Relationship between different sources of drinking water,water quality improvement and gastric cancer mortality in Changle County--A retrospectivecohort study in high incidence area

IM To investigate the relationship between different sources of drinking water supply, water quality improvement and gastric cancer mortality rate in a high risk area.METHODS A retrospectivecohort survey was carried out in all towns of this county to study the effect of different sources of drinking water supply and water quality improvement on gastric cancer mortality rate.RESULTS The gastric cancer mortality rate among the population 12405/105 drinking river water was obviously higher than that of drinking shallow well water (7485/105) (P<001) according to the Zhanggang Town 16 years accumulated data. The same pattern was presented in 7 towns after balancing the confounders. The gastric cancer mortality rate of population drinking river water was 8603/105, which was higher than those drinking shallow well water (6203/105) and tap water (2978/105) (P<001). When the drinking water switched from river and well water to tap water, the gastric cancer incidence decreased to 3033/105 and 2610/105, and the gastric cancer mortality decreased by 59% and 57% respectively.CONCLUSION The quality of drinking water is one of the important factors of increased incidence of gastric cancer in Changle County, and water quality improvement has a beneficial effect, but the cause of high gastric cancer incidence may be multifactorial in this area..

Human development index is associated with mortality-to-incidence ratios of gastrointestinal cancers

AIM:To identify the role of human development in the incidence and mortality rates of gastrointestinal cancers worldwide.METHODS:The age-standardized incidence and mortality rates for gastrointestinal cancers,including cancers of the esophagus,stomach,pancreas,liver,gallbladder,and colorectum,were obtained from the GLOBOCAN 2008 database and United States Cancer Statistics(USCS)report.The human development index(HDI)data were calculated according to the 2011 Human Development Report.We estimated the mortality-toincidence ratios(MIRs)at the regional and national levels,and explored the association of the MIR with development levels as measured by the HDI using a modified"drug dose to inhibition response"model.Furthermore,countries were divided into four groups according to the HDI distribution,and the MIRs of the four HDI groups were compared by one-way ANOVA followed by the Tukey-Kramer post-hoc test.Statespecific MIRs in the United States were predicted from the estimated HDI using the fitted non-linear model,and were compared with the actual MIRs calculated from data in the USCS report.RESULTS:The worldwide incidence and mortality rates of gastrointestinal cancers were as high as 39.4and 54.9 cases per 100000 individuals,respectively.Linear and non-linear regression analyses revealed an inverse correlation between the MIR of gastrointestinal cancers and the HDI at the regional and national levels(<0;P=0.0028 for regional level and<0.0001 for national level,ANOVA).The MIR differed significantly among the four HDI areas(very high HDI,0.620±0.033;high HDI,0.807±0.018;medium HDI,0.857±0.021;low HDI,0.953±0.011;P<0.001,oneway ANOVA).Prediction of the MIRs for individual United States states using best-fitted non-linear models showed little deviation from the actual MIRs in the United States.Except for 28 data points(9.93%of282),the actual MIRs of all gastrointestinal cancers were mostly located in the prediction intervals via the best-fit non-linear regression models.CONCLUSION:The inverse correlation between HDI and MIR demonstrates that more developed areas have a relatively efficacious healthcare system,resulting in low MIRs,and HDI can be used to estimate the MIR.

Trends and predictions for gastric cancer mortality in Brazil

AIM: To analyze the effect of age-period and birth cohort on gastric cancer mortality, in Brazil and across its five geographic regions, by sex, in the population over 20 years of age, as well as make projections for the period 2010-2029.METHODS: An ecological study is presented herein,which distributed gastric cancer-related deaths in Brazil and its geographic regions. The effects of ageperiod and birth cohort were calculated by the Poisson regression model and projections were made with the age-period-cohort model in the statistical program R. RESULTS: Progressive reduction of mortality rates was observed in the 1980's, and then higher and lower mortality rates were verified in the 2000's, for both sexes, in Brazil and for the South, Southeast and Midwest regions. A progressive decrease in mortality rates was observed for the Northeast(both sexes) and North(men only) regions within the period 1995-1999, followed by rising rates. CONCLUSION: Regional differences were demonstrated in the mortality rates for gastric cancer in Brazil, and the least developed regions of the country will present increases in projected mortality rates.

