摘要
目的分析上海市15岁以下儿童恶性实体肿瘤发病特征和变化趋势，为病因学研究提供线索，为防治措施的制定和评估提供依据。方法资料来源于上海市肿瘤登记信息系统和儿童肿瘤专项调查。采用儿童肿瘤国际分类ICCC-3进行归类分析。统计2002—2010年上海全市儿童恶性实体肿瘤发病情况及性别、年龄别和瘤别分布特征，应用基于Poisson分布的标化发病率比较方法，计算2007—2010年和2002—2006年两个时期标化发病率比。结果（1）2002—2010年上海全市共新诊断15岁以下儿童恶性实体肿瘤868例，分别占全部恶性肿瘤和全部儿童恶性肿瘤新发病例数的0．2％和65．8％。年均发病率为79．0／100万，标化发病率为80．2／100万。（2）男性儿童恶性实体肿瘤标化发病率为86．3／100万，女性为73．8／100万。0～4岁组发病率为93．4／100万，5～9岁为65．2／100万，10～14岁组为79．3／100万。（3）年均发病率最高的5种恶性实体瘤依次为：中枢神经系统肿瘤（23．8／100万）、淋巴瘤（11．0／100万）、生殖细胞恶性肿瘤（7．8／100万）、神经母细胞瘤（7．7／100万）和软组织肉瘤（6．8／100万）。（4）与2002—2006年相比，2007—2010年总的儿童恶性实体肿瘤发病率无明显改变，但男性儿童发病率显著增加，标化发病率分别为94．3／100万和79．5／100万，标化发病率比1．2（95％CI：1．0～1．4）。女性儿童发病率无明显变化。两个时期不同亚瘤别发病率比较差异均无统计学意义。儿童恶性实体肿瘤为罕见疾病，尤其是某些少见癌肿的病例数较少，波动较大，在结果解释时需加以注意。结论2002—2010年上海市儿童恶性实体肿瘤男性发病率高于女性，不同年龄段发病率不同，年龄发病率以0～4岁为最高，中枢神经系统肿瘤是最常见的儿童恶性实体肿瘤。研究结果为开展相关病因学等研究提供了重要线索，亦提示需积累更长时间和更多地区的人群监测资料加以证实和探讨可能的影响因素。
Objective To examine the recent incidences and trends of childhood malignant solid tumors in Shanghai. Method Data from the population-based Shanghai Cancer Registry and related retrospective survey were used to analyze the patterns of incidence and trends of malignant solid tumors diagnosed between 2002 and 2010 in children aged 0 - 14 years. The distributions of incidences were described according to gender, age and cancer types which were classified according to International Classification of Childhood Cancer （ ICCC ）. Annual age-standardized rates （ ASRs ） were adjusted by the world standard population. Approximate confidence intervals for standardized rate ratios （SRR） based Poisson distribution test-based methods were used to assess changes in incidence over the period 2002 - 2006 and 2007 - 2010. Result （ 1 ） A total of 868 cases of childhood malignant solid tumors were diagnosed in Shanghai during 2002 -2010, accounting for 65.8% of all childhood cancers. The ASR of 2002 -2010 was 80. 2 per million for all solid tumors. （ 2 ） The ASR was higher in boys （ 86. 3 per million） than in gifts（73.8 per million） with SRR 1.2 （95% CI 1.0 - 1.3）. Incidence rate was the highest in the first five years of life with 93.4 per million. The age-specific incidence rates in 5 - 9 and 10 - 14 age groups were 65.2 and 79.3 per million, respectively. （3） CNS tumors, lymphomas, germ cell tumors, neuroblastoma, and soft tissue sarcomas were the top 5 most common solid tumors in children, with the incidence rate of 23.8, 11.0, 7. 8, 7. 7 and 6. 8 per million, respectively. The patterns of subgroups varied in different age groups. Blastomas, such as neuroblastoma, retinoblastoma, were more common in the children aged 0 -4 years, whereas epithelial carcinomas and bone tumors developed more frequently in elder children aged 10 - 14 years. （4） Compared with the ASR in 2002 -2006, the ASR for both genders in 2007 -2010 had no substantial changes （78.7 per million in 2002 - 2006 and 82. 9 per million in 2007 - 2010）. However, among boys, the incidence rate in 2007 -2010 was significantly higher than that in 2002 -2006 with SRR 1.2 （95% CI： 1.0 - 1.4）. For specific subgroups of cancer, there were no substantial changes. Some cautions should be taken when interpreting results involving a small number of cases per year and those with wide 95% confidence intervals. Conclusion The incidence rate of pediatric malignant solid tumors among males was higher than females during 2002 -2010, and it differed among different age groups with the highest in the first five years of life. CNS tumor was the most common type of solid tumors in children. This was a unique characteristics comparing with adult reflected in disease spectrum and age of onset. The patterns of incidence and its trends for childhood malignant solid tumors in Shanghai could provide a basis for etiologic research and preventive interventions. The findings also suggest an urgent need for longer population-based surveillance to verify the pattern and changing trends.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2013年第4期288-294,共7页
Chinese Journal of Pediatrics
基金
卫生部2010-2012年度临床学科重点项目（卫规财函[2010]439-41）
