从肿瘤登记数据看中国恶性肿瘤的发病特点和趋势

恶性肿瘤是严重威胁人类健康的重大慢性病，是21世纪中国乃至全球严重的公共卫生问题之一。肿瘤控制已成为世界各国政府的卫生战略重点。据世界卫生组织（WHO）国际癌症研究署（IARC）发布的2014年全球癌症报告估计，中国癌症发病数约占全球癌症发病数的22%，在184个国家和地区中，中国癌症发病率位居第68位，居中等偏上水平[1]。近年来，随着我国社会、经济的发展，工业化、城市化、老龄化进程的加剧，以及人口增长和生活方式的改变，我国居民恶性肿瘤癌谱构成发生显著变化，总体发病水平呈上升趋势。肿瘤高发地区的防治工作实践已经证明，通过健康教育、危险因素干预以及有效的早诊早治等综合措施，可以有效地降低恶性肿瘤的发病率、死亡率，提高生存率。通过制定国家肿瘤防治政策、增加投入、采取有效措施系统地开展肿瘤防控工作，可以预防40%的恶性肿瘤发生，并使1/3的肿瘤发现于早期阶段并得到治愈[2]，临床的规范化诊疗可提高治疗效果，降低国家卫生经济负担，对构建和谐社会，实现全民健康的中国梦具有重大的意义。

从数据质量看信息价值：读《中国癌症发病率与死亡率，2012》

癌症是影响人类健康与寿命的主要疾病，现已成为全球重要的公共卫生问题之一。国际癌症研究报告数据显示，2012年全球新发癌症病例1410万，因癌症死亡人数为820万；预计至2020年，上述数据将分别增至1685万和1016万。2014年导致我国人群期望寿命损失的疾病以癌症为首，占比高达20.73%[1]，其发病、死亡分布、严重程度与流行趋势尤为人们所关注。早在1965年，WHO所属的国际癌症研究中心（International Agency for Research on Cancer，IARC）与国际癌症登记协会（International Association for Cancer Registries， IACR）即组织出版了《五大洲癌症发病率》，每5年1卷，向全球发布，至今已出版10卷，其数据来源于全球数百家肿瘤登记处，是以人群为基础的癌症数据资源，经过专家严格审查、咨询，统一向全球公布癌症的现状与流行趋势。自2005年以来，我国全国肿瘤登记中心（National Central Cancer Registry，NCCR）每年均以年报和论文形式发布癌症数据，作为一个全国性的大数据集，科学地观察癌症的发病率变化，并进行趋势分析，为制订我国癌症防控规划、探索病因及危险因素提供有价值的信息。

Nasopharyngeal carcinoma (NPC) is rare global y but common in China and exhibits a distinct ethnic and geographic distribution. In 2009, the National Central Cancer Registry in China provided real-time surveil ance information on NPC. Individual NPC cases were retrieved from the national database based on the ICD-10 topography code C11. The crude incidence and mortality of NPC were calculated by sex and location (urban/rural). China’s population in 1982 and Segi’s world population structures were used to determine age-standardized rates. In regions covered by the cancer registries in 2009, the crude incidence of NPC was 3.61/100,000 (5.08/100,000 in males and 2.10/100,000 in females; 4.19/100,000 in urban areas and 2.42/100,000 in rural areas). Age-standardized incidences by Chinese population (ASIC) and Segi’s world population (ASIW) were 2.05/100,000 and 2.54/100,000, respectively. The crude mortality of NPC was 1.99/100,000 (2.82/100,000 in males and 1.14/100,000 in females;2.30/100,000 in urban areas and 1.37/100,000 in rural areas). The age-standardized mortalities by Chinese population (ASMC) and world population (ASMW) were 1.04/100,000 and 1.35/100,000, respectively. The incidence and mortality of NPC were higher in males than in females and higher in urban areas than in rural areas. Both age-specific incidence and mortality were relatively low in persons younger than 30 years old, but these rates dramatical y increased. Incidence peaked in the 60-64 age group and mortality peaked in the over 85 age group. Primary and secondary prevention, such as lifestyle changes and early detection, should be carried out in males and females older than 30 years of age.

To estimate the cancer incidences and mortalities in China in 2010, the National Central Cancer Registry (NCCR) of China evaluated data for the year of 2010 from 145 qualified cancer registries covering 158,403,248 people (92,433,739 in urban areas and 65,969,509 in rural areas). The estimates of new cancer cases and cancer deaths were 3,093,039 and 1,956,622 in 2010, respectively. The percentage of morphologically verified cases were 67.11%; 2.99% of incident cases were identified through death certification only, with the mortality to incidence ratio of 0.61. The crude incidence was 235.23/100,000 (268.65/100,000 in males and 200.21/100,000 in females). The age-standardized rates by Chinese standard population (ASR China) and by world standard population (ASR world) were 184.58/100,000 and 181.49/100,000, respectively, with a cumulative incidence (0-74 years old) of 21.11%. The crude cancer mortality was 148.81/100,000 (186.37/100,000 in males and 109.42/100,000 in females). The ASR China and ASR world were 113.92/100,000 and 112.86/100,000, respectively, with a cumulative mortality of 12.78%. Lung, breast, gastric, liver, esophageal, colorectal, and cervical cancers were the most common cancers. Lung, liver, gastric, esophageal, colorectal, breast, and pancreatic cancers were the leading causes of cancer deaths. The coverage of cancer registration has rapidly increased in China in recent years and may reflect more accurate cancer burdens among populations living in different areas. Given the increasing cancer burden in the past decades, China should strengthen its cancer prevention and control.