Incidence and mortality of cervical cancer in China in 2015

Objective:To estimate the incidence and mortality of cervical cancer in China based on the cancer registration data in 2015,collected by the National Central Cancer Registry(NCCR).Methods:There were 501 cancer registries that submitted data to the NCCR,whose data were the basis for estimating the incidence and mortality of cervical cancer in China in 2015.After evaluating the data quality,368 registries’data were accepted for the analysis and stratified by area(urban/rural)and age group.Combined with data on the national population in 2015,the nationwide incidence and mortality of cervical cancer were estimated.Cervical Cancer cases of 22 cancer registries were applied for temporal trends from 2000 to 2015.The Chinese population census in 2000 and Segi’s population were used to calculate age-standardized incidence and mortality rates.Results:An estimated 111,000 new cases were attributed to cervical cancer in China in 2015,accounting for 6.24%of all female new cancer cases in that year in China.The crude rate(CR)of incidence and age-standardized incidence rates by the China standard population(ASIRC)and by Segi’s world standard population(ASIRW)of cervical cancer were 16.56/100,000,11.78/100,000,and 10.86/100,000,respectively.The cumulative incidence rate from birth to 74 years old was 1.15%,whereas the calculation of incidence rates over the truncated age range of 35-64 years by Segi’s world standard population(T-ASIRW)was 27.66/100,000.The estimates of cervical cancer deaths were about 33,800 and 3.94%of all female cancer-related deaths in China in 2015,with a crude mortality rate of 5.04/100,000.The age-standardized mortality rates adjusted by the Chinese standard population(ASMRC)and by world Segi’s population(ASMRW)were 3.29/100,000 and 3.15/100,000,respectively,with a cumulative mortality rate(0-74 years old)of 0.35%.Both the incidence and mortality were higher in rural than in urban areas.The age-specific cervical cancer incidence significantly increased with age,particularly after age 25 years,and peaked at 50-54 years old,whereas age-specific mortality increased rapidly after 35 years old,peaking at 80-84 years old.The age-standardized incidence rates increased by about 8.6(95%CI:6.9,10.3)per year during the period of 2000−2015.The age at diagnosis of patients with cervical cancer tended to be younger.In rural areas,the mean age at diagnosis decreased about 3.22 years from 2000 to 2015(𝛽=-0.33,P<0.001).Conclusions:China has a high burden of cervical cancer and important disparities among different regions.Es-pecially in the middle and western areas and rural areas,cervical cancer is a serious issue in women’s health,and prevention strategies need to be enhanced.Prevention and control strategies need to be enhanced and imple-mented with reference to local status,such as human papillomavirus(HPV)vaccination and screening programs.

Neutropenic Fever in Lung Cancer:Clinical Aspects Related to Mortality and Antibiotic Failure

Background and objectives:Lung cancer(LC)is the leading cause of cancer death.Patients treated with chemotherapy are at risk of developing chemotherapy-induced febrile neutropenia(FN),a potentially life-threatening complication.The aims of this study were(1)to characterize FN admissions of patients with LC in a pulmonology department,and(2)to determine associations between patient profiles,first-line antibiotic failure(FLAF)and mortality.Methods:Retrospective observational case-series,based on the analysis of medical records of LC patients that required hospitalization due to chemotherapy-induced FN.Results:A total of 42 cases of FN were revised,corresponding to 36 patients,of which 86.1%were male,with a mean age of 66.71±9.83 years.Most patients had a performance status(PS)equal or less than 1,and metastatic disease was present in 40.5%(n=17).Respiratory tract infections accounted for 42.9%(n=18)of FN cases,and multidrug-resistant Staphylococcus aureus was the most isolated agent.The mortality rate was 16.7%(n=7),and the FLAF was 26.2%(n=11).Mortality was associated with a PS≥2(P=0.011),infection by a Gram-negative agent(P=0.001)and severe anemia(P=0.048).FLAF was associated with longer hospitalizations(P=0.020),PS≥2(P=0.049),respiratory infections(P=0.024),and infection by a Gram-negative(P=0.003)or multidrug-resistant agent(P=0.014).Conclusions:Lower PS,severe anemia,and infections by Gram-negative or multi-resistant agents seem to be associated with worse outcomes in FN patients.

