中美两国恶性肿瘤疾病负担、流行趋势及归因风险因素比较

Comparison of the latest cancer statistics,cancer epidemic trends and determinants between China and the United States

目的比较中美两国主要恶性肿瘤的疾病负担、流行趋势、5年相对生存率和归因风险因素差异,为制定中国肿瘤防控政策提供参考。方法采用描述性研究方法,数据来源于GLOBOCAN数据库,美国国家癌症研究所的监测、流行病学与终末结果项目数据库,全球疾病负担2019数据库以及既往研究。主要指标包括不同部位恶性肿瘤的发病例数、死亡例数、Segi's世界人口年龄标准化发病率(世标发病率)和死亡率(世标死亡率),5年相对生存率,人群归因分数(PAF)。结果2022年中国新发恶性肿瘤482.5万例,死亡257.4万例,世标发病率(201.6/10万)低于美国(367.0/10万),世标死亡率(96.5/10万)高于美国(82.3/10万)。肺癌高居中国恶性肿瘤疾病负担首位,发病和死亡例数分别占全部恶性肿瘤的22.0%和28.5%。乳腺癌(11.5%)、前列腺癌(9.7%)和肺癌(9.5%)是美国发病前3位的恶性肿瘤,同时也是前5位死因的癌种,而中国恶性肿瘤死因第2~5位均为消化系统肿瘤(肝癌12.3%,胃癌10.1%,结直肠癌9.3%,食管癌7.3%)。2000—2018年,中国恶性肿瘤总体世标发病率呈上升趋势,世标死亡率呈下降趋势,而美国在2000年以后恶性肿瘤的发病率和死亡率均有明显下降趋势。中国乳腺癌、结直肠癌和甲状腺癌发病率上升较快,胃癌、肝癌和食管癌的发病率和死亡率下降,但仍具有较重的疾病负担。2003—2015年,中国总体恶性肿瘤5年相对生存率从30.9%上升到40.5%。但除食管癌外,其他主要恶性肿瘤5年相对生存率均低于美国。2019年,归因于潜在可改变风险因素的中国恶性肿瘤死亡PAF为48.3%,与美国相近(49.8%),其中,吸烟是最主要的可改变风险因素,中美两国PAF均>30%。另外,中国约有18.8%的恶性肿瘤来源于可以预防的慢性感染,如乙型肝炎病毒、幽门螺旋杆菌等,而美国只有<4%的恶性肿瘤归因于感染。结论中国恶性肿瘤防治工作取得了长足进展,但仍然面临严重的疾病负担,癌谱正在从发展中国家向发达国家转变,应重视可改变因素,综合施策,科学防癌。

Objective To provide supports for the cancer prevention and control strategies in China by comparing the disease burden,epidemic trends,5-year relative survival rate and major determinants of common cancers between China and the United States.Methods A descriptive secondary analysis was conducted using data extracted from the GLOBOCAN database,the Surveillance,Epidemiology,and End Results database,Global Burden of disease 2019 database,and previous studies.The main indicators included the cases of malignant tumors in different sites,the cases of deaths,the age-standardized incidence(world standard incidence)and mortality(world standard mortality),the 5-year relative survival rate,and population attributable fraction(PAF).Results In 2022,an estimated 4.825 million new cases and 2.574 million deaths of malignant neoplasms in China.The world standard incidence rate(201.6/100000)in China was lower than that in the United States(367.0/100000),and the world standard mortality rate(96.5/100000)was higher than that in the United States(82.3/100000).Lung cancer ranked first in the disease burden of malignant tumors in China,the new cases and deaths accounted for 22.0%and 28.5%of all malignant tumors,respectively.The top three malignant tumors in China were breast cancer(11.5%),prostate cancer(9.7%)and lung cancer(9.5%),which were also among the top five causes of death.However,the second to fifth leading causes of death from malignant tumors in China were digestive system tumors(liver cancer 12.3%,stomach cancer 10.1%,colorectal cancer 9.3%,and esophageal cancer 7.3%).From 2000 to 2018,the world standard incidence of malignant tumors showed an increasing trend and the world standard mortality of malignant tumors showed a decreasing trend in China,while the world standard incidence and mortality of malignant tumors in the United States showed a significant decreasing trend after 2000.The incidence of breast cancer,colorectal cancer and thyroid cancer increased rapidly in China,while the incidence and mortality of stomach cancer,liver cancer and esophageal cancer decreased,but they still had a heavy disease burden.From 2003 to 2015,the overall 5-year relative survival rate of malignant tumors increased from 30.9%to 40.5%in China.However,with the exception of esophageal cancer,the 5-year relative survival rates of other major malignant tumors were lower than those in the United States.In 2019,the PAF of malignant tumors death attributable to potential modifiable risk factors was 48.3%in China,which was similar to the United States(49.8%).Of these,smoking was the most important attributable risk factor,and the PAF was more than 30%both in China and the United States.In addition,about 18.8%of malignant tumors were caused by preventable chronic infections,such as hepatitis B virus and Helicobacter pylori,while less than 4%of malignant tumors in the United States were caused by infection.Conclusions China has made great progress in the prevention and treatment of malignant tumors,but it still faces a serious disease burden.The cancer spectrum is changing from developing countries to developed countries.We should pay attention to modifiable factors,take comprehensive measures,and prevent cancer scientifically.