Zhang Lei, Cao Fei, Zhang Guoyao, Shi Lei, Chen Suhua, Zhang Zhihui, Zhi Weiguo, Ma Tianjiang
Department of Oncology, Luohe Central Hospital, Luohe, China.
Front Oncol. 2019 Feb 21;9:98. doi: 10.3389/fonc.2019.00098. eCollection 2019.
Colorectal cancer (CRC) has emerged as a major public health concern in China during the last decade. In this study, we investigated the disease burden posed by CRC and analyzed temporal trends in CRC incidence and mortality rates in this country. We collected CRC incidence data from the Cancer Incidence in Five Continents, Volume XI dataset and the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of CRC by sex and age, from the 2016 Global Burden of Diseases Study. We used the average annual percentage change (AAPC) to quantify temporal trends in CRC incidence and mortality from 1990 to 2016 and found the ASIR of CRC increased from 14.25 per 100,000 in 1990 to 25.27 per 100,000 in 2016 (AAPC = 2.34, 95% confidence interval [CI] 2.29, 2.39). Cancer cases increased from 104.3 thousand to 392.8 thousand during the same period. The ASIR increased by 2.76% (95% CI 2.66%, 2.85%) and 1.70% (95% CI 1.64%, 1.76%) per year in males and females, respectively. The highest AAPC was found in people aged 15-49 years (2.76, 95% CI 2.59, 2.94). Cancer deaths increased from 81.1 thousand in 1990 to 167.1 thousand in 2016, while the ASMR remained stable (-0.04, 95% CI -0.13, 0.05), A mild increase (AAPC = 0.42, 95% CI 0.34, 0.51) was found among males and a significant decrease (AAPC = -0.75, 95% CI -0.90, -0.60) was found among females. Between 2016 and 2025, cancer cases and deaths are expected to increase from 392.8 and 167.1 thousand in 2016 to 642.3 (95% CI 498.4, 732.1) and 221.1 thousand (95% CI 122.5, 314.8) in 2025, respectively. Our study showed a steady increase in the CRC incidence in China over the past three decades and predicted a further increase in the near future. To combat this health concern, the prevention and management of known risk factors should be promoted through national polices. Greater priority should be given to CRC prevention in younger adults, and CRC screening should be widely adopted for this population.
在过去十年中,结直肠癌(CRC)已成为中国主要的公共卫生问题。在本研究中,我们调查了CRC造成的疾病负担,并分析了该国CRC发病率和死亡率的时间趋势。我们从《五大洲癌症发病率》第十一卷数据集中收集了CRC发病率数据,并从《2016年全球疾病负担研究》中获取了按性别和年龄划分的CRC年龄标准化发病率(ASIR)和年龄标准化死亡率(ASMR)。我们使用平均年度百分比变化(AAPC)来量化1990年至2016年期间CRC发病率和死亡率的时间趋势,发现CRC的ASIR从1990年的每10万人14.25例增加到2016年的每10万人25.27例(AAPC = 2.34,95%置信区间[CI] 2.29,2.39)。同期癌症病例从10.43万例增加到39.28万例。男性和女性的ASIR分别每年增加2.76%(95% CI 2.66%,2.85%)和1.70%(95% CI 1.64%,1.76%)。15 - 49岁人群的AAPC最高(2.76,95% CI 2.59,2.94)。癌症死亡人数从1990年的8.11万例增加到2016年的16.71万例,而ASMR保持稳定(-0.04,95% CI -0.13,0.05),男性中有轻微增加(AAPC = 0.42,95% CI 0.34,0.51),女性中有显著下降(AAPC = -0.75,95% CI -0.90,-0.60)。预计在2016年至2025年期间,癌症病例和死亡人数将分别从2016年的39.28万例和16.71万例增加到2025年的64.23万例(95% CI 49.84万例,73.21万例)和22.11万例(95% CI 12.25万例,31.48万例)。我们的研究表明,在过去三十年中中国CRC发病率稳步上升,并预测在不久的将来还会进一步上升。为应对这一健康问题,应通过国家政策促进对已知风险因素的预防和管理。应更加重视年轻成年人的CRC预防,并且应为该人群广泛采用CRC筛查。