2012－2021年山东省烟台市居民恶性肿瘤发病与生存状况及影响因素分析

刘海韵; 崔伟红; 徐迎春

doi:10.3784/jbjc.202309180491

2012－2021年山东省烟台市居民恶性肿瘤发病与生存状况及影响因素分析

Incidence and case survival status of cancer and influencing factors in Yantai, Shandong, 2012−2021

摘要

摘要:
目的了解山东省烟台市居民恶性肿瘤发病趋势、生存状况及其影响因素，为肿瘤预后评价和防治提供数据支持。
方法利用2012—2021年烟台市肿瘤随访登记资料，计算发病率及构成等指标；采用年度变化百分比（APC）进行发病率变化趋势分析；采用 Kaplan-Meier 法计算生存率及中位生存时间；两组或多组生存率比较采用Log-Rank检验；采用Cox比例风险回归模型进行单因素和多因素生存分析。
结果 2012—2021年烟台市共报告新发恶性肿瘤233 097例，粗发病率为357.16/10万，中国标化死亡率（中标率）为224.63/10万，世界标化死亡率（世标率）为222.23/10万；粗发病率、中标率和世标率均逐年上升（APC_粗=4.67%，APC_中=4.85%，APC_世=4.90%，均P<0.001）。全市恶性肿瘤发病率男性、农村分别高于女性和城市（χ²=4 022.551、χ²=330.024，均P<0.001），但女性（APC=5.66%，P<0.001）和城市（APC=6.69%，P<0.001）增幅大于男性（APC=3.950%，P<0.001）和农村（APC=3.28%，P=0.004）；发病率随年龄组增加不断上升（趋势χ²=383 334.330，P<0.001），65～74岁（APC=7.30%，P<0.001）和<35岁（APC=6.71%，P=0.001）年龄组发病率增幅居前；发病率最高的病理类型是上皮性肿瘤（204.27/10万），且增幅最大（APC=9.85%，P<0.001）。所有患者中位生存时间为2.05（95%置信区间：2.03～2.07）年，5年生存率为41.74%，其中，乳腺癌（81.12%）最高，胰腺癌（11.01%）最低。 Cox回归分析显示，诊断时期、性别、地区、年龄和病理类型均为恶性肿瘤患者生存状况的影响因素（均P<0.05）。
结论 2012—2021年山东省烟台市恶性肿瘤发病率呈逐年上升趋势，并呈现年轻化，但生存状况明显改善，今后需加强重点癌种及生存劣势患者的综合防治。

Abstract:
Objectives To understand the incidence trend, case survival status of cancer and influencing factors in Yantai of Shandong province, and provide data support for the prognosis evaluation and prevention of cancer.
Methods The follow-up and registration data of cancer cases collected from Yantai Cancer Registry from 2012 to 2021 were used to calculate the incidence rate and constituent. Annual percent of change (APC) was used to analyze the trend of incidence. The survival rate and median survival time were calculated by Kaplan-Meier method. Log-Rank test was used for comparison of survival rates between or among groups. Cox proportional hazards regression model was used for univariate and multivariate survival analysis.
Results A total of 233 097 cancer cases were reported in Yantai from 2012 to 2021, the crude incidence rate was 357.16/100 000, the age standardized mortality rates based on China population and world population were 224.63/100 000 and 222.23/100 000 respectively; which were all showed increasing trends year by year with APC=4.67%, APC=4.85% and APC=4.90% (all P<0.001); the incidence rate was higher in men than in women and in rural area than in urban area (χ²=4 022.551, χ²=330.024, all P<0.001), but the upward trend was greater in women (APC=5.66%, P<0.001)than in men (APC=3.95%, P<0.001)and in urban area (APC=6.69%, P<0.001)than in rural area (APC=3.28%, P=0.004). The incidence rate increased with age in the past decade (trend χ²=383 334.330, P<0.001), with the higher increase in age group 65-74 years (APC=7.30%, P<0.001) and <35 years (APC=6.71%, P=0.001). The incidence of epithelial malignancy was highest (204.27/100 000)and showed the largest upward trend (APC=9.850%, P<0.001). The median survival time in the cancer cases in Yantai was 2.05 years (95% confidence interval: 2.03−2.07)and the 5-year survival rate was 41.74% with the highest of breast cancer cases (81.12%)and the lowest of pancreatic cancer cases (11.01%). Cox regression analysis showed that the period of diagnosis, gender, area, age and pathological type were the influencing factors of the survival status of the cancer cases (all P<0.05).
Conclusion In the past decade, the incidence of cancer increased gradually in Yantai, especially in younger population, but the survival status was significantly improved. It is necessary to further strengthen the comprehensive prevention and control of priority cancer and in patients with poor survival.

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