To explore the survival rate and its trend of malignant tumor in childbearing-aged female(MTCF)with 15-49 years old in Qidong,Jiangsu Province in the past 45 years.Methods A total of 10014 patients with MTCF(including benign tumors of brain and central nervous system)aged 15-49 years registered in the Qidong Cancer Registry System and All-Cause Mortality Registration System which affiliated to Qidong Liver Cancer Institute from January 1,1972 to December 31,2016 were selected in the study.The 1-,5-,and 10-year observed survival rate(OSR)and relative survival rate(RSR)of MTCF patients were calculated by SURV 3.01 software,and Hakulinen likelihood ratio test was applied for comparison of RSR of MTCF patients in nine periods(1972-1976,1977-1981,1982-1986,1987-1991,1992-1996,1997-2001,2002-2006,2007-2011,2012-2016,every 5-year interval,ranging from the 1st to the 9th 5-year)and seven age groups(15-19,20-24,25-29,30-34,35-39,40-44,45-49 years,every 5-year interval,ranging from the 1st to the 7th 5-year)in the past 45 years.average annual percentage change(AAPC)of 1-,5-,and 10-year OSR and RSR of MTCF patients were analyzed.The procedures followed in this study were in accordance with the regulations of the Ethics Committee of Qidong People′s Hospital and were reviewed and approved by this Ethics Committee(Approval No.ER-XXM-LWTG-2021-051).Results①From 1972-2016,the 1-,5-,and 10-year OSR of MTCF patients in Qidong were 53.23%,36.54%,and 32.54%,respectively,and the 1-,5-,and 10-year RSR were 53.34%,36.98%,and 33.45%,respectively.The 1-and 5-year RSR increased from 44.04%and 25.06%in the 1st 5-year interval to 83.24%and 68.04%in the 9th 5-year interval,and 10-year RSR increased from 21.14%in the 1st 5-year interval to 47.24%in the 8th 5-year interval.The differences were statistically significant among the 1-,5-,and 10-year RSR of MTCF patients in nine periods(χ^(2)=1291.19,P<0.001).The AAPC of 1-,5-,and 10-year OSR of MTCF patients in Qidong were 2.18%,3.30%,and 3.66%,respectively,and AAPC of 1-,5-,and 10-year RSR were 2.18%,3.28%,and 3.61%,respectively,and the upward trend of 1-,5-,and 10-year OSR and RSR of MTCF patients in nine periods all were statistically significant(1-,5-,and 10-year OSR:t=5.62,P=0.001;t=6.47,P<0.001;t=6.45,P<0.001;1-,5-,and 10-year RSR:t=5.63,P=0.001;t=6.50,P<0.001;t=6.48,P<0.001).②The 5-year RSR of MTCF patients in the 1st to 7th 5-year intervals of Qidong within 45 years were 27.47%,32.29%,33.21%,34.76%,34.87%,36.00%,and 40.60%,respectively.When comparing the overall 5-year RSR among these seven age groups,there was a statistically significant difference(χ^(2)=90.66,P<0.001).The AAPC of 5-year RSR of patients in the 1st to 7th 5-year intervals were 3.56%,2.48%,3.47%,3.18%,3.02%,3.54%,and 3.32%,respectively,and the 5-year RSR patients in these seven age groups showed a statistically significant upward trend in nine periods(t=5.03,P=0.002;t=6.34,P<0.001;t=10.80,P<0.001;t=5.24,P=0.001;t=5.66,P=0.001;t=5.09,P=0.001;t=6.66,P<0.001).③Among the top 10 MTCF patients in terms of incidence in Qidong,the highest 5-year RSR was for thyroid cancer(97.05%),while the lowest was for liver cancer(6.86%).Conclusions The overall survival rate of MTCF patients in Qidong in the past 45 years has shown an upward trend.It is important to continue focusing on the health of women of childbearing age and strengthen screening strategies for key cancers such as liver cancer.Early detection,diagnosis,and treatment are crucial in order to further improve the overall survival rate of MTCF patients.