Epidemiology of Cancer in Systemic Sclerosis—Systematic Review and Meta-Analysis of Cancer Incidence, Predictors and Mortality

Objectives: The study was conducted to improve our understanding of the epidemiology of cancer in systemic sclerosis (SSc) by evaluating the incidence, prevalence, relative risk of overall and site-specific malignancies, predictors and cancer-attributable mortality. Methods: MEDLINE, CINAHL, EMBASE and Cochrane Library (inception-May 2012) were searched. Estimates were combined using a random effects model. Consistency was evaluated using the I2 statistic. Results: 4876 citations were searched to identify 60 articles. The average incidence of malignancy in SSc was 14 cases/1000 person-years;the prevalence ranged between 4%-22%. Cancer was the leading cause of non-SSc related deaths with a mean of 38%. Overall SIR for all-site malignancy risk was 1.85 (95%CI 1.52, 2.25;I276%). There was a greater risk of lung (SIR 4.69, 95%CI 2.84, 7.75;I293%) and haematological (SIR 2.58, CI 95% 1.75, 3.81;I20%) malignancies, including non-Hodgkin’s lymphoma (SIR 2.55, 95%CI 1.40, 4.67;I20%). SSc patients were at a higher risk of leukemia (SIR 2.79, 95%CI 1.22, 6.37;I20%), malignant melanoma (SIR 2.92, 95%CI 1.76, 4.83;I235%), liver (SIR 4.75, 95%CI 3.09, 7.31;I20%), cervical (SIR 2.28, 95%CI 1.26, 4.09;I254%) and oropharyngeal (SIR 5.0, 95%CI 2.18, 11.47;I258%) cancers. Risk factors include a-RNAP I/III seropositivity, male sex, and late onset SSc. Smoking and longstanding interstitial lung disease increase the risk of lung cancer;Barrett’s esophagus and a positive family history of breast cancer, respectively, increase the risk of esophageal adenocarcinoma and breast cancer. Conclusions: SSc patients have a two-fold increase in all-site malignancy, and greater risk of lung and haematological malignancies that contribute significantly to mortality. Vigilance should be considered in SSc patients with risk factors for cancer.

Perioperative mortality of metastatic spinal disease with unknown primary: A case report and review of literature

BACKGROUND Spinal metastases are common in patients with malignancies,but studies on those metastasized from unknown primaries are scarce due to the difficulty in treatment and the relatively poor prognosis.Knowledge of surgical complications,particularly perioperative mortality,in patients with spinal metastases from unidentified sources is still insufficient.CASE SUMMARY A 54-year-old man with chest-back pain was diagnosed with spinal metastasis in the seventh thoracic vertebra(T7).Radiographic examinations,as well as needle biopsy and immunohistochemical tests were performed to verify the characteristics of the lesion,resulting in an inconclusive diagnosis of poorly differentiated cancer from an unknown primary lesion.Therefore,spinal surgery was performed using the posterior approach to relieve symptoms and verify the diagnosis.Postoperative histologic examination indicated that this poorly differentiated metastatic cancer was possibly sarcomatoid carcinoma.As the patient experienced unexpectedly fast progression of the disease and died 16 d after surgery,the origin of this metastasis was undetermined.We discuss this case with respect to reported perioperative mortality in similar cases.CONCLUSION A comprehensive assessment prior to surgical decision-making is essential to reduce perioperative mortality risk in patients with spinal metastases from an unknown origin.

External validation of nomograms for predicting cancer-specific mortality in penile cancer patients treated with definitive surgery

Using a population-based cancer registry,Thuret et al.developed 3 nomograms for estimating cancerspecific mortality in men with penile squamous cell carcinoma.In the initial cohort,only 23.0% of the patients were treated with inguinal lymphadenectomy and had pN stage.To generalize the prediction models in clinical practice,we evaluated the performance of the 3 nomograms in a series of penile cancer patients who were treated with definitive surgery.Clinicopathologic information was obtained from 160 M0 penile cancer patients who underwent primary tumor excision and regional lymphadenectomy between 1990 and 2008.The predicted probabilities of cancer-specific mortality were calculated from 3 nomograms that were based on different disease stage definitions and tumor grade.Discrimination,calibration,and clinical usefulness were assessed to compare model performance.The discrimination ability was similar in nomograms using the TNM classification or American Joint Committee on Cancer staging(Harrell's concordance index = 0.817 and 0.832,respectively),whereas it was inferior for the Surveillance,Epidemiology and End Results staging(Harrell's concordance index = 0.728).Better agreement with the observed cancer-specific mortality was shown for the model consisting of TNM classification and tumor grade,which also achieved favorable clinical net benefit,with a threshold probability in the range of 0 to 42%.The nomogram consisting of TNM classification and tumor grading was shown to have better performance for predicting cancer-specific mortality in penile cancer patients who underwent definitive surgery.Our data support the integration of this model in decision-making and trial design.

