上海市区胃癌发病的时间趋势和特点分析

目的分析1973-2004年上海市区胃癌发病的时间趋势，探讨近年来上海市区胃癌发病的新特点。方法全部资料来源于上海市恶性肿瘤登记报告系统。分别按粗率和标准化率逐年统计1973-2004年市区男性和女性户籍居民的胃癌发病率，用对数线性回归法计算其年度变化百分比（APC），对上海市区近32年的胃癌发病趋势进行估计。对已全部计算机化的2002-2004年上海市区胃癌发病资料，从性别、年龄、诊断分期、病理类型、发病部位等角度进行独立或联合分析，以探讨近年来上海市区胃癌发病的新特点。上海市区的人口资料来自上海市公安局。率的标准化采用世界标准人口。构成比的比较采用χ^2检验。统计分析采用SPSS 10．0软件包。结果1973-2004年上海市区男性和女性居民的胃癌标化发病率均呈现显著而持续的下降趋势，其中男性下降了54．4％，女性下降了37．6％。2002-2004年上海市区共登记报告新发胃癌7630例，男性和女性胃癌的标化发病率分别为27．4／10万和14．0／10万。40岁以下人群的胃癌发病率较低，男女性无明显差异。40岁以上人群的胃癌发病率明显上升且男性逐渐高于女性。在诊断分期上，46．1％的病例具有详细的诊断分期记录，其中Ⅳ期胃癌比例最多，Ⅰ期最少。74．1％的病例为病理诊断，71．7％的病例具有详细的病理类型记录，其中腺癌占76．8％，印戒细咆癌占9．4％。男性腺癌和管状腺癌的比例高于女性，而女性印戒细胞癌的比例高于男性。肠型胃癌仍占主导地位且男性多于女性，而女性弥漫型胃癌的比例高于男性。发病部位以胃窦癌最为常见且女性比例高于男性，而贲门癌男性明显高于女性。远端胃癌中女性的比例高于男性，而近端胃癌中男性明显高于女性。结论上海市区胃癌发病率在1973-2004年间呈现显著而持续的下降趋势，且近年来在性别、年龄、诊断分期、病理类型、发病部位等方面表现出一些有意义的发病特点。

Time trends and characteristics of gastric cancer incidence in urban Shanghai

OBJECTIVE: To study the time trends during 1973 - 2004 and the current characteristics of gastric cancer incidence in Shanghai and to develop strategies for control and prevention. METHODS: All data from the Malignant Cancer Registry System of Shanghai were retrieved and time trends of male and female incidence rates for gastric cancer in urban population from 1973 to 2004 were assessed by annual percentage change (APC) of the crude rates and age-adjusted rates. The APC was calculated by fitting a least squares regression line to the natural logarithm of the rates, using the calendar year as a regressor variable. Based on the computerized data from 2002 to 2004, the current characteristics of urban gastric cancer incidence were analyzed regarding sex, age, stage at diagonsis, histopathologic type and location of the tumor (s). The number and structure of population were obtained from Shanghai Municipal Public Security Bureau. The incidence rates were standardized under the world population. The constituent ratios were analyzed by Chi-square test. Statistical analyses were performed with the SPSS software package for Windows, version 10.0. RESULTS: Substantially and continuously decreasing trends were noticed in gastric cancer incidence during the past 32 years in urban Shanghai, both in males and in females. The age-standardized rates (ASR) dropped 54.4% in males and 37.6% in females. From 2002 to 2004, 7630 new cases of gastric cancer were registered in urban Shanghai with the ASRs of male and female gastric cancer as 27.4 and 14.0 per 100 000. Under the age of 40, the age-specific incidence was quite low that no differences were found between men and women. However, the incidence increased significantly after age of 40 and differences of increase were shown between the two sexes. About 46.1% of all the cases had detailed records of TNM stage, in which IV stage was the majority while I stage the least. About 74.1% of all the cases were diagnosed histopathologically and 71.7% of all had detailed records on histopathologic types. Adenocarcinoma was the most common type (76.8%), followed by signet ring cell carcinoma (9.4%). The proportions of adenocarcinoma and tubular adenocarcinoma were higher in males than in females while signet ring cell cancer was higher in females than in males. Intestinal type gastric cancer was the most prominent type in Lauren system. The proportion of male was higher than female in intestinal type whereas female was higher than male in diffused type. In lesion location, the antrum was the most common tumor site. The gastric antrum cancer of females was more common than males while the gastric cardia cancer presented quite the contrary. The proximal gastric cancer was more prevalent in males than in females whereas the distal gastric cancer was in opposite pattern. CONCLUSION: A dramatic decreasing trend during 1973 - 2004 and several current and interesting characteristics in view of gender, age, stage at diagnosis, histopathologic type and tumor location of gastric cancer in urban Shanghai were determined in this study, which might contribute to the development of control and prevention strategy for gastric cancer.