扬中市上消化道癌发病和死亡趋势分析及早诊早治效果评价

发布时间：2018-07-10 02:54

本文选题：胃癌 + 食管癌　；参考：《南京医科大学》2017年硕士论文

【摘要】：恶性肿瘤是严重影响人类健康,威胁生命的重要慢性非传染性疾病,是全世界居民的主要死亡原因之一。据世界卫生组织所属的国际癌症研究机构的数据(GLOBOCAN 2012)显示,2012年中国新发癌症307万例,死于癌症的病人达221万例,其中胃癌发病40万例,死亡33万例;食管癌发病22万例,死亡20万例。胃癌和食管癌在我国居民癌症死因谱中分别位居第三位和第四位。江苏省扬中市是我国上消化道肿瘤高发地之一,当地胃癌、食管癌的高发病率和高死亡率给居民带来了极大的健康和经济负担。目的收集扬中市1991-2013年恶性肿瘤登记报告资料,描述胃癌、食管癌发病和死亡趋势,为扬中市制定上消化道癌防制对策和干预措施提供依据:对扬中市开展的上消化道癌胃镜筛查及早诊早治项目的有效性进行评价。方法本论文包括两个部分,第一部分以扬中市1991-2013年上消化道癌症监测资料为基础,分析近20年来胃癌、食管癌发病与死亡现状和流行趋势,采用Joinpoint软件计算年度变化百分比(APC)及其95%可信区间(CI),采用Graphpad Prism软件绘制趋势图和生存曲线。第二部分通过收集扬中市2006~2012年40-69参加上消化道癌早诊早治项目的居民的相关资料,描述参加筛查的研究对象的基本特征、内镜筛查和病理检查数据,随访并观察结局。同时,从肿瘤登记报告系统中选择同期因症就诊而发现的胃癌、食管癌病人为对照组,比较两组患者的生存率,评价内镜筛查项目对患者生存率的影响,组间生存率比较采用Log-rank 检验。结果1.1991~2013年,扬中市新登记报告胃癌8537例,其中男性5459例,女性3078例,粗发病率从1991年的172.0/10万降至2013年的106.51/10万,年龄标化发病率从1991年的165.11/10万下降至2013年的53.46/10万,男性和女性胃癌的发病率 APC 分别为-3.6%(95%CI:-4.5%~-2.7%)和-4.8%(95%CI:-5.7%~-3.9%)。胃癌的发病率在45岁组以后快速上升,在70~74岁组达到高峰。标化死亡率在1992~2001年间波动幅度不大,从2002年的66.43/10万呈下降趋势,2011 年时降至 17.37/10 万,死亡率 APC=-13.5%(95%CI:-16.9%~-10.0%)。2.1991~2013年,扬中市新登记食管癌6493例,其中男性3446例,女性3047例,粗发病率自1991年来保持稳定,年龄标化发病率从1991年的107.06/10万下降至2013年的37.04/10万。男性和女性食管癌的发病率APC分别为-2.5%(95%CI:-3.4%~-1.5%)和-4.9%(95%CI:-5.8%~-3.9%)。食管癌发病率在 40岁组以后快速上升,在75~79岁组达到高峰。标化死亡率从1991年的25.12/10万上升至1993年的62.94/10万,在1994~2003年间标化发病率保持稳定,2004开始发病率呈下降趋势,从2004年的45.32/10万降至2011年的13.98/10万,死亡率 APC 为-17.7%(95%CI:-26.2%~-8.3%)。3.2006~2012年,共筛查12453例40~69岁的当地居民,其中男性5334例,女性7119例,共检出60例胃癌和106例食管癌病人,其中100%的胃癌和98.11%的食管癌病人为处于早期阶段。查出的胃癌和食管癌病人1年、3年、5年生存率分别为98.0°%、90.0%和89.0%,显著高于同期因症就诊发现的患者(Log-rank检验,X2=333.2,P0.001)。结论扬中市胃癌和食管癌的发病率、死亡率均高于全国平均水平,但呈现明显的下降趋势。经过内镜筛查诊断出的胃癌和食管癌病人的生存率显著高于同期因症就诊获得诊断的病人,筛查显示良好的效果,但其成本和可接受性还需要进一步探讨。
[Abstract]:Malignant tumor is an important chronic non communicable disease which seriously affects human health and life. It is one of the main causes of death in the world. According to the data of International Cancer Research Institute of WHO (GLOBOCAN 2012), 3 million 70 thousand cases of new cancer in China were found in 2012, and 2 million 210 thousand cases of cancer died of cancer. There were 400 thousand cases of disease, 330 thousand cases of death, 220 thousand cases of esophageal cancer and 200 thousand cases of death. Gastric cancer and esophageal cancer were ranked third and fourth respectively in the cause of cancer death in our country. Yangzhong, Jiangsu Province, was one of the high incidence areas of upper digestive tract tumors in China, local gastric cancer, high incidence of esophageal cancer and high mortality brought great health to the residents. Objective to collect data on the registration of malignant tumor in Yangzhong for 1991-2013 years, to describe the trend of gastric cancer, the incidence and death of cancer of the esophagus, and to provide the basis for the prevention and control of the upper digestive tract cancer in Yangzhong: the evaluation of the effectiveness of the gastroscope screening for the early diagnosis and treatment of the upper digestive tract cancer in Yangzhong. The thesis consists of two parts. The first part, based on the data of cancer monitoring in the upper digestive tract of 1991-2013 years in Yangzhong, analyzes the status and trend of cancer and death in the last 20 years, uses the Joinpoint software to calculate the annual change percentage (APC) and its 95% reliable interval (CI), and uses the Graphpad Prism software to draw the trend map. And the survival curve. The second part, by collecting data from the residents of the early diagnosis and early treatment of upper digestive tract cancer in the city of Yangzhong, 40-69 2006~2012, describes the basic features of the subjects involved in the screening, the endoscopic screening and the pathological examination data, follow-up and observation of the outcome. The survival rate of the two groups of patients was compared and the survival rate of the two groups was compared. The survival rate of the patients was evaluated by the endoscopic screening program. The survival rate of the group was compared with the Log-rank test. Results in 1.1991~2013 years, 8537 cases of gastric cancer were reported in Yangzhong, including 5459 men and 3078 women, and the crude incidence was from 172.0/10 million in 1991. To 106.51/10 million in 2013, the incidence of age standardization decreased from 165.11/10 million in 1991 to 53.46/10 million in 2013. The incidence of gastric cancer in men and women was -3.6% (95%CI:-4.5%~-2.7%) and -4.8% (95%CI:-5.7%~-3.9%) respectively. The incidence of gastric cancer increased rapidly after 45 years of age, and reached the peak in the group of 70~74 years. The standardized mortality rate was 1. During the period of 992~2001, the fluctuation was not significant, from the decline trend of 66.43/10 million in 2002, to 17.37/10 million in 2011, the death rate of APC=-13.5% (95%CI:-16.9%~-10.0%).2.1991~2013, 6493 cases of newly registered esophageal cancer in Yangzhong, including 3446 males and 3047 females. The crude incidence rate remained stable since 1991, and the age standardized incidence rate was from 1991. The incidence of 107.06/10 million in 2013 was 37.04/10 million. The incidence of esophageal cancer in men and women was -2.5% (95%CI:-3.4%~-1.5%) and -4.9% (95%CI:-5.8%~-3.9%). The incidence of esophageal cancer increased rapidly after 40 years of age and reached the peak in the group 75~79 years. The standardized mortality rate increased from 25.12/10 million in 1991 to 62.94/10 million in 1993, at 1994. The incidence of the standardized incidence was stable during the period of ~2003. The incidence of the 2004 onset was decreased from 45.32/10 million in 2004 to 13.98/10 million in 2011. The mortality rate was -17.7% (95%CI:-26.2%~-8.3%).3.2006~2012, and 12453 40~69 years old were screened, including 5334 males and 7119 females. 60 cases of gastric cancer and 106 cases of esophageal cancer were detected. Patients, of which 100% of gastric cancer and 98.11% of the patients with esophageal cancer were in the early stage. The 1, 3, and 5 year survival rates were 98 and 90% and 89%, respectively, compared to those found in the same period (Log-rank test, X2=333.2, P0.001). Conclusion the incidence and mortality of gastric and esophageal cancer in Yangzhong are all It was higher than the national average, but showed a significant downward trend. The survival rate of the patients with gastric and esophageal cancer diagnosed by endoscopic screening was significantly higher than that of the patients diagnosed with the same period. The screening showed good results, but the cost and acceptability need to be further discussed.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735

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