2020年中国与韩国和日本肝癌发病和死亡的比较分析

目的分析2020年中国肝癌发病、死亡情况,并比较韩国、日本的肝癌负担,为我国进一步完善肝癌的防治策略提供依据。方法从GLOBOCAN 2020提取中国、韩国及日本的肝癌发病及死亡相关数据,分析并比较不同性别、年龄别肝癌发病率和死亡率差异。结果2020年中国肝癌新发病例410038例,发病率为28.3/10万(男性40.8/10万,女性15.2/10万),世标率18.2/10万。韩国肝癌新发病例14788例,发病率28.8/10万(男性42.6/10万,女性15.1/10万),世标率14.3/10万。日本肝癌新发病例45663例,发病率为36.1/10万(男性48.3/10万,女性24.4/10万),世标率10.4/10万。2020年中国因肝癌死亡病例391152例,病死率27.0/10万(男性38.8/10万,女性14.6/10万),世标率17.2/10万。韩国肝癌死亡病例11158例,病死率21.8/10万(男性31.6/10万,女性11.9/10万),世标率9.9/10万。日本肝癌死亡病例28155例,病死率22.3/10万(男性29.4/10万,女性15.4/10万),世标率4.8/10万。结论我国是肝癌高发地区,相较于东亚邻国韩国和日本,我国肝癌发病及病死年龄更早。应针对不同性别、年龄组以及不同地区,制订相应的肝癌防治策略。

2022年全球及中国肺癌流行状况分析

目的根据国际癌症研究机构发布的2022年全球癌症统计报告,结合性别、年龄、人类发展指数(HDI)等特征分析2022年全球及中国肺癌发病和死亡情况。方法全球185个国家和地区的肺癌数据来源于GLOBOCAN 2022数据库,HDI根据联合国开发计划署公布的《2021年人类发展报告》数据进行整理。将癌症数据进行年龄、性别、HDI分层,描述全球及中国肺癌流行情况。采用Pearson相关分析评估年龄标化发病率(ASIR)、年龄标化死亡率(ASMR)及死亡发病比(M/I)与HDI之间的相关性。结果2022年全球肺癌总发病人数为248.1万,位列各癌种发病人数的第1位,ASIR(23.6/10万)位列各癌种的第3位;全球肺癌总死亡人数为181.7万,位列各癌种死亡人数的第1位,ASMR(16.8/10万)位列各癌种的第1位。2022年中国肺癌总发病人数为106.1万,占全球肺癌发病人数的42.8%,位列中国各癌种的第1位,ASIR(40.8/10万)位列中国各癌种的第1位;中国肺癌总死亡人数为73.3万,占全球肺癌死亡人数的40.4%,位列中国各癌种的第1位,ASMR(26.7/10万)位列中国各癌种的第1位。全球及中国男性肺癌发病人数、ASIR、死亡人数、ASMR均高于女性。全球及中国肺癌发病人数、ASIR、死亡人数、ASMR随年龄增长呈现上升趋势,40~44岁年龄组之后增长迅速。各个国家和地区ASIR、ASMR与HDI呈正相关(r=0.7393、0.6865,均P<0.0001),M/I与HDI呈负相关(r=-0.6881,P<0.0001)。结论全球及中国肺癌疾病负担严重,流行情况在不同HDI水平的国家和地区、性别、年龄别之间存在差异。

