中国癌症发病趋势及潜在影响因素分析

及时分析癌症发病趋势对于癌症预防与控制具有重要意义，是中国公共卫生的优先任务。本文旨在估算1983年至2017年中国32种癌症的发病趋势，并预测至2032年的变化，评估风险因素和人口老龄化的影响。采用人口基础的队列研究方法，利用《五大洲癌症发病率数据库》（1983-2017）中的数据，收集了32种癌症的新发病例。数据分析截止到2024年5月23日，主要采用世界卫生组织（WHO）世界标准人口进行年龄标准化发病率（AIR），使用joinpoint回归计算年平均百分比变化（AAPC），并利用Møller分解分析评估风险因素和人口老龄化对发病率变动的贡献，按癌种和性别进行分层。共纳入3,677,027例新发癌症病例（男性54.9%，女性45.1%），数据显示，1983-2017年间，男性中11种癌症，女性中14种癌症的AIR持续上升，且趋势预计将持续到2032年。其中，甲状腺癌增长最为明显（男性AAPC：7.82%；95% CI，6.92%-10.38%；女性：8.59%；95% CI，7.84%-10.42%），其次是前列腺癌（4.71%；95% CI，3.12%-9.95%）和肾癌（3.61%；95% CI，3.11%-5.82%）在男性中，子宫颈癌（4.43%；95% CI，3.36%-9.44%）和肾癌（3.66%；95% CI，2.98%-6.86%）在女性中。同期，肺癌的AIR在男性中呈下降趋势，在女性中则持续上升。相反，胃癌、肝癌、喉癌及鼻窦癌的AIR预计将从1983年到2032年逐步下降。未来，2018年至2032年间，癌症发病例的增加主要由风险因素推动的有18种癌症（男性）和11种（女性），而人口老龄化则对其他癌症的发病率上升起到作用。总体而言，随着中国癌症谱的演变，部分癌症发病率持续上升，主要受风险因素影响，部分则由人口老龄化驱动。有效的一级预防措施以减少风险暴露至关重要，同时，二级预防措施也应加强，以改善老年人群的癌症生存率。

Timely analysis of cancer incidence trends is crucial for cancer prevention and control, which is a public health priority in China.To estimate incidence trends for 32 cancers in China from 1983 to 2017 and project changes to 2032, assessing distinct changes due to risk factors and an aging population.This population-based cohort study used data from the Cancer Incidence in Five Continents database (1983-2017). New cases of 32 cancers were collected. Data were analyzed from October 15, 2023, to May 23, 2024.Age-standardized incidence rate (AIR) standardized to the World Health Organization World Standard Population, average annual percentage changes (AAPC) using joinpoint regression, and percentage change due to aging and risk factors, using Møller decomposition analysis, stratified by cancer and sex.A total of 3 677 027 new cancer cases (54.9% male, 45.1% female) were included in the analysis. Increased AIRS were observed for 11 cancers in males and 14 in females from 1983 to 2017, with trends expected to continue until 2032. Thyroid cancer showed the highest increase (AAPC: 7.82% in males; 95% CI, 6.92%-10.38%; 8.59% in females; 95% CI, 7.84%-10.42%), followed by prostate (4.71%; 95% CI, 3.12%-9.95%) and kidney (3.61%; 95% CI, 3.11%-5.82%) cancers in males, and cervical (4.43%; 95% CI, 3.36%-9.44%) and kidney (3.66%; 95% CI, 2.98%-6.86%) cancers in females. The AIRs of lung cancer tended to decrease in males but increase in females during 1983-2017. In contrast, the AIRs of stomach, liver, larynx, and nose and sinuses cancers decreased from 1983 to 2032. From 2018 to 2032, cancer cases were projected to increase primarily due to risk factors for 18 cancers in males and 11 in females, while aging would be associated with the increase in other cancers.In this population-based cohort study of incident cancer in the general population, the cancer landscape in China is evolving, with an increasing incidence primarily due to risk factors in 20 cancers and aging in others. Primary prevention efforts to reduce risk exposure are crucial, and further basic research is needed. Additionally, second prevention efforts are imperative to improve cancer survival, particularly among older individuals.