基于SEER数据库分析肺腺癌的发病率及生存趋势

Trends in the incidence and survival of lung adenocarcinoma:an analysis and research based on SEER database

目的研究肺腺癌流行病学的最新趋势。方法利用监测、流行病学和最终结果数据库(SEER)收集2000年1月至2016年12月肺腺癌病人资料,分析年龄调整后的发病率、年龄标准化后的相对生存率变化趋势。结果共纳入肺腺癌病人310702例,年龄调整后发病率分别从2000年的21.3/100000上升到2016年的21.5/100000,特别是在女性、年龄≥70岁、黑种人、美洲印第安人/阿拉斯加原住民(AI/AN)、亚洲/太平洋岛民(API)、病理分级Ⅰ级、局限期和远处转移者中,分别从2000年的18.6/100000、110.3/100000、22.4/100000、6.5/100000、16.6/100000、1.7/100000、4.3/100000、11.0/100000上升至2016年的20.8/100000、135.0/100000、23.8/100000、8.5/100000、19.1/100000、2.0/100000、5.5/100000、11.4/100000,其中年龄≥70岁者升高幅度最大,但在男性、<60岁、60~<70岁、白种人、病理分级为Ⅱ~Ⅳ级以及局部转移者中,经年龄调整后的发病率是降低的,分别从2000年的25.0/100000、5.8/100000、85.4/100000、21.6/100000、4.3/100000、6.5/100000、0.2/100000、4.8/100000降至2016年的22.5/100000、4.7/100000、69.8/100000、21.4/100000、4.0/100000、4.4/100000、0.1/100000、4.2/100000,其中60~<70岁者降低幅度最大。研究期间,经年龄标准化后的3年相对生存率和5年相对生存率均是升高的,分别从2000年的26.2%、20.3%上升到2016年的32.7%、25.0%。亚组分析发现,女性、60~<70岁、API、病理分级Ⅰ级、局部转移者的3年、5年相对生存率升高得较明显,其3年相对生存率分别从2000年的30.8%、27.5%、27.6%、53.0%、41.0%上升至2011年的37.7%、35.9%、39.3%、67.6%、52.6%,其5年相对生存率分别从2000年的24.1%、21.1%、18.8%、46.3%、29.9%上升至29.3%、27.2%、27.7%、61.1%、41.5%。结论总体上,肺腺癌经年龄调整后的发病率略有升高,经年龄标准化后的相对生存率逐渐升高。其中,病理分级较低、局限期发病率和生存率的升高可能得益于肺癌筛查及治疗水平的提高。

Objective To investigate the latest trends of epidemiology of lung adenocarcinoma(LADC).Methods The data of patients with LADC from January 2000 to December 2016 were obtained from the Surveillance,Epidemiological,and End Results(SEER)database,and the trends of age-adjusted incidence and age-standardized relative survival rate were analyzed.Results A total of 310702 cases of LADC were included.The age-adjusted incidence of LADC increased slightly from 21.3/100000 in 2000 to 21.5/100000 in 2016,especially among populations of females,older than age 70 years,blacks,American Indian/Alaska Native(AI/AN),Asian/Pacific Islander(API),and those with pathological gradingⅠ,limited stage,and distant metastasis,the incidences increased from 18.6/100000,110.3/100000,22.4/100000,6.5/100000,16.6/100000,1.7/100000,4.3/100000 and 11.0/100000 in 2000 to 20.8/100000,135.0/100000,23.8/100000,8.5/100000,19.1/100000,2.0/100000,5.5/100000 and 11.4/100000 in 2016 respectively.The incidence increased the largest among population aged 70 years or above.The age-adjusted incidences of LADC decreased among populations of men,younger than 60 years old,aged from 60 to younger than 70 years old,whites,and those with pathological gradingⅡ-Ⅳand local metastasis from 25.0/100000,5.8/100000,85.4/100000,21.6/100000,4.3/100000,6.5/100000,0.2/100000 and 4.8/100000 in 2000 to 22.5/100000,4.7/100000,69.8/100000,21.4/100000,4.0/100000,4.4/100000,0.1/100000 and 4.2/100000 in 2016 respectively.The incidence decreased the largest in population aged from 60 to younger than 70 years old.The age-standardized 3-year and 5-year relative survival rates increased during the study period from 26.2%and 20.3%in 2000 to 32.7%and 25.0%in 2016 respectively.Subgroup analysis results showed that the 3-year and 5-year relative survival rates in populations of female,aged from 60 to younger than 70 years old,API,and those with pathological grading I and local metastasis increased significantly.The 3-year relative survival rates increased from 30.8%,27.5%,27.6%,53.0%and 41.0%in 2000 to 37.7%,35.9%,39.3%,67.6%and 52.6%in 2011 respectively,meanwhile the 5-year relative survival rate increased from 24.1%,21.1%,18.8%,46.3%and 29.9%in 2000 to 29.3%,27.2%,27.7%,61.1%and 41.5%in 2011 respectively.Conclusions Overall,the age-adjusted incidence of lung adenocarcinoma increased slightly,and the age-standardized relative survival rates of lung adenocarcinoma gradually increased.Among them,the increase in the incidence and survival rate of patients with lower pathological grading and limited stage may benefit from lung cancer screening and the improvement of treatment.