2015—2021年百色市4类慢性病早死概率变化趋势及预测分析

背景我国居民慢性非传染性疾病(慢性病)疾病负担较严峻,已成为制约人群健康期望寿命提高的重要影响因素。目的了解百色市2015—2021年4类重大慢性病(恶性肿瘤、心脑血管疾病、糖尿病和慢性呼吸系统疾病)早死情况及实现“健康中国2030”目标情况,为制定西部贫困地区慢性病防控策略提供借鉴。方法收集2015—2021年登记在百色市疾病预防控制中心死因监测系统的死亡数据,计算死亡率、早死概率等指标,运用Joinpoint 24.0软件,以平均年度变化百分比(AAPC)和率的变化趋势进行描述。结果2015—2021年,百色市4类慢性病粗死亡率为549.06/10万(AAPC=0.13%),标化死亡率为302.92/10万(AAPC=-5.66%),变化趋势均无统计学意义(P>0.05);女性4类慢性病标化死亡率呈下降趋势(AAPC=-1.66%,P=0.046)。其中总人群、男性、女性心脑血管疾病粗死亡率呈上升趋势(AAPC=2.74%,P=0.004;AAPC=2.43%,P=0.013;AAPC=3.17%,P=0.011),男性、女性慢性呼吸系统疾病标化死亡率呈下降趋势(AAPC=-8.66%,P=0.023;AAPC=-8.17%,P=0.027)。总人群、男性、女性4类慢性病早死概率分别为15.77%、26.03%、10.42%,其慢性呼吸系统疾病早死概率均呈下降趋势(AAPC=-6.89%,P=0.012;AAPC=-7.18%,P=0.007;AAPC=-6.94%,P=0.020)。男性4类慢性病早死概率约为女性的2.5倍。按照百色市2015—2021年4类慢性病早死概率平均增长速度,预计2030年百色市4类慢性病早死概率为14.62%,而2030年4类慢性病早死概率目标值为13.69%,只有女性、恶性肿瘤和慢性呼吸系统疾病早死概率目标值高于预测值。需将2021—2030年4类慢性病早死概率的平均下降速度提高至2.63%,才能实现2030年的早死概率目标,其中男性的平均下降速度应提高至2.70%。糖尿病早死概率应被重点关注,其预测值低于目标值且差距较大,下降速度应提高至6.76%。结论2015—2021年百色市总人群、男性、女性心脑血管疾病粗死亡率呈上升趋势,慢性呼吸系统疾病死亡率和早死概率呈下降趋势。以目前平均增长速度预测,百色市距离实现“健康中国2030”目标值尚有差距。应以男性为重点关注人群,以糖尿病和心脑血管疾病为重点干预疾病,使2021—2030年平均增长速度达到-2.63%,才可实现“健康中国2030”目标。

Socioeconomic inequalities in cancer incidence and mortality:An analysis of GLOBOCAN 2022

Background:Given the recent updates in cancer burden estimates by GLOBOCAN 2022,this study was undertaken to provide pertinent perspectives within the context of the Human Development Index(HDI)and major world economies.Methods:Datasets sourced from GLOBOCAN encompassed cancer cases and deaths across all cancer types in 2022,alongside projections up to 2050.Cancer incidences and deaths of the top 10 cancers within China and four distinct HDI-classified regions were compared using descriptive analyses.Age-standardized incidence rates(ASIRs)and mortality rates(ASMRs)worldwide for the most prevalent cancers in 2022 across ten largest economies and four-tier HDIs were examined.The top five cancer types concerning both incidence and mortality in China were delineated by sex and age group.Results:In males,prostate cancer predominated in countries with low,high(except China),and very high HDI.Prostate and liver cancers were prominent causes of death in countries with low HDI.In females,breast and cervical cancers predominated in countries with low-to-medium HDI.Lung and colorectal cancer incidence and deaths increased with high HDI for both sexes.ASIRs and ASMRs for breast,prostate,lung,and colorectal cancers in the top 10 economies were higher than the global average.However,liver,stomach,and cervical cancers in most Western countries exhibited lower rates.In China,hematologic malignancies(43%)were prevalent among children aged 0-14 years,whereas thyroid cancer led among adolescents and young adults aged 15-39 years.Regarding incidence and mortality,lung cancer predominated for individuals over 40 years,except for females aged 40-59 years,in whom breast cancer predominated.Projected trends indicated substantial increases in new cancer cases(76.6%)and deaths(89.7%)over the next three decades.Conclusions:Infection-and poverty-related cancer burdens are offset by increased prostate,breast,colorectal,and lung cancer incidence associated with rapid societal and economic transitions.Cancer incidence and mortality patterns in China feature characteristics of developed and developing countries,necessitating tailored,evidence-based,and comprehensive strategies for effective cancer prevention and control.

