2016年上海市结肠直肠癌发病和死亡情况与2002—2016年间的变化趋势分析

doi:10.16139/j.1007-9610.2021.04.010

摘要/Abstract

摘要：

目的：分析2016年上海市结肠直肠癌发病和死亡的基本情况及其2002—2016年间的变化趋势。 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年结肠直肠癌发病和死亡资料,按诊断或死亡年份、性别、部位和年龄组分层分析,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。分析结肠直肠癌发病和死亡数量、粗率、年龄别率和标化率趋势。按性别划分的结肠癌和直肠癌的发病和死亡标化率也应用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结肠直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 1960年世界标准人口构成调整计算发病和死亡的标化率。结果：2016年上海市结肠直肠癌新发病例数和死亡人数分别为9 337例和4 599人,粗发病率为64.48/10万,标化发病率为24.64/10万,粗死亡率为31.76/10万,标化死亡率为10.13/10万,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随着年龄的增长而增加。年龄别发病的数量和率值分别在60~64岁组和80~84岁组达到高峰,年龄别死亡的数量和率值均在85岁以上组达到高峰。结肠直肠癌的标化发病率在2002—2016年间以年均1.07%的增速上升,标化死亡率维持稳定状态。结论：按性别或年龄组分层的结肠直肠癌现况和趋势反映了上海户籍人口在相关危险因素、筛查技术应用和诊疗水平发展等方面的变化。以人群为基础的癌症发病和死亡资料可用于减少癌症负担。

关键词: 结肠直肠癌, 发病率, 死亡率, 流行病学, 上海

Abstract:

Objective To investigate the colorectal cancer (CRC) incidence and mortality in 2016 Shanghai and trend change between 2002 and 2016. Methods Data of CRC incidence and death between 2002 and 2016 were collected from the population-based cancer registry and Vital Statistics System of Shanghai Municipal Center for Disease Control and Prevention. CRC incidence and mortality including year of incidence and mortality, gender, cancer site and age-group were analyzed. CRC incidence and mortality, and proportion, crude rate, age-specific rate, and age-standardized rate were also calculated. Trends of incidence and death of CRC, crude rate, age-specific rate and age-standardized rate were estimated. Trends of gender-standardized CRC incidence and death and the annual percent change(APC) were estimated by Joinpoint analysis. The incidence and proportion of new CRC cases with selected diagnostic character in different years were also calculated. Age-standardized incidence and mortality were calculated using Segi’s 1960 world standard population. Results CRC incidence and mortality were 9 337 and 4 599 in Shanghai 2016. Crude incidence was 64.48/10⁵, and age-standardized rate was 24.64/10⁵. Crude mortality was 31.76/10⁵, and age-standardized rate was 10.13/10⁵. Age-standar-dized incidence and mortality in males were higher than those in females. Age-specific case number and rate and age-specific death number and rate increased with aging. Age-specific case number and rate reached peak at age group both 60-64 years and 80-84 years, and age-specific death number and rate reached peak at age group more than 85 years. Overall, age-standardized CRC incidence between 2002 and 2016 increased 1.07% per year, and age-standardized CRC mortality was stable. Conclusions The current status and trends of CRC stratified by gender or age-group reflect the changes in risk factors, screening test use, and advances in diagnosis and treatment in Shanghai permanent population. Data of population-based cancer incidence and mortality can be used to decrease cancer burden.

Key words: Colorectal cancer, Incidence, Mortality, Epidemiology, Shanghai

中图分类号:

吴春晓, 龚杨明, 顾凯, 庞怡, 鲍萍萍, 王春芳, 施亮, 向詠梅, 窦剑明, 付晨, 施燕. 2016年上海市结肠直肠癌发病和死亡情况与2002—2016年间的变化趋势分析[J]. 外科理论与实践, 2021, 26(04): 325-335.

WU Chunxiao, GONG Yangming, GU Kai, PANG Yi, BAO Pingping, WANG Chunfang, SHI Liang, XIANG Yongmei, DOU Jianming, FU Chen, SHI Yan. Colorectal cancer incidence and mortality in Shanghai 2016 and trend analysis 2002—2016[J]. Journal of Surgery Concepts & Practice, 2021, 26(04): 325-335.

