摘要
目的建立男性包皮环切术(MC)覆盖率与阴茎癌发病率的累积关联,开发用于预测阴茎癌发病率和指导设定MC覆盖目标的辅助决策工具。方法以“circumcision”结合“rate、prevalence”或“incidence”为关键词,检索PubMed、Embase和Google数据库,以“包皮环切术”结合“率”为关键词,检索中国知网和万方数据知识服务平台;同时系统检索现有公开发布的报告文件,包括由美国国际开发署主要资助的人口与健康调查计划(www.dhsprogram.com)和美国总统艾滋病紧急救援计划通过美国疾病控制与预防中心资助的基于人群的艾滋病毒影响评估项目,分期采集并估计2009-2022年全球185个国家/地区的MC覆盖率,并通过GLOBOCAN 2022获取全球阴茎癌发病率。采用分布滞后非线性模型建立MC覆盖率与阴茎癌发病率近20年的累积关联,采用0.632自助法随机生成1000组训练集和测试集评价模型稳定性,通过比较模型的决定系数(R2)及均方误差(MSE),采用最优子集法选定最佳模型,最终开发公共卫生决策的辅助工具。结果2022年全球阴茎癌发病率为0.788/10万,MC覆盖率为39.53%,相较于20年前升高2.67%。最终纳入模型的因子为MC覆盖率、人类发展指数、男性HPV感染率和包茎率;模型在自助法随机数据集上的平均R2为0.74±0.06,平均MSE为0.62±0.35,表明模型较为稳定;最终选定预测模型的R2为0.74,MSE为0.42,表明模型拟合效果较好,并据此开发了交互式预测工具MAC-Pecker。模型显示MC覆盖率与阴茎癌发病率呈负相关;80%MC覆盖率对应阴茎癌发病率为0.056/10万,0.1%MC覆盖率对应为1.318/10万。在阴茎癌发病率高于1/100万的140个国家/地区中,有116个国家/地区可以通过提高MC覆盖率至55.94%~82.48%,实现将阴茎癌发病率降至1/100万的目标。结论MC覆盖率与阴茎癌发病率近20年的累积效应存在负相关;据此开发的辅助决策工具MAC-Pecker可为不同国家/地区依据各自国情制定MC覆盖目标提出建议。
Objective To establish the cumulative association between male circumcision(MC)coverage and the incidence of penile cancer,and to develop a decision-support tool for predicting penile cancer incidence and guiding the setting of MC coverage targets.Methods Using keywords such as"circumcision"combined with"rate,prevalence"or"incidence"we searched PubMed,Embase,and Google databases.Using"circumcision"combined with"rate"as keywords,we searched the China National Knowledge Infrastructure and Wanfang Data Knowledge Service Platform.Additionally,we systematically reviewed publicly available reports,including the Demographic and Health Surveys program(www.dhsprogram.com),primarily funded by the United States Agency for International Development.and the Population-based HIV Impact As-sessment project funded by the U.S.Presidents Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention.We collected and estimated MC coverage in 185 countries/regions worldwide from 2009 to 2022 and ob-tained global penile cancer incidence data from GLOBOCAN 2022.A distributed lag nonlinear model was used to establish the cumulative association between MC coverage and penile cancer incidence over the past 20 years.The 0.632 bootstrap method was employed to randomly generate 1000 training and testing sets to evaluate model stability.By comparing the coefficient of determination(R^(2))and mean squared error(MSE)of the models,the best model was selected using the op-timal subset method,ultimately developing a decision-support tool for public health.Results In 2022、the global inci-dence of penile cancer was 0.788 per 100000 males,with an MC coverage rate of 39.53%.representing a 2.67%in-crease compared to 20 years ago.The final model included factors such as MC coverage.Human Development Index(HDI),male HPV infection rate,and phimosis rate.The model achieved an average R2 of 0.7410.06 and an average MSE of 0.62±0.35 on bootstrap-generated datasets,indicating good stability.The selected predictive model had an R2 of 0.74 and an MSE of 0.42.demonstrating excellent fit.and an interactive prediction tool named MAC-Pecker was devel-oped.The model revealed a negative correlation between MC coverage and penile cancer incidence.An 80%MC coverage corresponded to a penile cancer incidence of 0.056 per 1000000 males,while a 0.1%MC coverage corresponded to 1.318 per 1000000 males.Among the 140 countries/regions with a penile cancer incidence higher than one per million,116 could reduce the incidence to below one per million by increasing MC coverage to between 55.94%and 82.48%.Con-clusion There is a negative correlation between MC coverage rate and cumulative effect of penis cancer incidence rate in recent 20 years;The auxiliary decision-making tool MAC-Pecker developed based on this provides recommendations for different countries/regions to set MC coverage targets according to their respective national conditions.
作者
李赛卓
游以勒
李文衍
梁宝生
王胜锋
LI Saizhuo;YOU Yile;LI Wenyan;LIANG Baosheng;WANG Shengfeng(Department of Epidemiology and Health Statistics,School of Public Health,Peking University,Key Laboratory of Epidemiology for Major Diseases,Ministry of Education,Beijing100191,China;Department of Biostatistics,School of Public Health,Peking University,Beijing100191,China)
出处
《中华肿瘤防治杂志》
北大核心
2025年第9期562-574,共13页
Chinese Journal of Cancer Prevention and Treatment
基金
国家自然科学基金(72342015)
十四五国家重点研发计划(2022YFC3602901)
北京市自然科学基金(QY23074)。
关键词
阴茎癌
包皮环切术
关联研究
区域医疗行动规划
分布滞后非线性模型
penile cancer
circumcision
association study
regional medical action planning
distributed lag non-linear model