2003—2019年上海市嘉定区结直肠癌流行趋势研究

背景结直肠癌已成为上海市嘉定区发病率排名第三的恶性肿瘤,其疾病负担仍在加重。目的分析2003—2019年上海市嘉定区结直肠癌流行趋势,为结直肠癌防治提供科学依据。方法基于2003—2019年上海市嘉定区肿瘤登记资料,计算粗发病率、粗死亡率、标化发病率、标化死亡率等统计指标(以2010年中国标准人口构成进行标化调整),利用Joinpoint Regression Program 4.9.1.0软件分析发病率和死亡率的变化趋势。结果2003—2019年上海市嘉定区结直肠癌新发病例5020例,粗发病率52.12/10万,标化发病率26.27/10万,死亡病例2419例,粗死亡率25.12/10万,标化死亡率11.16/10万,男性的粗发病率和粗死亡率均高于女性(P<0.05);总人群标化发病率总体呈现上升趋势(APC=2.63%,P<0.05),其中男性标化发病率呈上升趋势(APC=3.48%,P<0.05),女性标化发病率无明显变化趋势(APC=1.39%,P=0.119),均未发现转折点;总人群标化死亡率无明显变化趋势(APC=-0.49%,P=0.250),其中男性标化死亡率无明显变化趋势(APC=0.34%,P=0.545),女性标化死亡率呈现下降趋势(APC=-1.94%,P<0.05)。结论2003—2019年上海市嘉定区结直肠癌总体发病率总体仍有上升,其中男性呈上升趋势,女性无明显变化趋势;总体死亡率无明显变化趋势,其中男性无明显变化,女性呈下降趋势,应继续加强结直肠癌的防控工作,重点关注男性人群。

1990-2021年中国食管癌疾病负担:与日本和韩国的对比分析

目的分析1990-2021年我国食管癌疾病负担及变化趋势,并与日本、韩国进行对比。方法基于2021年全球疾病负担数据库,分析1990-2021年我国食管癌的发病率、死亡率和伤残调整生命年(DALYs)及相应的年龄标化率,同时按不同年龄、性别进行描述性分析,并与日本、韩国进行对比。运用估计年度变化百分比和相对变化率评估食管癌疾病负担的变化趋势。纳入吸烟、饮酒、低蔬菜饮食、咀嚼烟草4个危险因素,分析食管癌DALYs和死亡负担归因于各危险因素的比例。运用因素分解方法分析人口增长、人口老龄化和流行病学变化对食管癌发病人数的贡献比例。利用年龄-时期-队列模型分析年龄、时期和出生队列对食管癌发病情况的效应趋势。使用Pearson相关分析评估年龄标化DALYs率与社会人口指数(SDI)的相关性。通过自回归移动平均模型预测未来20年中国的食管癌发病人数及年龄标化发病率(ASIR)。结果2021年,中国食管癌发病人数、死亡人数和DALYs分别为32.08万、29.64万和689.87万,较1990年分别增加了54.61%、40.61%和17.88%。2021年,我国食管癌ASIR、年龄标化死亡率(ASMR)和年龄标化DALYs率分别为15.04/10万、14.13/10万和317.18/10万,高于日本(分别为6.22/10万、3.81/10万和84.34/10万)和韩国(分别为3.52/10万、2.29/10万和50.15/10万);3个国家男性的食管癌疾病负担均高于女性。2021年,吸烟和饮酒是我国食管癌死亡的两大危险因素,发病人数的增长主要由人口增长及人口老龄化引起。此外,我国食管癌ASIR随年龄增长而上升,在85~89岁达到峰值。1990-2021年,中国、日本、韩国的SDI与食管癌年龄标化DALYs率呈负相关。预测到2041年,我国食管癌ASIR将持续降低至9.14/10万,但发病人数将增加至39.82万。结论我国食管癌疾病负担沉重,未来应加强吸烟、饮酒等危险因素的防控,并促进重点人群的早筛、早诊、早治。

