Guo Tian'an, Xie Li, Zhao Jiang, Song Wang, Dai Weixing, Liu Fangqi, Zheng Ying, Xu Ye
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Department of Tumor Prevention, Tumor Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Jan 25;21(1):33-40.
To explore the trend change of the morbidity and mortality of colorectal cancer in China in order to provide reference to the prevention and control of colorectal cancer.
According to the 1-3 volumes of "Pathogenesis and death of malignancies in pilot program city and county of China", "Pathogenesis and death of cancer in China"(2003-2007) and "Registration annual report of tumor in China" published in 2011 and 2012, data of pathogenesis and death of colorectal cancer from 10 tumor registration spots, including Beijing urban, Shanghai urban, Wuhan urban, Harbin urban (defined as city urban), and Hebei Ci County, Jiangsu Qidong District, Zhejiang Jiashan District, Guangxi Fusui County, Fujian Changle District, Henan Lin County (defined as rural district), between 1988 and 2009 were collected. The morbidity and mortality were elucidated with world population standardized rate. Ratio of pathogenesis to death was calculated with crude rate of morbidity and mortality. Data of 22 years were enrolled into the linear regression analysis to calculate the annual change rate of morbidity and mortality statistically.
(1) Colon cancer: morbidity presented increasing trend; male morbidity in city urban increased faster; mortality presented increasing trend as well; no significant difference of increasing velocity was observed between city urban and rural district; morbidity and mortality in city urban were higher compared to rural district; morbidity and mortality of males were higher compared to females; except stable Fujian Changle District, ratio of pathogenesis to death presented decreased trend in Shanghai urban and Hebei Ci County, and increased trend in other 7 spots (all P<0.05). (2) Rectal cancer: morbidity presented increasing trend, and its increasing velocity of city urban was faster compared to rural district; mortality presented decreased trend, especially in females, and this trend in rural district was worse compared to city urban; morbidity and mortality of males were higher compared to females, while no significant difference was observed between city urban and rural district; morbidity and mortality of males and females in Zhejiang Jiashan District were all decreased (all P<0.05); except stable Harbin city, ratio of pathogenesis to death presented increased trend in other 9 spots (all P<0.05). (3) Ratio analysis of morbidity and mortality showed that percentage of colon cancer increased gradually in all 10 spots between 1988-2009.
In the past 2 decades, the overall morbidity and mortality of colorectal cancer are higher in city urban and in male as compared with rural district and female. Colon cancer has higher morbidity than rectal cancer and its morbidity and mortality present increased trend, while morbidity of rectal cancer presents increased trend but its mortality presents decreased trend.
探讨我国结直肠癌发病与死亡的趋势变化，为结直肠癌的防治提供参考。
依据《中国肿瘤登记试点市、县恶性肿瘤发病与死亡》1 - 3卷、《中国肿瘤发病与死亡》（2003 - 2007年）以及2011年和2012年发布的《中国肿瘤登记年报》，收集1988年至2009年北京城区、上海城区、武汉城区、哈尔滨城区（定义为城市地区）以及河北磁县、江苏启东市、浙江嘉善县、广西扶绥县、福建长乐市、河南林县（定义为农村地区）10个肿瘤登记点的结直肠癌发病与死亡数据。采用世界人口标化率阐述发病率和死亡率。用发病率和死亡率的粗率计算发病与死亡比。将22年的数据纳入线性回归分析，统计计算发病率和死亡率的年变化率。
（1）结肠癌：发病率呈上升趋势；城市地区男性发病率上升更快；死亡率也呈上升趋势；城市地区和农村地区上升速度无显著差异；城市地区发病率和死亡率高于农村地区；男性发病率和死亡率高于女性；除福建长乐市稳定外，上海城区和河北磁县发病与死亡比呈下降趋势，其他7个地区呈上升趋势（均P<0.05）。（2）直肠癌：发病率呈上升趋势，城市地区上升速度快于农村地区；死亡率呈下降趋势，尤其是女性，农村地区下降趋势比城市地区更明显；男性发病率和死亡率高于女性，城市地区和农村地区无显著差异；浙江嘉善县男性和女性发病率和死亡率均下降（均P<0.05）；除哈尔滨城区稳定外，其他9个地区发病与死亡比呈上升趋势（均P<0.05）。（3）发病率与死亡率比值分析显示，1988 - 2009年期间，10个地区结肠癌所占百分比均逐渐上升。
在过去20年中，结直肠癌总体发病率和死亡率城市地区高于农村地区，男性高于女性。结肠癌发病率高于直肠癌，其发病率和死亡率呈上升趋势，而直肠癌发病率呈上升趋势但其死亡率呈下降趋势。
