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目的阐明上海市杨浦区2002-2012年间食管癌的发病率和死亡率,评估治疗对生存的影响。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食管癌发病和死亡资料,应用年均变化百分比(APC)模型分析患者发病的时间趋势,应用Kaplan-Meier模型并结合log-rank检验进行生存分析。结果 2002-2012年间杨浦区共报告食管癌新发病例1 184例,占同期全区恶性肿瘤的2.54%。其中男性878例,女性306例;男女发病年龄分别为(67.79±12.68)岁和(75.70±9.80)岁。食管癌男性平均粗发病率为14.39/10~5,显著高于女性(5.26/10~5,P<0.05);男性标化发病率为4.67/10~5,明显高于女性(1.51/10~5,P<0.05)。2002-2012年间杨浦区食管癌男女合计的粗发病率趋势年均下降0.4%(P<0.05),但标准化发病率无明显变化。因食管癌死亡1 072例。年均粗死亡率男性为12.79/10~5,女性为5.02/10~5(P<0.05);标化死亡率男性为3.80/10~5,女性为1.34/10~5(P<0.05)。男性40岁之后,女性55岁之后发病率与死亡率均明显上升。整体中位生存时间为0.70年。手术治疗组的中位生存时间为1.19年,非手术治疗组的中位生存时间为0.59年(P<0.05)。食管癌患者的1~5年的生存率分别为45.30%、29.10%、22.30%、19.10%和17.80%。手术治疗组1~5年生存率分别为66.70%、47.80%、39.20%、32.60%和31.30%,显著高于非手术治疗组37.60%、22.30%、16.10%、14.10%和12.80%(P<0.05)。结论 2002-2012年间上海市杨浦区户籍人群食管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食管癌患者的生存期,提高食管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。
Objective To clarify the incidence and mortality of esophageal cancer in Yangpu District of Shanghai from 2002 to 2012 and evaluate the impact of treatment on survival. Methods The data of onset and death of esophageal cancer from household registration population in Yangpu District from January 2002 to December 2012 were systematically analyzed. The time trend of onset was analyzed by APC model. The Kaplan-Meier model Combined with log-rank test for survival analysis. Results A total of 1 184 newly diagnosed cases of esophageal cancer were reported in Yangpu District from 2002 to 2012, accounting for 2.54% of the total malignant tumors in the same period. Among them, 878 were males and 306 were females. The age of onset was (67.79 ± 12.68) years and (75.70 ± 9.80) years respectively. The average crude incidence of esophageal cancer was 14.39 / 10 ~ 5, significantly higher than that of females (5.26 / 10 ~ 5, P <0.05). The male morbidity was 4.67 / 10-5, significantly higher than that of females ~ 5, P <0.05). Between 2002 and 2012, the overall crude incidence of esophageal cancer in Yangpu District decreased by 0.4% annually (P <0.05), but there was no significant change in the standardized incidence. 1 072 cases of esophageal cancer death. The average annual mortality was 12.79 / 10 ~ 5 for males and 5.02 / 10 ~ 5 for females (P <0.05). The standardized death rate was 3.80 / 10 ~ 5 for males and 1.34 / 10 ~ 5 for females (P <0.05) . After the age of 40, the morbidity and mortality of women after the age of 55 were significantly increased. The overall median survival time was 0.70 years. The median survival time in the surgical treatment group was 1.19 years, and the median survival time in the non-surgical treatment group was 0.59 years (P <0.05). The survival rates of patients with esophageal cancer from 1 to 5 years were 45.30%, 29.10%, 22.30%, 19.10% and 17.80%, respectively. The 1-year and 5-year survival rates of surgical treatment group were 66.70%, 47.80%, 39.20%, 32.60% and 31.30%, respectively, which were significantly higher than those of non-operation group 37.60%, 22.30%, 16.10%, 14.10% and 12.80% 0.05). Conclusions The mortality rate of esophageal cancer in hukou households in Yangpu district of Shanghai from 2002 to 2012 is close to the morbidity. Male morbidity and mortality were higher than women. Surgical treatment can significantly prolong the survival of patients with esophageal cancer, improve the early diagnosis of esophageal cancer and timely surgical removal of patients is expected to improve the overall survival rate.