2002-2012年上海市杨浦区社区人群食管癌的发病和生存情况分析

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1184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14.39/105,显著高于女性(5.26/105,P<0.05);男性标化发病率为4.67/105,明显高于女性(1.51/105, 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1072例。年均粗死亡率男性为12.79/105,女性为5.02/105(P<0.05);标化死亡率男性为3.80/105,女性为1.34/105(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 analyze the incidence and mortality of esophageal cancer patients among permanent residents in Yangpu district of Shanghai from January 2002 to December 2012 and to evaluate the effect of surgical treatment on their survivals. Methods The data of esophageal cancer in permanent residents of Yangpu district were extracted from the database of cancer registration and management system in Shanghai. The temporal trend in the incidence and mortality of esophageal cancer was assessed using annual percent change (APC) model. Kaplan-Meier analysis with log-rank test was performed for survival analysis. Results A total of 1184 esophageal cancer patients were diagnosed from January 2002 to December 2012, accounting for 2.54% of the total patients with malignant diseases. Of those, 878 were males, with an average age of onset of (67.79±12.68) years; and 306 were females with an average age of onset of (75.70±9.80) years. The crude incidence rate was 14.39/105 in males, which was significantly higher than that in females (5.26/105, P<0.05). The standardized incidence rate was 4.67/105 in males, being significantly higher than 1.51/105 in females (P<0.05). The crude incidence of esophageal cancer showed a slight decrease (APC=0.4, P<0.05) from 2002 to 2012; however, the standardized incidence showed no significant change. A total of 1072 cases died of esophageal cancer during this period. The annual crude mortality was 12.79/105 in males, which was significantly higher than that in females (5.02/105, P<0.05). The standardized mortality rate was 3.80/105 in males and 1.34/105 in females (P<0.05). Both the incidence and mortality rates increased rapidly after 40 and 55 years old for