2002—2016年上海市小肠癌发病、死亡和生存分析.pdf

论著?240:J Surg Concepts Pract 2023,Vol.28,No.32002一2 0 16 年上海市小肠癌发病、死亡和生存分析吴春晓，顾凯，庞怡，王春芳，施亮，向梅，龚杨明，窦剑明，施燕，付晨（上海市疾病预防控制中心，上海200336)摘要 目目的：分析2 0 0 2 一2 0 16 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2 0 0 2 一2 0 16 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Segis1960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方法计算期望生存率，最终获得1 5年相对生存率。结果：2 0 0 2 一2 0 16 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2 8 0 例和17 4人，粗发病率为2.0 2/10 万，标化发病率为0.96/10 万，粗死亡率为1.2 5/10 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。2 0 0 2 一2 0 13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。关键词小肠癌；发病；死亡；生存；流行病学；上海中图分类号：R735.3*2文献标志码：A文章编号：10 0 7-96 10(2 0 2 3)0 3-0 2 40-0 9D01:10.16139/j.1007-9610.2023.03.011Incidence,mortality and survival analysis of small intestine cancer in Shanghai population-based study from 2002to2016WU Chunxiao,GU Kai,PANG Yi,WANG Chunfang,SHI Liang,XIANG Yongmei,GONG Yangming,DOU Jianming,SHIYan,FUChenShanghai Municipal Center for Disease Control and Prevention,Shanghai 200336,ChinaAbstractJ Objective:To investigate the incidence,mortality and survival of small intestine cancer in Shanghaifrom 2002 to 2016.Methods:Data of new small intestine cancer cases and deaths from 2002 to 2016 were obtained fromthe population-based cancer registry and Vital Statistics System of Shanghai Municipal Center for Disease Control and Pre-vention.The incidence and mortality of small intestine cancer stratified by year of diagnosis or death,gender and age-groupwere analyzed.Cases or deaths,proportion,crude rate,age-specific rate,age-standardized rate and others were calculated.Trends of cases or deaths,crude rate,age-specific rate and age-standardized rate of incidence and mortality with follow-upinformation were estimated.The annual percent change(APC)of age-standardized rates of incidence and mortality was esti-mated by Joinpoint analysis.The new cases and proportions with selected diagnostic character of small intestine cancer indfferent diagnosis years were also calculated.Age-standardized rates were calculated using Segis 1960 world standardpopulation.The 1-to 5-year observed survival rates were calculated based on the life table.The probabilities of survivingfrom O to 99 years old were estimated according to the Elandt-Johnson model,and then the cumulative expected survivalrates were calculated according to the Ederer II method.Finally,the l-to 5-year relative survival rates were calculated.Results:The age-standardized rates of incidence and mortality of small intestine cancer were stable in Shanghai from 2002基金项目：国家重点研发计划项目（2 0 2 2 YFC3600800）通信作者：顾凯，E-mail：g u k a i s c d e.s h.c n241.外科理论与实践2 0 2 3年第2 8 卷第3期to 2016.The new average cases and deaths of small intestine cancer were 280 and 174 per year in Shanghai.The crude rateof incidence was 2.02/10,and the age-standardized rate was 0.96/105.The crude rate of mortality was 1.25/10,and the age-standardized rate was 0.54/10.The age-standardized rates of incidence and mortality in males were higher than those infemales.The age-specific cases or deaths and rates of incidence and mortality increased with aging.Duodenum cancer wasthe dominant anatomical site.Adenocarcinoma was the most histopathological type,and the proportion of gastrointestinalstromal tumors was increasing.The 5-year observed survival rate of small intestine cancer diagnosed from 2002 to 2013 was36.34%in Shanghai,and the 5-year relative survival rate was 39.98%.All survival rates of male were lower than those offemale.The 5-year observed and relative survival rates were stable.And those decreased with the increase of diagnosticyears and stages.Relative to other sites,the rates of the duodenum cancer were the lowest.Relative to other histopathologi-cal types,those of gastrointestinal stromal tumors were the highest.Conclusions:The diagnostic level of small intestinecancer has been improved in Shanghai,continuously.But the survival rates have not been improved with the times.The pro-portion of stage I was low and without improvement for a long time.This study provides useful information to further re-search,control and prevention of small intestine cancer.Improvement of the surveillance and research on small intestinecancer will help to promote more efficient control and prevention strategies then decrease cancer burden.Key words Small intestine cancer;Incidence;Mortality;Survival;Epidemiology;Shanghai小肠是一个具有高度增生性上皮的巨大器官，但小肠癌却非常罕见，流行病学资料也相当缺乏。小肠可能有独特的DNA复制控制和修复机制，值得进一步探索!。上海市疾病预防控制中心每年更新上海市恶性肿瘤统计资料，本研究分析2 0 0 2 一2016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，为小肠癌的防治研究提供参考依据。1资料和方法1.1资料来源和质量控制根据中国肿瘤登记工作指导手册(2 0 16)2 和世界