Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical University, Dongguan, China.
Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.
Lancet Oncol. 2023 Nov;24(11):1206-1218. doi: 10.1016/S1470-2045(23)00444-8. Epub 2023 Oct 11.
Lung cancer is the second most common cancer worldwide, yet the distribution by histological subtype remains unknown. We aimed to quantify the global, regional, and national burden of lung cancer incidence for the four main subtypes in 185 countries and territories.
In this population-based study, we used data from Cancer Incidence in Five Continents Volume XI and the African Cancer Registry Network to assess the proportions of adenocarcinoma, squamous cell carcinoma, small-cell carcinoma, and large-cell carcinoma among all lung cancers by country, sex, and age group and subsequently applied these data to corresponding national (GLOBOCAN) estimates of lung cancer incidence in 2020. Unspecified morphologies were reallocated to specified subtypes. Age-standardised incidence rates were calculated using the world standard population to compare subtype risks worldwide, adjusted for differences in age composition between populations by country.
In 2020, there were an estimated 2 206 771 new cases of lung cancer, with 1 435 943 in males and 770 828 in females worldwide. In males, 560 108 (39%) of all lung cancer cases were adenocarcinoma, 351 807 (25%) were squamous cell carcinoma, 163 862 (11%) were small-cell carcinoma, and 115 322 (8%) were large-cell carcinoma cases. In females, 440 510 (57%) of all lung cancer cases were adenocarcinoma, 91 070 (12%) were squamous cell carcinoma, 68 224 (9%) were small-cell carcinoma, and 49 246 (6%) were large-cell carcinoma cases. Age-standardised incidence rates for adenocarcinoma, squamous cell carcinoma, small-cell carcinoma, and large-cell carcinoma, respectively, were estimated to be 12·4, 7·7, 3·6, and 2·6 per 100 000 person-years in males and 8·3, 1·6, 1·3, and 0·9 per 100 000 person-years in females worldwide. The incidence rates of adenocarcinoma exceeded those of squamous cell carcinoma in 150 of 185 countries in males and in all 185 countries in females. The highest age-standardised incidence rates per 100 000 person-years for adenocarcinoma, squamous cell carcinoma, small-cell carcinoma, and large-cell carcinoma, respectively, for males occurred in eastern Asia (23·5), central and eastern Europe (17·5), western Asia (7·2), and south-eastern Asia (11·0); and for females occurred in eastern Asia (16·0), northern America (5·4), northern America (4·7), and south-eastern Asia (3·4). The incidence of each subtype showed a clear gradient according to the Human Development Index for male and female individuals, with increased rates in high and very high Human Development Index countries.
Adenocarcinoma has become the most common subtype of lung cancer globally in 2020, with incidence rates in males exceeding those of squamous cell carcinoma in most countries, and in females in all countries. Our findings provide new insights into the nature of the global lung cancer burden and facilitates tailored national preventive actions within each world region.
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肺癌是全球第二大常见癌症，但组织学亚型的分布情况仍不清楚。我们旨在量化全球、区域和国家层面 185 个国家和地区四种主要肺癌亚型的发病率负担。
在这项基于人群的研究中，我们使用了《五大洲癌症发病率》第十一卷和非洲癌症登记处网络的数据，评估了腺癌、鳞状细胞癌、小细胞癌和大细胞癌在所有肺癌中的比例，按国家、性别和年龄组进行评估，并随后将这些数据应用于 2020 年全球肺癌发病率的相应国家（全球癌症观察站）估计值。未指明形态学的病例被重新分配到指定的亚型。使用世界标准人口计算年龄标准化发病率，以比较全球范围内的亚型风险，并根据各国人口年龄构成的差异进行调整。
2020 年，全球估计有 2206771 例新肺癌病例，男性 1435943 例，女性 770828 例。在男性中，560108 例（39%）所有肺癌病例为腺癌，351807 例（25%）为鳞状细胞癌，163862 例（11%）为小细胞癌，115322 例（8%）为大细胞癌。在女性中，440510 例（57%）所有肺癌病例为腺癌，91070 例（12%）为鳞状细胞癌，68224 例（9%）为小细胞癌，49246 例（6%）为大细胞癌。男性中腺癌、鳞状细胞癌、小细胞癌和大细胞癌的年龄标准化发病率估计分别为 12.4、7.7、3.6 和 2.6/100000 人年，女性中分别为 8.3、1.6、1.3 和 0.9/100000 人年。在全球范围内，男性中腺癌的发病率超过了鳞状细胞癌，在所有 185 个国家中，女性中也都如此。男性中腺癌、鳞状细胞癌、小细胞癌和大细胞癌的年龄标准化发病率最高的国家分别为东亚（23.5）、中欧和东欧（17.5）、西亚（7.2）和东南亚（11.0）；女性中则分别为东亚（16.0）、北美（5.4）、北美（4.7）和东南亚（3.4）。每个亚型的发病率在男性和女性个体中都表现出明显的梯度，随着人类发展指数的增加，发病率也随之升高。
2020 年，腺癌已成为全球最常见的肺癌亚型，在大多数国家，男性的发病率超过了鳞状细胞癌，在所有国家，女性的发病率都超过了鳞状细胞癌。我们的研究结果为全球肺癌负担的性质提供了新的见解，并有助于在世界各地区制定有针对性的国家预防措施。
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