上海市杨浦区与江苏省启东市2002—2012年人群的肝癌发病和生存情况比较

[目的]分析上海市杨浦区2002-2012年肝癌的发病和生存情况,并与江苏省启东市肝癌的发病和生存情况进行比较。[方法]系统整理2002年1月至2012年12月上海市肿瘤登记报告中杨浦区户籍人群肝癌发病和死亡资料,分析患者发病的时间趋势,采用Kaplan-Meier法和log-rank检验进行生存分析,并且与江苏省启东市的相关统计资料进行比较。[结果]2002-2012年杨浦区共登记报告肝癌新发患者3 389例。男性标化发病率为15.70/10万,女性为5.45/10万(P<0.05)。11年间因肝癌死亡3 026例。年均标化死亡率男性为13.38/10万,女性为4.66/10万(P<0.05)。整体中位生存时间为0.41年,手术治疗组的中位生存时间为1.40年,明显优于非手术治疗组的0.35年(P<0.05)。历年杨浦区与启东市的肝癌发病率之比约为1:3,差异有统计学意义。两者历年死亡率之比约为1:3,生存率之比约为2:1,差异有统计学意义。[结论]2002-2012年间上海市杨浦区户籍人群肝癌死亡率接近发病率。男性发病率与死亡率均高于女性。手术治疗可显著延长肝癌患者的生存期和改善预后,提高肝癌早期诊断水平和及时手术切除有望提高患者整体生存率。两组不同之处在于,杨浦区人群发生肝癌的主要原因可能是乙型肝炎病毒(HBV)感染,而启东市人群发生肝癌可能是在HBV感染、黄曲霉毒素暴露、遗传因素、饮水污染和微量元素缺乏等多个因素的协同作用下引起的。

Comparison of incidence and survival of liver cancer between permanent residents in Yangpu District of Shanghai and Qidong City of Jiangsu Province during 2002-2012

[Objective] To analyze the incidence and mortality of liver cancer and survival situation among permanent residents in Yangpu District of Shanghai from January 2002 to December 2012, and compare these data with the statistics obtained from Qidong City of Jiangsu Province. [Methods] The data on liver cancer among permanent residents in Yangpu District were collected from the database of cancer registration and management system in Shanghai. The temporal trend in the incidence and mortality of liver cancer was assessed and compared with the related statistical data from Qidong City of Jiangsu Province. Kaplan-Meier analysis with log-rank test was performed for survival analysis. [Results] A total of 3 389 cases of liver cancer were diagnosed from January 2002 to December 2012. The standardized incidence rate was 15.70/10⁵ in males, significantly higher than 5.45/10⁵ in females (P<0.05). A total of 3 026 cases died of liver cancer during this period. The standardized mortality rate was 13.38/10⁵ in males and 4.66/10⁵ in females (P<0.05). The median survival time was 0.41 years in total, 1.40 years in those who received surgery, significantly higher than 0.35 years in those without surgery (P<0.05). The ratios between Yangpu District and Qidong City were around 1:3 in both incidence and mortality rates, and about 2:1 in survival rate. [Conclusion] The mortality of liver cancer close to its incidence among permanent residents in Yangpu District of Shanghai during 2002-2012. Both the incidence and mortality of liver cancer were significantly higher in males than in females. Surgical resection significantly prolongs overall survival time and improves prognosis. Early diagnosis and prompt surgical resection can improve the overall survival rate of liver cancer patients. HBV infection may be the major risk factor of liver cancer in Yangpu District, while liver cancer in Qidong City is likely to be caused by the interaction among many factors including HBV infection, exposure to aflatoxin, genetic factors, drinking water pollution, and lack of microelement.