我国恶性肿瘤防治研究和实践需要技术、管理和观念的创新

恶性肿瘤是我国人口在平均寿命之前死亡的最主要原因。从2000-2011年中国大陆地区恶性肿瘤年龄调整发病率和死亡率的变化规律来看,针对危险因素/病因进行一级预防可以显著降低胃癌、食管癌和原发性肝癌的发病率,进而降低其死亡率,但在这12年中临床治疗对降低恶性肿瘤整体死亡率方面的贡献却没有明显提升。探索何种早期肿瘤能够快速进展为晚期肿瘤,并针对这些肿瘤的癌前病变和早期肿瘤开展积极、特异性二级预防是避免过度诊断和过度治疗的关键。需要多中心前瞻性随机对照临床试验和第三方独立随访研究来评价某些临床治疗方法对各种恶性肿瘤的长期疗效。恶性肿瘤防治实践需要在中国人群研究基础上进行技术、管理和观念的系列创新,建立并完善肿瘤防控的“关口前移”运行机制,以缓解和降低我国不断增长的疾病负担。

Innovations on technology, management and concept are indispensible for scientific research, prevention and treatment of malignant tumor in China

Malignant tumor has become the top cause of deaths before the average life expectancy in Chinese population. From the variations in the morbidity rate and mortality rate of malignant tumor in the mainland of China between 2000 and 2011, the primary prevention targeting the risk factors/etiological agents significantly reduced the morbidity rates of gastric cancer, esophageal cancer, and primary liver cancer, therefore reduced the mortality rates of these cancers. However, the contribution of clinical treatments to the mortality reduction was not obviously improved during this period. Importantly, it is necessary to conduct research to identify precancerous lesions and early tumors which are prone to progress to aggressive diseases for the active secondary prevention to avoid over-diagnosis and over-treatment. Multi-center, prospective randomized controlled clinical trials and prognosis evaluation independently carried out by third parts are needed to evaluate the long-term effectiveness of some clinical treatment efficiency for cancers with different histological types. On the basis of a series of population-based studies in China, the prevention and clinical treatments for malignant tumor need innovations on technology, management, and even concept; the mechanisms of "forward placement of strategic pass" for the prevention and control of malignant tumor should be established and improved to reduce the increasing disease burden due to malignant tumor in China.