2022年全球和中国胰腺癌发病及死亡分析

目的根据国际癌症研究机构发布的2022年全球癌症统计报告,结合性别、年龄和人类发展指数(HDI)等,分析2022年全球及中国胰腺癌的发病和死亡情况。方法全球185个国家和地区的胰腺癌数据来源于GLOBOCAN 2022数据库,HDI根据联合国开发计划署公布的《2022年人类发展报告》获取。将癌症数据按年龄、性别和HDI分层,描述全球及中国的胰腺癌流行情况。使用Pearson相关分析评估标化发病率(SIR)、标化死亡率(SMR)及死亡发病比(M/I)与HDI的相关性。结果2022年全球胰腺癌总发病人数为51.10万,在各癌种中位列第12位,SIR(4.7/10万)位列第15位;全球胰腺癌总死亡人数为46.74万,在各癌种中位列第6位,SMR(4.2/10万)位列第9位。中国胰腺癌总发病人数为11.87万,在中国各癌种中位列第10位,占全球胰腺癌总发病人数的23.22%,SIR(4.4/10万)位列中国各癌种的第13位;中国胰腺癌总死亡人数为10.63万,在中国各癌种中位列第6位,占全球胰腺癌总死亡人数的22.74%,SMR(3.9/10万)位列中国各癌种的第8位。全球及中国的男性胰腺癌发病人数、死亡人数、SIR和SMR均高于女性。胰腺癌SIR和SMR均与HDI呈正相关(r=0.77、0.77,均P<0.001),而M/I与HDI呈负相关(r=-0.43,P<0.001)。全球及中国的胰腺癌发病人数、死亡人数、SIR和SMR随年龄增长呈上升趋势,从45~49岁开始迅速增长。结论全球及中国胰腺癌疾病负担严重,胰腺癌的发病和死亡率随年龄增长呈上升趋势。男性的胰腺癌发病率和死亡率均高于女性。HDI与胰腺癌SIR和SMR呈正相关,而与M/I呈负相关。

1990-2019年中美两国归因于高BMI的食管癌疾病负担和死亡预测分析

目的分析1990—2019年中国和美国人群归因于高体重指数(BMI)的食管癌疾病负担变化趋势,并进行未来10年的死亡预测。方法使用2019年全球疾病负担(GBD 2019)数据,获取1990—2019年期间中国和美国归因于高BMI的食管癌疾病负担的不同年份、性别和年龄的死亡率、伤残调整生命年(DALYs)数据。Joinpoint回归分析用于分析长期变化趋势,贝叶斯年龄-时期-队列分析(BAPC)用于预测2020—2030年归因于食管癌的年龄标准化死亡率。结果1990—2019年,中国归因于高BMI的食管癌年龄标准化死亡率由1.44/10^(5)增长至1.80/105,年龄标准化DALYs率从34.17/10^(5)增长至40.79/10^(5)。从性别角度看,1990—2019年中国和美国男性的死亡人数、DALYs及相应的年龄标准化率均呈上升趋势;中国女性的年龄标准化死亡率及DALYs率呈下降趋势,降幅分别为21.36/10^(5)、29.71/10^(5)。Joinpoint分析结果显示,1990-2019年中国总人口和男性归因于食管癌的死亡率平均年度百分比(AAPC)分别以0.78%(95%CI:0.71~0.84)和1.52%(95%CI:1.44~1.60)的速度上升,女性AAPC以0.88%(95%CI:-0.96~-0.80)的速度下降;而美国女性AAPC以0.07%(95%CI:0.02~0.09)的速度缓慢上升。预测在2020-2030年,中国和美国归因于高BMI的食管癌死亡负担呈持续上升趋势。结论1990-2019年中国归因于高BMI的食管癌疾病负担呈显著上升趋势,预计2020-2030年我国由高BMI导致的食管癌疾病负担将会继续增高。

1990—2019年中国胆囊癌疾病负担研究及未来趋势分析

背景胆囊癌早期发现难度大,治疗效果不佳,病死率很高,对于胆囊癌流行病学的进一步研究,可为胆囊癌的防治策略制订提供一定价值数据依据。目的分析1990—2019年中国胆囊癌疾病负担流行趋势,估计其年龄、时期和队列效应及未来变化趋势。方法于2023年3—6月检索2019年全球疾病负担研究(GBD 2019)数据库,提取1990—2019年中国胆囊癌的发病率、患病率、死亡率、伤残调整寿命年(DALYs)率以及对应的标化率等疾病负担相关数据,通过Joinpoint软件计算其年度变化百分比(APC)、平均年度变化百分比(AAPC)分析1990—2019年中国胆囊癌的疾病负担变化趋势情况。构建贝叶斯年龄-时期-队列(BAPC)模型预测2020—2030年中国胆囊癌的发病情况。结果1990—2019年中国胆囊癌标化发病率由1990年1.58/10万上升至2019年的2.01/10万,AAPC为0.82%(95%CI=0.65%~1.00%);标化患病率由1990年的1.64/10万上升至2019年的2.40/10万,AAPC为1.34%(95%CI=1.14%~1.54%);标化死亡率由1990年的1.61/10万上升至2019年的1.82/10万,AAPC为0.40%(95%CI=0.24%~0.56%);标化DALYs率由1990年的35.18/10万上升至2019年的37.71/10万,AAPC为0.25%(95%CI=0.12%~0.38%);趋势变化均具有统计学意义(P<0.001)。BAPC模型分析结果显示,1990—2019年中国胆囊癌发病率和死亡率净漂移值分别为0.99(95%CI=0.81~1.18)和0.42(95%CI=0.21~0.63),胆囊癌发病率和死亡率随年龄增长均呈上升趋势,80岁及以上年龄组人群胆囊癌发病率均达到最高,发病和死亡风险随时期推移均呈现先下降后上升再下降趋势,均在2005—2009年达峰值,随出生队列推移均呈现先上升后下降趋势。BAPC模型预测结果显示,2020—2030年中国胆囊癌造成的标化发病率、患病率、死亡率和DALYs率均呈略微上升趋势。结论1990—2019年中国胆囊癌标化发病率、患病率、死亡率和DALYs率均呈上升趋势,疾病负担仍较为严重,应加强男性人群和老年人群胆囊癌防治,大力开展防癌知识宣传、控制胆管疾病和推广健康生活方式,以降低胆囊癌疾病负担。

