外科理论与实践 ›› 2023, Vol. 28 ›› Issue (03): 240-248.doi: 10.16139/j.1007-9610.2023.03.011
吴春晓, 顾凯(), 庞怡, 王春芳, 施亮, 向詠梅, 龚杨明, 窦剑明, 施燕, 付晨
收稿日期:
2023-04-17
出版日期:
2023-05-25
发布日期:
2023-08-18
通讯作者:
顾凯,E-mail:基金资助:
WU Chunxiao, GU Kai(), PANG Yi, WANG Chunfang, SHI Liang, XIANG Yongmei, GONG Yangming, DOU Jianming, SHI Yan, FU Chen
Received:
2023-04-17
Online:
2023-05-25
Published:
2023-08-18
摘要:
目的:分析2002—2016年上海市小肠癌发病、死亡和生存的基本情况及其变化趋势。方法:采用上海市疾病预防控制中心建立的人群基础肿瘤登记管理系统和死因登记系统收集的2002—2016年上海市小肠癌发病、死亡和随访资料,按诊断或死亡年份、性别和年龄组等因素分层分析,计算数量、构成比、粗率、年龄别率、年龄标准化率(简称标化率)等指标。分析小肠癌发病和死亡数量、粗率、年龄别率和标化率趋势。标化率应用Joinpoint软件计算年度变化百分比分析变化趋势。计算不同诊断年份组合的小肠癌新发病例的部分诊断特征指标的数量和构成比。应用Segi’s 1960年世界标准人口构成调整计算发病和死亡的标化率。1~5年观察生存率应用寿命表法计算,应用Elandt-Johnson模型推算0~99岁逐岁的生存概率,再根据Ederer Ⅱ方法计算期望生存率,最终获得1~5年相对生存率。结果:2002—2016年上海市小肠癌标化发病率和标化死亡率均呈稳定状态,年均新发病例和死亡人数分别为280例和174人,粗发病率为2.02/10万,标化发病率为0.96/10万,粗死亡率为1.25/10万,标化死亡率为0.54/10万,男性发病和死亡的标化率均高于女性。年龄别发病和死亡的数量和率值总体上随着年龄的增长而增多。小肠癌以十二指肠为主,腺癌居多,胃肠道间质瘤的数量和占比增长明显。2002—2013年上海市小肠癌诊断病例的5年观察生存率为36.34%,5年相对生存率为39.98%,男性的各项生存率指标均低于女性。5年观察和相对生存率保持稳定状态,随诊断年龄和诊断时分期的增长而降低,十二指肠相对其他部位的生存率最低,胃肠道间质瘤则相对其他病理组织学类型的生存率最高。结论:上海市小肠癌诊断水平在不断改善,但是生存率没有随着时间的变化而提升,Ⅰ期比例较低且没有提升。本研究为小肠癌的进一步研究和预防控制提供了依据,加强相关监测和研究有助于调整防治措施,减少负担。
中图分类号:
吴春晓, 顾凯, 庞怡, 王春芳, 施亮, 向詠梅, 龚杨明, 窦剑明, 施燕, 付晨. 2002—2016年上海市小肠癌发病、死亡和生存分析[J]. 外科理论与实践, 2023, 28(03): 240-248.
WU Chunxiao, GU Kai, PANG Yi, WANG Chunfang, SHI Liang, XIANG Yongmei, GONG Yangming, DOU Jianming, SHI Yan, FU Chen. Incidence, mortality and survival analysis of small intestine cancer in Shanghai population-based study from 2002 to 2016[J]. Journal of Surgery Concepts & Practice, 2023, 28(03): 240-248.
表1
2002—2016年上海市小肠癌发病和死亡概况
Category | Gender | Average number | Proportion /% | Crude rate /10-5 | ASR/10-5 | TASR/10-5 | Cumulative rate /% | |||
---|---|---|---|---|---|---|---|---|---|---|
35-64 years | 0-64 years | 0-74 years | 0-84 years | |||||||
Incidence | Both | 280 | 0.49 | 2.02 | 0.96 | 1.52 | 0.05 | 0.11 | 0.20 | |
Male | 152 | 0.49 | 2.19 | 1.09 | 1.73 | 0.06 | 0.13 | 0.22 | ||
Female | 128 | 0.48 | 1.84 | 0.83 | 1.30 | 0.05 | 0.10 | 0.17 | ||
Mortality | Both | 174 | 0.52 | 1.25 | 0.54 | 0.68 | 0.02 | 0.06 | 0.13 | |
Male | 98 | 0.48 | 1.40 | 0.66 | 0.84 | 0.03 | 0.07 | 0.16 | ||
Female | 76 | 0.58 | 1.10 | 0.44 | 0.51 | 0.02 | 0.05 | 0.11 |
表2
2002—2016年上海市小肠癌诊断特征变化趋势
Category | 2002—2006 | 2007—2011 | 2012—2016 | |||||
---|---|---|---|---|---|---|---|---|
Cases | % | Cases | % | Cases | % | |||
Morphological verification | 793 | 72.09 | 1 108 | 76.31 | 1 273 | 76.78 | ||
Anatomic site | ||||||||
Duodenum | 726 | 66.00 | 949 | 65.36 | 1 117 | 67.37 | ||
Jejunum | 47 | 4.27 | 51 | 3.51 | 71 | 4.28 | ||
Ileum | 54 | 4.91 | 66 | 4.55 | 65 | 3.92 | ||
Others and unspecified | 273 | 24.82 | 386 | 26.58 | 405 | 24.43 | ||
Histological type | ||||||||
Adenocarcinoma, unspecified | 335 | 30.45 | 486 | 33.47 | 604 | 36.43 | ||
Adenocarcinoma, specified | 172 | 15.64 | 196 | 13.50 | 146 | 8.81 | ||
GIST | 56 | 5.09 | 192 | 13.22 | 290 | 17.49 | ||
