中国膀胱癌流行现状与趋势分析

目的分析2015年中国膀胱癌发病与死亡情况以及1998—2015年的时间变化趋势。方法收集整理全国501个登记处上报国家癌症中心的2015年肿瘤登记数据,经审核质控后统计膀胱癌性别、年龄别、地区别和合计粗发病率、粗死亡率、年龄标化率等指标,并汇总1998—2015年间中国肿瘤登记膀胱癌世标发病率和世标死亡率,采用对数线性模型拟合年度变化百分比(APC)或平均年度变化百分比(AAPC)。结果膀胱癌居中国恶性肿瘤发病谱第13位,粗发病率为5.80/10万,中标发病率为3.60/10万,世标发病率为3.57/10万;粗死亡率为2.37/10万,中标死亡率为1.31/10万,世标死亡率为1.32/10万。男性膀胱癌居恶性肿瘤发病谱第7位,发病率为女性的3.8倍,男性死亡率为女性的4.0倍。城市地区发病率为农村的1.4倍,西部地区发病率和中部地区相近,均低于东部地区,死亡率的地区分布特征与发病率相似。膀胱癌的年龄别发病率和死亡率分别在45岁和55岁组快速上升,在80~84岁组和85岁组到达高峰。时间趋势分析显示,中国膀胱癌发病率在2007年出现下降拐点,1998—2007年世标发病率呈上升趋势(APC=2.58,P<0.001),2007—2015年呈下降趋势(APC=-3.82,P<0.001)。膀胱癌世标死亡率呈持续下降趋势,速度有所减缓,1998—2003年和2003—2015年的年平均下降速度分别为3.65%(P=0.002)和1.42%(P<0.001)。结论膀胱癌是威胁中国居民健康的主要恶性肿瘤之一,存在明显的性别、地区和年龄流行差异。中国膀胱癌发病率和死亡率呈下降趋势,仍需进一步加强烟草控制,倡导中老年患者树立早诊早治意识。

Bladder cancer incidence,mortality and temporal trends in China

Objective To describe the epidemiological characteristics of bladder cancer in 2015 and temporal trends in China.Methods From 501 cancer registries in China,we collected data of cancer new cases,deaths and populations in 2015.After qualified,sex-specific,area-specific,age-specific and overall incidence/mortality rates(including age-standardized rates by Chinese standard population and by world standard population)and estimated cases of bladder cancer were calculated.Annual Percent Change(APC)/Average Annual Percent Change(AAPC)fitted from Log-line model was applied to evaluate the temporal trends of bladder cancer incidence/mortality rates from 1998 to 2015.Results Bladder cancer is the 13^th most common cancer in China.The crude,age-standardized by China standard population and by world standard population rates were 5.80/10⁵,3.60/10⁵ and 3.57/10⁵ for incidence,and 2.37/10⁵,1.31/10⁵ and 1.32/10⁵ for mortality,respectively.The incidence of bladder cancer ranked 7^th in male.The incidence and mortality of male were 3.8 and 4.0 times as high as those of female.Bladder cancer incidence in urban area was 1.4 times as high as that in rural area.Incidence in western areas and middle areas of China were similar,which were lower than that in eastern areas.Geographical distribution characteristics of mortality was along with incidence.Both incidence and mortality remained low before 45 and 55 years old,then they increased rapidly and peaked at 80-84 and over 85 years old age group.Temporal trend analysis suggested that bladder cancer incidence in China increased in 1998-2007(APC=2.58,P<0.001),while decreased from 2007 to 2015(APC=-3.82,P<0.001).Bladder cancer mortality declined gradually,with APCs for 1998-2003 and 2003-2015 of 3.65%(P=0.002)and 1.42%(P<0.001).Conclusions Bladder cancer is one of the main cancers in China.Its epidemiological distributions varies among different sex,area and age group.Both incidence and mortality of bladder cancer decline.More efforts on tobacco control should be made,and awareness of early diagnosis and early treatment could be enhanced for the middle-aged and elderly.