低剂量CT筛查对人群肺癌死亡率及全因死亡率影响的Meta分析

目的:系统评价低剂量计算机断层扫描(low-dose computed tomography screening, LDCT)在筛查人群中降低肺癌死亡率和全因死亡率的有效性。方法:计算机检索PubMed、Embase、Cochrane Library、中国知网、万方数据知识服务平台等数据库公开发表、国内外有关LDCT筛查肺癌的前瞻性研究,检索时间为2000年1月至2023年8月。对符合纳入标准的研究进行数据提取及质量评价,主要结局指标为肺癌死亡率,次要结局指标为全因死亡率、预防1例患者因肺癌死亡或全因死亡需筛查人数。使用R 4.3.1软件进行Meta分析。结果:共纳入9项前瞻性研究,涵盖了123 880名被筛查者,年龄范围为40~75岁,各项研究的中位随访时间在3.6~13.0年。Meta分析结果显示,相比于非LDCT筛查组,LDCT筛查降低了人群16%的肺癌死亡率(RR=0.84,95%CI:0.78~0.91,P<0.001);全因死亡率降低情况差异无统计学意义(RR=0.93,95%CI:0.84~1.03,P=0.151)。亚组分析表明,非LDCT筛查组(对照组)具体亚类与肺癌死亡率降低情况相关。Meta回归结果表明,中位随访时间与全因死亡率降低情况相关。若通过LDCT筛查预防1例患者因肺癌死亡,在非影像学预防/全人群中预计需筛查人数为139名;预防1例患者全因死亡预计需筛查人数为81名。结论:使用LDCT进行肺癌筛查能明显降低40~75岁人群的肺癌死亡率,对特定年龄和风险群体进行LDCT筛查具有重要的公共卫生意义。

中国胃癌流行病学现状

目的:通过对中国人群肿瘤登记数据中胃癌资料进行分析,了解全国胃癌流行现状。方法:根据全国肿瘤登记中心的数据,评估全国胃癌流行情况及胃癌长期变化趋势。结果:2012年中国胃癌新发病例约42.4万例,死亡病例约29.8万例。2000年至2012年我国城市地区男性与女性胃癌发病率、死亡率保持平稳,农村地区男性呈上升趋势,农村地区女性变化不大,调整年龄后发病率和死亡率均呈下降趋势。2003年至2005年胃癌5年相对生存率为27.4%(95%CI:26.7%~28.1%)。结论:胃癌是中国常见的恶性肿瘤,疾病负担严重,农村地区尤为明显,是国家癌症防治的重点。

中国部分市县1998～2002年恶性肿瘤的发病与死亡

[目的]探讨中国人群肿瘤发病、死亡的流行特征。[方法]分析中国30个肿瘤登记处1998￣2002年的肿瘤登记资料。[结果]全国30个肿瘤登记处覆盖人口37813997人,覆盖3.04%的全国人口。1998￣2002年新病例386910例,死亡病例266033例。世界年龄结构调整恶性肿瘤发病率在78.4/10万￣623.8/10万间;世界人口调整死亡率在78.9/10万￣260.1/10万之间。[结论]中国最常见的恶性肿瘤,男性为肺癌、胃癌、肝癌和食管癌;女性为乳腺癌、食管癌、胃癌、肺癌、肝癌和子宫颈癌。