Other mesenchymal tumors | 148 | 13.45 | 139 | 9.57 | 17 | 1.03 | ||
Neuroendocrine carcinoma | 22 | 2.00 | 35 | 2.41 | 44 | 2.65 | ||
Others and unspecified | 367 | 33.36 | 404 | 27.82 | 557 | 33.59 | ||
Stage | ||||||||
Ⅰ | 71 | 6.45 | 107 | 7.37 | 95 | 5.73 | ||
Ⅱ | 130 | 11.82 | 164 | 11.29 | 182 | 10.98 | ||
Ⅲ | 101 | 9.18 | 128 | 8.82 | 131 | 7.90 | ||
Ⅳ | 161 | 14.64 | 202 | 13.91 | 245 | 14.78 | ||
Unknown | 637 | 57.91 | 851 | 58.61 | 1 005 | 60.62 |
表3
2002—2013年上海市小肠癌诊断病例生存情况
Gender | Observed cases | Observed survival rate/% | MST1 | Relative survival rate/% | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1-year | 2-year | 3-year | 4-year | 5-year | (years) | 1-year | 2-year | 3-year | 4-year | 5-year | ||||
Total | 3 210 | 61.97 | 48.98 | 43.25 | 39.02 | 36.34 | 1.92 | 63.45 | 51.05 | 45.87 | 42.13 | 39.98 | ||
Male | 1 743 | 59.53 | 46.49 | 40.42 | 35.95 | 33.31 | 1.73 | 61.08 | 48.65 | 43.17 | 39.17 | 37.07 | ||
Female | 1 467 | 64.85 | 51.92 | 46.58 | 42.62 | 39.90 | 2.36 | 66.35 | 53.99 | 49.18 | 45.75 | 43.54 |
表4
2002—2013年上海市小肠癌诊断病例5年生存率特征分析
Category | Observed cases | 5-year observed survival rate (95% CI)/% | 5-year relative survival rate (95% CI)/% |
---|---|---|---|
Total | 3 210 | 36.34 (34.63-38.05) | 39.98 (38.10-41.86) |
Gender | |||
Male | 1 743 | 33.31 (31.03-35.59) | 37.07 (34.54-39.61) |
Female | 1 467 | 39.90 (37.34-42.46) | 43.54 (40.75-46.34) |
Diagnostic period | |||
2002—2004 | 596 | 36.00 (31.97-40.03) | 39.40 (34.99-43.81) |
2005—2007 | 760 | 37.47 (33.98-40.97) | 40.96 (37.14-44.78) |
2008—2010 | 869 | 37.87 (34.59-41.15) | 41.59 (37.99-45.19) |
2011—2013 | 985 | 34.30 (31.24-37.36) | 38.00 (34.61-41.39) |
Age group/year | |||
15-45 | 169 | 60.97 (53.41-68.53) | 61.28 (53.69-68.88) |
45-54 | 466 | 54.85 (50.22-59.48) | 55.66 (50.96-60.36) |
55-64 | 785 | 45.86 (42.31-49.42) | 47.25 (43.59-50.92) |
65-74 | 868 | 34.56 (31.31-37.81) | 37.73 (34.18-41.27) |
≥75 | 922 | 15.74 (13.29-18.19) | 22.28 (18.81-25.76) |
Anatomic site | |||
Duodenum | 2 124 | 30.17 (28.16-32.19) | 33.33 (31.10-35.55) |
Jejunum | 122 | 49.65 (40.51-58.78) | 53.85 (43.94-63.76) |
Ileum | 150 | 40.89 (32.92-48.85) | 46.07 (37.09-55.05) |
Others and unspecified | 814 | 49.27 (45.77-52.76) | 53.69 (49.87-57.50) |
Histological type | |||
Adenocarcinoma, unspecified | 1 055 | 28.05 (25.26-30.85) | 30.44 (27.41-33.47) |
Adenocarcinoma, specified | 437 | 37.08 (32.40-41.76) | 40.35 (35.25-45.45) |
GIST | 373 | 74.65 (70.12-79.19) | 80.32 (75.44-85.19) |
Other mesenchymal tumors | 294 | 68.33 (62.91-73.75) | 73.25 (67.43-79.06) |
Neuroendocrine carcinoma | 76 | 66.28 (55.50-77.06) | 71.25 (59.66-82.84) |
Others and unspecified | 975 | 17.97 (15.48-20.46) | 21.16 (18.23-24.10) |
Stage | |||
Ⅰ | 220 | 62.47 (55.91-69.03) | 68.16 (61.01-75.32) |
Ⅱ | 374 | 51.29 (46.15-56.44) | 55.47 (49.90-61.04) |
Ⅲ | 293 | 33.54 (27.89-39.20) | 36.44 (30.30-42.57) |
Ⅳ | 459 | 17.08 (13.47-20.70) | 18.23 (14.37-22.09) |
Unknown | 1 864 | 35.23 (33.01-37.45) | 39.22 (36.75-41.69) |
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