摘要
目的:分析2002—2020年上海市胆道癌发病和死亡的流行特征及其变化趋势。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全死因登记系统收集的2002—2020年上海市胆囊和肝外胆管等胆道器官恶性肿瘤的发病和死亡资料,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。标化率应用Segi’s 1960年世界标准人口构成调整计算。应用Joinpoint分析软件对胆道癌不同分组的标化年度变化百分比趋势、年龄别率和新发病例的部分诊断特征分类构成比进行分析。结果:上海市胆道癌的年新发病例数从2002年的963例逐年增长到2020年的1537例,标化发病率从3.91/10万变化至3.59/10万,年死亡人数从830人逐年增长到1225人,标化死亡率从3.36/10万减少至2.69/10万。2020年,上海市胆道癌粗发病率为10.43/10万,男性为9.54/10万,女性为11.30/10万,标化发病率为3.59/10万,男性为3.54/10万,女性为3.61/10万,性别间的差异没有统计学意义(P=0.731);粗死亡率为8.31/10万,男性为7.60/10万,女性为9.00/10万。标化死亡率为2.69/10万,男性为2.69/10万,女性为2.66/10万,性别间的差异也没有统计学意义(P=0.874)。发病和死亡的年龄别数量和率值总体上随着年龄的增长而增多。分性别趋势分析显示,2002—2020年上海市男性胆道癌的标化发病率变化无统计学意义(P=0.179),标化死亡率变化也无统计学意义(P=0.738);女性胆道癌的标化发病率以年均1.58%的减速下降(P<0.001),标化死亡率在2002—2011年间的变化无统计学意义(P=0.774),在2011—2020年间则以年均3.72%的减速下降(P<0.001)。新发病例通过病理确诊的占比上升,影像学检查确诊的占比下降。胆囊占比最多,但已显著下降,肝外胆管占比则从25.75%上升至42.88%。诊断时未分期占比超过60%,Ⅰ~Ⅲ期占比总和仍低于Ⅳ期占比。结论:上海市胆道癌标化发病率和死亡率相对较高,且呈现出差异较大的流行特征。上海在胆道疾病诊疗方面的提升,可能对胆道癌发病特征带来影响,而对提高生存率和降低死亡率的影响相对滞后,反映出在上海胆道癌的筛查、诊断和生存率提高上仍有较大的空间。本研究为胆道癌的进一步研究和预防控制提供了依据。
Objective To analyze the epidemiological characteristics and trends of the incidence and mortality of biliary tract cancer in Shanghai from 2002 to 2020.Methods Data on new cases and deaths of malignant tumors of the gallbladder,extrahepatic bile ducts,and other biliary tract organs from 2002 to 2020 were obtained from the Populationbased Cancer Registry and Vital Statistics System of Shanghai Municipal Center for Disease Control and Prevention.Cases or deaths,proportion,crude rate,age-specific rate,age-standardized rate(ASR)and others were calculated stratified by year of diagnosis or death,gender and age-group.ASRs were calculated using Segi′s 1960 world standard population.Trends of the annual percent change(APC)of ASRs,age-specific rates and proportions of new cases with selected diagnostic character of biliary tract cancer stratified by different groups were analyzed by Joinpoint analysis software.Results Annual new cases of biliary tract cancer in Shanghai increased from 963 in 2002 to 1537 in 2020,with ASR of incidence changing from 3.91/10⁵to 3.59/10⁵.Annual deaths increased from 830 to 1225,with ASR of mortality decreased from 3.36/10⁵to 2.69/10⁵.In 2020,the crude rate of incidence of biliary tract cancer was 10.43/10⁵(9.54/10⁵in males and 11.30/10⁵in females)in Shanghai,and the ASR was 3.59/10⁵(3.54/10⁵in males and 3.61/10⁵in females),with no statistically significant gender difference(P=0.731).The crude rate of mortality was 8.31/10⁵(7.60/10⁵in males and 9.00/10⁵in females),and the ASR was 2.69/10⁵(2.69/10⁵in males and 2.66/10⁵in females),also with no significant gender difference(P=0.874).Age-specific nunbers and rates of incidence and mortality generally increased with aging.Stratified by gender,the trend of ASRs of incidence of biliary tract cancer in Shanghai in males showed no significant change(P=0.179)from 2002 to 2020,nor did that of ASRs of mortality(P=0.738).In females,the ASRs of incidence decreased at an average annual rate of 1.58%(P<0.001),while the trend of ASRs of mortality showed no significant change from 2002 to 2011(P=0.774),but ASRs decreased at an average annual rate of 3.72%from 2011 to 2020(P<0.001).Among new cases,the proportions of morphological verification increased,while the proportions of imaging verification decreased.The gallbladder was the most common site,but its proportions decreased significantly,whereas the proportions of extrahepatic bile duct increased from 25.75%to 42.88%.Over 60%of cases were unknown stage at diagnosis,while the combined proportions of stagesⅠ-Ⅲremained less than that of stageⅣ.Conclusions The ASRs for incidence and mortality of biliary tract cancer in Shanghai remain relatively high,with distinct epidemiological characteristics.The improvement in the diagnosis and treatment of biliary diseases maybe have impact on the incidence patterns of biliary tract cancer in Shanghai,but the effect on increasing survival rates and reducing mortality rates is relatively lagging.It needs a big progress to advance the screening,diagnosis,and survival of biliary tract cancer in Shanghai.This study provides a foundation for further research and prevention strategies for biliary tract cancer.
作者
吴春晓
庞怡
陈蕾
施燕
顾凯
WU Chunxiao;PANG Yi;CHEN Lei;SHI Yan;GU Kai(Shanghai Municipal Center for Disease Control and Prevention,Shanghai 201107,China)
出处
《外科理论与实践》
2025年第3期214-222,共9页
Journal of Surgery Concepts & Practice
基金
四大慢病重大专项(2024ZD0524200)。
关键词
胆道癌
发病
死亡
流行病学
上海
Biliary tract cancer
Incidence
Mortality
Epidemiology
Shanghai