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参考文献 30

[1]	Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249. doi: 10.3322/caac.21660 URL
[2]	吴春晓, 顾凯, 龚杨明, 等. 2015年中国结直肠癌发病和死亡情况分析[J]. 中国癌症杂志, 2020, 30(4):241-245.
[3]	Gong Y, Peng P, Bao P, et al. The implementation and first-round results of a community-based colorectal cancer screening program in Shanghai, China[J]. Oncologist, 2018, 23(8):928-935. doi: 10.1634/theoncologist.2017-0451 URL
[4]	国家癌症中心. 中国肿瘤登记工作指导手册(2016)[M]. 北京: 人民卫生出版社, 2016:59-75.
[5]	Parkin DM, Chen VW, Ferlay J, et al. Comparability and Quality Control in Cancer Registration. IARC Technical Report No 19[M]. Lyon: IARC Press,1994.
[6]	上海市疾病预防控制中心. 上海市恶性肿瘤发病率、死亡率和生存率(2001-2012)[M]. 上海: 上海科学普及出版社, 2017:1-6.
[7]	Bosman FT, Carneiro F, Hruban RH, et al. WHO Classification of Tumours of the Digestive System, 4th Ed, Vo-lume 3[M]. Lyon: IARC Press, 2010.
[8]	卢伟, 郑莹. 肿瘤命名与编码[M]. 上海: 第二军医大学出版社,2011.
[9]	Segi M. Cancer mortality for selected sites in 24 countries (1950-1957)[M]. Japan: Tohoku University School of Medicine,1960.
[10]	Joinpoint Regression Program, Version 4.8.0.1[CP].April, 2020; Statistical Research and Applications Branch, National Cancer Institute.
[11]	Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates[J]. Stat Med, 2000, 19(3):335-351. doi: 10.1002/(sici)1097-0258(20000215)19:3<335::aid-sim336>3.0.co;2-z pmid: 10649300
[12]	Ferlay J, Ervik M, Lam F, et al.Global Cancer Observatory: Cancer Today[DB/OL]. Lyon, France:International Agency for Research on Cancer.[2021-07-15] https://gco.iarc.fr/today,accessed .
[13]	Bray F. Transitions in human development and the global cancer burden[M]// Stewart BW, Wild CP, eds. World Cancer Report 2014. Lyon: IARC Press, 2014:42-55.
[14]	Fidler MM, Soerjomataram I, Bray F. A global view on cancer incidence and national levels of the human develop-ment index[J]. Int J Cancer, 2016, 139(11):2436-2446. doi: 10.1002/ijc.30382 URL
[15]	Arnold M, Sierra MS, Laversanne M, et al. Global patterns and trends in colorectal cancer incidence and mortality[J]. Gut, 2017, 66(4):683-691. doi: 10.1136/gutjnl-2015-310912 URL
[16]	龚杨明, 顾凯, 彭鹏, 等. 社区居民大肠癌筛查工作规范解读[J]. 上海预防医学, 2017, 29(2):99-101.
[17]	Wu K, Keum N, Nishihara R, et al. Cancers of the colon and rectum[M]// ThunMJ, LinetMS, CerhanJR, et al,eds. Cancer Epidemiology and Prevention. 4th ed. New York, NY: Oxford University Press, 2018:681-706.
[18]	Brenner H, Kloor M, Pox CP. Colorectal cancer[J]. Lancet, 2014, 383(9927):1490-1502. doi: 10.1016/S0140-6736(13)61649-9 URL
[19]	马新源, 李其龙, 姚开颜, 等. 嘉善县大肠癌早诊早治项目进展情况[J]. 中国肿瘤, 2009, 18(9):725-727.
[20]	沈永洲, 钱菁, 何锋, 等. 海宁市2007-2008年大肠癌早诊早治筛查结果分析[J]. 中国肿瘤, 2009, 18(9):728-730.
[21]	杨永恒, 冯文猛, 王东,主等编. 中国人类发展报告特别版[M]. 北京: 中译出版社, 2019
[22]	Siegel R, Desantis C, Jemal A. Colorectal cancer statisics, 2014[J]. CA Cancer J Clin, 2014, 64(2):104-117. doi: 10.3322/caac.21220 URL
[23]	Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society[J]. CA Cancer J Clin, 2018, 68(4):250-281. doi: 10.3322/caac.21457 URL
[24]	Zeng H, Chen W, Zheng R, et al. Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries[J]. Lancet Glob Health, 2018, 6(5):e555-e567.
[25]	Siegel RL, Miller KD, Goding Sauer A, et al. Colorectal cancer statistics, 2020[J]. CA Cancer J Clin, 2020, 70(3):145-164. doi: 10.3322/caac.21601 URL
[26]	World Cancer Research Fund/American Institute for Cancer Research. The Continuous Update Project Expert Report 2018. Diet, Nutrition, Physical Activity and Cancer: Colorectal Cancer[EB/OL]. [2021-07-15]. https://wcrf.org/wp-content/uploads/2021/02/Colorectal-cancer-report.pdf , accessed.
[27]	Schreuders EH, Ruco A, Rabeneck L, et al. Colorectal cancer screening: a global overview of existing programmes[J]. Gut, 2015, 64(10):1637-1649. doi: 10.1136/gutjnl-2014-309086 pmid: 26041752
[28]	上海市疾病预防控制中心. 上海市慢性病及其危险因素监测报告2007[M]. 上海: 上海科学普及出版社,2012.
[29]	上海市疾病预防控制中心. 上海市慢性病及其危险因素监测报告2010[M]. 上海: 上海科学普及出版社,2012.
[30]	上海市疾病预防控制中心. 上海市慢性病及其危险因素监测报告2013[M]. 上海: 上海科学普及出版社,2014.

