Chen Jian-Guo, Zhu Jian, Zhang Yong-Hui, Chen Yong-Sheng, Lu Jian-Hua, Zhu Yuan-Rong, Chen Hai-Zhen, Shen Ai-Guo, Wang Gao-Ren, Groopman John D, Kensler Thomas W
Department of Epidemiology, Qidong Liver Cancer Institute / Qidong People's Hospital / Affiliated Qidong Hospital of Nantong University, Qidong, Jiangsu, China.
Department of Epidemiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu, China.
PeerJ. 2021 Feb 3;9:e10600. doi: 10.7717/peerj.10600. eCollection 2021.
Liver cancer is one of the most dominant malignant tumors in the world. The trends of liver cancer mortality over the past six decades have been tracked in the epidemic region of Qidong, China. Using epidemiological tools, we explore the dynamic changes in age-standardized rates to characterize important aspects of liver cancer etiology and prevention.
Mortality data of liver cancer in Qidong from 1958 to 1971 (death retrospective survey) and from 1972 to 2017 (cancer registration) were tabulated for the crude rate (CR), and age-standardized rate and age-birth cohorts. The average annual percentage change was calculated by the Joinpoint Regression Program.
The natural death rate during 1958-2017 decreased from 9‰ to 5.4‰ and then increased to 8‰ as the population aged; cancer mortality rates rose continuously from 57/10 to 240/10. Liver cancer mortality increased from 20/10 to 80/10, and then dropped to less than 52/10 in 2017. Liver cancer deaths in 1972-2017 accounted for 30.53% of all cancers, with a CR of 60.48/10, age-standardized rate China (ASRC) of 34.78/10, and ASRW (world) of 45.71/10. Other key features were the CR for males and females of 91.86/10 and 29.92/10, respectively, with a sex ratio of 3.07:1. Period analysis showed that the ASRs for mortality of the age groups under 54 years old had a significant decreasing trend. Importantly, birth cohort analysis showed that the mortality rate of liver cancer in 40-44, 35-39, 30-34, 25-29, 20-24, 15-19 years cohort decreased considerably, but the rates in 70-74, and 75+ increased.
The crude mortality rate of liver cancer in Qidong has experienced trends from lower to higher levels, and from continued increase at a high plateau to most recently a gradual decline, and a change greatest in younger people. Many years of comprehensive prevention and intervention measures have influenced the decline of the liver cancer epidemic in this area. The reduction of intake levels of aflatoxin might be one of the most significant factors as evidenced by the dramatic decline of exposure biomarkers in this population during the past three decades.
肝癌是全球最主要的恶性肿瘤之一。在中国启东这个肝癌流行地区，已对过去六十年间肝癌死亡率的变化趋势进行了追踪。我们运用流行病学工具，探究年龄标准化率的动态变化，以描述肝癌病因及预防的重要方面。
整理了启东1958年至1971年（死亡回顾调查）以及1972年至2017年（癌症登记）期间的肝癌死亡率数据，得出粗死亡率（CR）、年龄标准化率以及年龄出生队列数据。通过Joinpoint回归程序计算平均年变化百分比。
1958年至2017年期间，自然死亡率随着人口老龄化从9‰降至5.4‰，随后又升至8‰；癌症死亡率则从57/10万持续上升至240/10万。肝癌死亡率从20/10万升至80/10万，之后在2017年降至低于52/10万。1972年至2017年期间，肝癌死亡人数占所有癌症死亡人数的30.53%，粗死亡率为60.48/10万，中国年龄标准化率（ASRC）为34.78/10万，世界年龄标准化率（ASRW）为45.71/10万。其他关键特征包括男性和女性的粗死亡率分别为91.86/10万和29.92/10万，性别比为3.07:1。时期分析表明，54岁以下年龄组的死亡率年龄标准化率呈显著下降趋势。重要的是，出生队列分析显示，40 - 44岁、35 - 39岁、30 - 34岁、25 - 29岁、20 - 24岁、15 - 19岁年龄队列的肝癌死亡率大幅下降，但70 - 74岁以及75岁以上年龄队列的死亡率有所上升。
启东肝癌粗死亡率经历了从较低水平到较高水平，再从在高原水平持续上升到最近逐渐下降的过程，且在年轻人中变化最大。多年的综合预防和干预措施对该地区肝癌疫情的下降产生了影响。黄曲霉毒素摄入量的降低可能是最显著的因素之一，过去三十年该人群中暴露生物标志物的显著下降证明了这一点。
