上海市区女性生殖系统恶性肿瘤发病趋势分析

目的对1972～1999年上海市区常见的女性生殖系统恶性肿瘤的发病率进行统计,分析其发病趋势及变化原因,为防治措施的制定提供依据.方法根据上海市肿瘤发病登记处收集的1972～1999年的上海市区卵巢癌、宫颈癌、宫体癌和不明部位子宫癌的病例资料和相应年份的人口资料,分别计算各年龄组的年龄别发病率.并采用直接法计算世界人口标化发病率,对数线性回归法计算标化率的年变化率(Annual percentage change,APC),并对病例数进行加权计算.结果1972～1999年上海市肿瘤登记处共登记卵巢癌6106例、宫颈癌8063例,宫体癌3 933例和不明部位子宫癌1 312例.28年来,宫体癌和卵巢癌的标化发病率呈上升趋势,分别从1972～1974年的2.49/10万和4.77/10万上升至1996～1999年的4.75/10万和6.88/10万,年增长率分别为3.0%和2.0%.同期宫颈癌的标化发病率从26.66/10万快速下降至2.18/10万,年下降率达10.5%.不明部位子宫癌的标化发病率亦呈下降趋势(P＜0.01).宫体癌以55～64和65～74岁组发病率上升最快,年增长率分别为2.5%和3.3%.卵巢癌各年龄组的发病率均有上升趋势,年变化率都在1.0%以上.宫颈癌发病率下降最快的年龄组是45～54和55～64岁组,25～34和35～44岁组的发病率在近几年有升高趋势.结论上述肿瘤的发病率及年龄别发病率的变化趋势提示,上海女性生活方式和环境因素的改变可能是导致这种变化的重要原因.

Incidence trends of gynecologic cancers in urban shanghai,1972-1999

Objective To explore the time trends of incidence of gynecologic cancers in urban Shanghai during 1972 and 1999. Methods Data on the incidences of ovary, cervix and corpus uteri, uteri not otherwise specified (NOS) cancers were obtained from a population-based cancer registry in Shanghai. Age-specific rates per 100,000 person-years were calculated for eight 3-year periods (1972-1995) and one 4-year period (1996-1999). Rates for each period were age-adjusted to the world standard population by direct method using 5-year age groups. Annul percentage changes (APC) in incidence were estimated by means of a linear regression of the logarithm of the respective rates on calendar, weighted by the number of cases. Results Between 1972-1999, 6,106 ovary cancer, 8,063 cervix uteri cancer, 3,933 corpus uteri cancer and 1,312 uteri NOS cancer patients were registered at the Shanghai Cancer Registry. The overall age-adjusted corpus uteri and ovary cancer incidence rates increased 90.8% and 44.2%, or 3.0% and 2.0% per year, respectively, from 1972-1974 to 1996-1999, while that of cervix uteri and uteri NOS cancer decreased 91.8% and 80.2% or 10.5% and 7.1% per year, respectively. Age-specific rates increased in all age groups for ovary and corpus uteri cancers. The increases were more pronounced at ages 55-64, 65-74 for corpus uteri cancer, whereas the estimated annual increases for ovary cancer were over 1.0% for all age groups. The decreases in cervix uteri rates were considerably more rapid at ages 45-54 and 55-64. However, the incidence rates under age 45 increased since late 1980s. Conclusion The findings from this study indicate that the incidence rates of three gynecologic cancers differ by age and in their time trends, suggesting that environmental factors including lifestyle might play an important role in these changes.