分类	部位	ICD-10	性别	计数	构成比%	粗率/10万	标化率/10万	截缩率/10万	累积率%
分类	部位	ICD-10	性别	计数	构成比%	粗率/10万	标化率/10万	35~64岁	0~64岁	0~74岁	0~84岁
发病	结肠直肠	C18-21	合计	9 337	12.55	64.48	24.64	37.30	1.31	2.90	5.44
			男性	5 441	14.00	75.74	30.03	44.96	1.58	3.56	6.61
			女性	3 896	10.95	53.40	19.52	29.69	1.03	2.24	4.37
	结肠	C18	合计	5 755	7.73	39.74	14.98	21.44	0.75	1.75	3.41
			男性	3 201	8.24	44.56	17.44	24.31	0.85	2.05	3.99
			女性	2 554	7.18	35.00	12.67	18.61	0.65	1.45	2.87
	直肠	C19-20	合计	3 530	4.74	24.38	9.54	15.67	0.55	1.13	2.00
			男性	2 211	5.69	30.78	12.44	20.39	0.71	1.49	2.58
			女性	1 319	3.71	18.08	6.75	10.97	0.38	0.78	1.47
	肛门	C21	合计	52	0.07	0.36	0.12	0.18	0.01	0.01	0.03
			男性	29	0.07	0.40	0.15	0.25	0.01	0.02	0.04
			女性	23	0.06	0.32	0.10	0.11	0	0.01	0.03
死亡	结肠直肠	C18-21	合计	4 599	12.43	31.76	10.13	10.52	0.38	1.00	2.72
			男性	2 684	11.80	37.36	12.94	12.80	0.46	1.28	3.47
			女性	1 915	13.42	26.25	7.64	8.26	0.29	0.71	2.06
	结肠	C18	合计	2 804	7.58	19.36	6.09	5.94	0.21	0.58	1.68
			男性	1 586	6.97	22.08	7.53	6.93	0.25	0.71	2.11
			女性	1 218	8.54	16.69	4.85	4.97	0.18	0.46	1.31
	直肠	C19-20	合计	1 769	4.78	12.22	3.97	4.49	0.16	0.41	1.03
			男性	1 081	4.75	15.05	5.33	5.75	0.21	0.57	1.34
			女性	688	4.82	9.43	2.74	3.22	0.11	0.25	0.74
	肛门	C21	合计	26	0.07	0.18	0.06	0.09	0	0.01	0.01
			男性	17	0.07	0.24	0.08	0.12	0	0.01	0.02
			女性	9	0.06	0.12	0.05	0.06	0	0.01	0.01

