J Natl Cancer Inst:1978-2013年,子宫内膜癌发病率变化趋势

2017-10-23 Ryy “肿瘤资讯”微信号

子宫内膜癌是女性第六常见肿瘤,与雌激素水平密切相关。随着时间的推移,全球子宫内膜癌发病率变化趋势如何?导致疾病的高危因素发生了哪些变化?我们应该如何针对性的采取措施预防?近期发表的一项研究通过高质量数据分析表明子宫内膜癌的发病率在部分国家已经翻倍增长,肥胖成为该病增加最主要的罪魁祸首,通过体重的控制及运动可以降低子宫内膜癌发病风险。

子宫内膜癌是女性第六常见肿瘤,与雌激素水平密切相关。随着时间的推移,全球子宫内膜癌发病率变化趋势如何?导致疾病的高危因素发生了哪些变化?我们应该如何针对性的采取措施预防?近期发表的一项研究通过高质量数据分析表明子宫内膜癌的发病率在部分国家已经翻倍增长,肥胖成为该病增加最主要的罪魁祸首,通过体重的控制及运动可以降低子宫内膜癌发病风险。

背景

子宫内膜癌(绝大多数为子宫内膜来源的腺癌)在全球女性癌症排名中排名第6、癌症死亡原因排名第14位。2012年新发病例约320 000例,死亡约76000例。主要发生在女性绝经后。全球不同国家年龄标准化发病率(ASRs)从1-30/100 000不等。人口发展指数较高的国家发病率居高,约占所有病例的2/3,撒哈拉以南的非洲、中东和中亚一些国家发病率则比较低。

激素在子宫内膜癌中发挥重要作用,包括月经初潮较早、绝经较晚、未育、激素替代(MHU)、肥胖等非对抗性雌激素是该病的主要危险因素,其他危险因素还包括糖尿病高血压及内膜癌家族史。而生育次数较多、初产或末次生育年龄较大、雌孕激素口服避孕(OC)及吸烟可以降低疾病风险。在大部分地区高风险因素持续增高,特别是肥胖,近30年全球增多了1倍。高体重指数(BMI)约占全球子宫内膜癌病因的34%,在北美可高达48%。以往对子宫内膜癌发病趋势的研究局限于特定的国家或地区,数据陈旧。本次依据国际癌症研究署的最新数据分析当代子宫内膜癌发病率的变化趋势。

方法

数据来源 42个国家1978-2007年子宫内膜癌(ICD-10 C54)的发病数据来源于IARC CI5plus癌症注册数据库,其中部分国家数据更新至2013年。42个国家中,2个国家发病率数据以国家癌症登记处数据为基础,其余国家数据以地区或区域登记数据为主。美国发病率按黑人及白人区分。对应的人口学数据来自IARC。

数据分析

按世界标准人口计算每100000人的年龄标准化发病率。采用Joinpoint回归分析发病率随时间的变化趋势。评估每个国家发病率的变化丰度及趋势,近10年(根据不同国家的可获得数据分为1998–2007 、2004–2013)ASR的年均变化百分比(AAPC)。采用年龄-时期-队列(APC)模型评价23个人群,她们具有连续25年的数据并且2006-2007年间每年都有超过100万的女性人群。APC模型可以评估效应队列(出生年份)及时间(确诊年份)对总体发病趋势的影响。

结果

发病率横断面分析 总体来说,2006-2007年ASRs(所有年龄)最高的地区是北美及欧洲,斯洛伐克及美国白人均为19/100 000(95%CI=: 斯洛伐克18-21;美国白人18-20)。 ASRs(所有年龄)最低的是中等收入国家(南非1, 95% CI = 0-3, 印度 3, 95% CI = 3-4)。绝经后女性(年龄>50岁)发病率是绝经前(25-49岁)的4-20倍。不同的国家之间,无论是对绝经前还是绝经后女性来说发病率可以相差10倍之多。

随时间变化趋势 近10年ASR变化趋势见图1。半数以上的人群ARS具有统计学意义上的增加。发病率低的国家具有最快的增幅(南非10年间发病率翻倍,增长率11.3%/年,95% CI = 4.0 -19.0)。16个国家发病率没有发生统计学意义的变化(绝大多数为北欧国家),3个国家发病率具有显着下降的趋势(斯洛文尼亚–1.4%,95% CI = –2.8-0;奥地利–0.9%,95% CI = –1.2–0.5;和瑞典–0.6%,95%CI= –0.9–0.2)。大部分国家仍延续着既往的变化趋势。美国黑人女性的发病率在早期是低于白人女性的,但自90年代末期,黑人女性发病率迅速增加(3.1%/年, 95% CI = 2.2-3.9),至2011年两个种族的发病率已经相近。绝经前女性的发病率与绝经后女性发病率的上升相一致。但也有一些例外。在一些国家绝经后女性发病率显着增加,但绝经前女性发病率却显着下降(丹麦,捷克共和国,和荷兰)或稳定(巴西,泰国,以色列,保加利亚,波兰,克罗地亚,意大利,西班牙,和爱尔兰)。挪威、芬兰和法国绝经前女性的发病率显着下降但老年患者(绝境后)的发病率却始终稳定。

APC分析及发病年龄变化趋势

11个群体中连续世代及时期发病风险增加。增长最为明显的是日本、菲律宾、白俄罗斯、新加坡、哥斯达黎加和新西兰。

结论

在一些国家,特别是社会经济快速转型的国家,子宫内膜癌的发病率随着时间推移及世代交替不断增加。

点评:

我国近年来子宫内膜发病率及病死率逐年增高。80%以上的子宫内膜癌与雌激素水平有关。因此,子宫内膜癌的增多可能与外源性雌激素的使用——围绝经期或绝经后女性——或内源性雌激素暴露(未育、少育、初潮早及肥胖)有关。生殖因素也影响着子宫内膜癌的发病率。高生育次数可以降低子宫内膜癌风险,但随着社会经济的转型,这种保护作用在下降。接近半数的低生育国家(2个子女/女性)在亚洲、拉美及加勒比。低生育国家女性子宫内膜癌的风险更大。全球目前都在面临超重及肥胖问题,1980-2013年间超重及肥胖的比例分别增加了30%及38%。而这一因素是完全可以通过饮食及生活方式的调节而改善的。适当控制体重(BMI 21-23)及运动(每天至少30分钟中等程度的体力活用)可以预防59%以上的子宫内膜癌风险。

该研究采用高质量的数据,系统性分析了5大洲43个人群将近36年的数据,提供了全球子宫内膜癌的发病变化趋势,针对性的提供了预防建议。研究的局限性在于,部分国家年龄组数据缺乏、没有调整子宫切除手术人群的影响,可能会导致发病率数值的偏倚。

原始出处:

Lortet-Tieulent J,et al.,International Patterns and Trends in Endometrial Cancer Incidence, 1978-2013.J Natl Cancer Inst. 2017 Oct 16.

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    2018-04-29 qidongfanjian
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    2018-08-08 drj2003
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