分类	年龄组（岁）	年龄别率/10万			年龄别率2007—2011/2002—2006			年龄别率2012—2016/2007—2011
分类	年龄组（岁）	2002—2006	2007—2011	2012—2016	比值	Z值	P值	比值	Z值	P值
发病	20-	0.77	0.69	0.91	0.90	0.45	0.649	1.32	1.10	0.272
	25-	1.46	1.72	1.73	1.18	1.01	0.314	1.00	0.03	0.977
	30-	3.49	3.73	4.02	1.07	0.57	0.566	1.08	0.75	0.453
	35-	6.41	5.60	6.27	0.87	1.59	0.113	1.12	1.32	0.185
	40-	11.65	10.61	13.84	0.91	1.67	0.094	1.30	4.45	<0.001
	45-	21.72	21.94	24.34	1.01	0.28	0.776	1.11	2.60	0.009
	50-	39.32	39.72	43.73	1.01	0.38	0.704	1.10	3.66	<0.001
	55-	59.27	62.62	70.42	1.06	2.18	0.029	1.12	5.74	<0.001
	60-	84.50	97.64	100.92	1.16	5.82	<0.001	1.03	1.72	0.085
	65-	127.76	133.73	141.43	1.05	1.99	0.046	1.06	2.78	0.005
	70-	182.15	182.53	187.03	1.00	0.11	0.915	1.02	1.23	0.218
	75-	223.40	240.53	244.05	1.08	3.82	<0.001	1.01	0.79	0.428
	80-	251.11	274.73	279.25	1.09	3.85	<0.001	1.02	0.83	0.409
	≥85	202.62	241.07	249.21	1.19	5.31	<0.001	1.03	1.32	0.187
死亡	20-	0.24	0.31	0.09	1.34	0.76	0.446	0.28	2.42	0.015
	25-	0.56	0.52	0.51	0.93	0.26	0.794	0.98	0.07	0.945
	30-	1.22	1.48	0.98	1.21	1.03	0.305	0.67	2.21	0.027
	35-	1.89	2.14	1.84	1.13	0.83	0.409	0.86	1.01	0.312
	40-	3.85	3.07	3.74	0.80	2.26	0.024	1.22	1.73	0.084
	45-	7.49	6.77	6.50	0.90	1.62	0.106	0.96	0.56	0.574
	50-	12.19	12.55	12.48	1.03	0.61	0.544	0.99	0.12	0.907
	55-	20.59	20.48	21.73	0.99	0.13	0.898	1.06	1.63	0.104
	60-	31.33	35.50	30.54	1.13	3.05	0.002	0.86	4.46	<0.001
	65-	52.13	53.23	51.09	1.02	0.58	0.561	0.96	1.25	0.210
	70-	85.10	92.34	80.82	1.09	2.89	0.004	0.88	4.61	<0.001
	75-	134.82	150.92	144.86	1.12	4.58	<0.001	0.96	1.75	0.080
	80-	195.35	227.51	232.96	1.16	5.86	<0.001	1.02	1.09	0.275
	≥85	230.21	301.62	331.90	1.31	9.06	<0.001	1.10	4.33	<0.001

分类	2002—2006		2007—2011		2012—2016
分类	例数	构成比%	例数	构成比%	例数	构成比%
诊断亚部位（ICD-10编码与名称）
C18.0盲肠/回盲部	1 185	4.14	1 353	3.74	1 376	3.04
C18.1阑尾	129	0.45	141	0.39	296	0.65
C18.2升结肠	3 548	12.41	5 068	14.00	4 954	10.93
C18.3结肠肝曲	694	2.43	787	2.17	688	1.52
C18.4横结肠	1 216	4.25	1 426	3.94	1 653	3.65
C18.5结肠脾曲	224	0.78	241	0.67	208	0.46
C18.6降结肠	997	3.49	1 415	3.91	1 678	3.70
C18.7乙状结肠	4 697	16.43	6 130	16.93	8 322	18.36
C18.8结肠交搭跨越	224	0.78	220	0.61	246	0.54
C18.9未特指的结肠	3 632	12.70	4 631	12.79	7 981	17.61
C19直肠乙状结肠连接处	676	2.36	724	2.00	755	1.67
C20直肠	11 104	38.84	13 806	38.13	16 868	37.22
C21肛门和肛管	263	0.92	265	0.73	297	0.66
病理组织学类型
管状腺癌	4 574	16.00	5 473	15.12	4 490	9.91
神经内分泌癌	202	0.71	370	1.02	693	1.53
乳头状腺癌	851	2.98	396	1.09	224	0.49
绒毛状腺癌	422	1.48	282	0.78	191	0.42
乳头状管状腺癌	532	1.86	896	2.47	865	1.91
黏液腺癌	1 550	5.42	2 080	5.74	2 185	4.82
印戒细胞癌	163	0.57	218	0.60	260	0.57
其他和未分型腺癌	12 751	44.60	18 154	50.14	24 431	53.91
其他分型	239	0.84	243	0.67	254	0.56
未分型	7 305	25.55	8 095	22.36	11 729	25.88
诊断时分期
Ⅰ	1 610	5.63	2 221	6.13	3 988	8.80
Ⅱ	5 153	18.02	6 616	18.27	7 488	16.52
Ⅲ	3 887	13.60	5 883	16.25	6 858	15.13
Ⅳ	3 583	12.53	5 049	13.94	5 811	12.82
不详	14 356	50.22	16 438	45.40	21 177	46.73