CA:全新癌症统计:美国癌症死亡率较峰值下降32%,肺癌生存率提高,乳腺癌发病率缓慢增长

2022-01-17 MedSci原创 MedSci原创

每年美国癌症协会(ACS)都会预估美国新发癌症病例和死亡人数,并汇编基于人口的癌症发生率和结果的最新数据。

每年美国癌症协会(ACS)都会预估美国新发癌症病例和死亡人数,并汇编基于人口的癌症发生率和结果的最新数据。

2022年,最新的研究报告(发病率数据截至2018年,死亡率数据截至2019年)于1月12日发表在影响因子高达508.702的“神刊” CA: A Cancer Journal for Clinicians 上。相关数据可访问互动网站Cancer Statistics Center ( https://cancerstatisticscenter.cancer.org/)。

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报告指出,在过去28年中,美国死于癌症的风险有所下降。癌症死亡率从1991年峰值至2019年下降了32%。其中一些下降似乎与肺癌患者诊断后寿命延长的比例增加有关,还有部分原因是更多人在疾病早期被诊断。

在美国,癌症仍然是仅次于心脏病的第二大常见死因。2022年,美国预计将新增190万例癌症病例和609,360例癌症死亡,即每天约1,670例死亡,其中约350例死于肺癌。肺癌是癌症死亡的主要原因。

按性别来看,前列腺癌、肺和支气管癌(以下简称肺癌)以及结直肠癌几乎占2022年男性所有发病病例的一半(48%),仅前列腺癌就占诊断的27%。对女性而言,乳腺癌、肺癌和结直肠癌占所有新诊断癌症的51%,仅乳腺癌就占约三分之一(31%)。

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2022年美国按性别分类预估的十大主要癌症类型的新病例和死亡人数。 (来源:CA: A Cancer Journal for Clinicians)

癌症死亡率继续下降

1991年至2019年间癌症死亡率下降了32%,这意味着这些年的癌症死亡人数比死亡率未下降的情况下要少近350万。这一成功很大程度上是因为吸烟人数减少,从而导致肺癌和其他与吸烟有关的癌症的死亡率下降。

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1991–2019年美国男性和1992–2019年女性避免癌症死亡的人数。蓝线代表每年记录的实际癌症死亡人数;红线表示如果癌症死亡率保持在峰值,预计的癌症死亡人数。(来源:CA: A Cancer Journal for Clinicians)

导致死亡率下降的其他因素还包括:1)乳腺癌和结肠癌术后化疗;2)许多癌症的联合治疗;3)某些癌症(乳腺癌、宫颈癌、结肠癌、前列腺癌、直肠癌以及肺癌等)通过筛查预防和/或早期发现。

从2015年到2019年,死于癌症的风险每年下降约2%,而1990年代为每年1%。癌症死亡率的加速下降显示了预防、筛查、早期诊断、治疗的力量,以及我们向一个没有癌症的世界前进的整体潜力。

研究人员指出,要想成功降低癌症死亡率,需要在两个同样重要的领域进行更多的投资:1)扩展知识、推进更好的治疗选择的癌症研究;2)确保成功、有针对性的癌症控制干预措施能更广泛、更公平地适用于所有人群。

肺癌早期诊断的进展

肺癌在疾病各个阶段的前景比以往任何时候都更加光明。近年来,越来越多的肺癌患者在癌症早期阶段被诊断出来,从而延长了寿命。

 

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2004年至2018年,美国不同肺癌诊断阶段发病率趋势。AAPC表示平均年百分比变化。(来源:CA: A Cancer Journal for Clinicians)

2014年至2018年,局部性阶段疾病(无迹象表明癌症扩散到肺外)诊断率每年增长4.5%,而晚期疾病诊断率急剧下降。结果是3年生存率总体增加。2004年,100例被诊断为肺癌的患者中有21例在确诊后3年内仍然存活。到2018年,这一数字已上升到100例中有31例。

存活率的提高主要是由于诊断肺癌的测试、电视辅助胸腔镜手术(VATS)、病理分期的更新、针对肺癌最常见基因突变的药物等方面的改善。

以下是一些关于肺癌的其他统计数据:

  • 肺癌每天仍造成350多人死亡,是所有类型癌症中导致死亡人数最多的,超过乳腺癌、前列腺癌和胰腺癌的总和。它造成的死亡是结直肠癌的2.5倍,结直肠癌是美国第二大癌症死亡原因。

  • 预计2022年死于肺癌的10人中有8人(81%)是吸烟导致的。吸烟量和时长都会增加死于肺癌的风险。吸烟的人患肺癌的可能性是从不吸烟的人的25倍。

  • 二手烟导致了近3%的肺癌新诊断。预计2022年,二手烟将导致其中约3%的死亡。

  • 继吸烟之后,肺癌的下一个主要原因是暴露在氡气中。氡气从土壤中释放出来,并在室内积聚。

  • 如果将肺癌非吸烟相关死亡单独分类,则其将在癌症死亡原因中位列第八。

前列腺癌死亡风险下降速度趋于稳定

从1990年代中期到2010年代中期,死于前列腺癌的风险降低了约50%,这是因为治疗的改善,以及通过前列腺特异性抗原(PSA)检测进行筛查,有助于在早期发现癌症(仅位于前列腺)。但近年来,死于前列腺癌的风险每年仅下降0.6%。进展缓慢的原因可能与癌症筛查指南的变化有关。

尽管筛查有助于降低死亡率,但越来越多的证据表明通过前列腺癌的过度诊断和过度治疗,PSA检测造成了不应有的伤害。因此,美国预防服务工作组(USPSTF)改变了他们的筛查指南。2008年,USPSTF建议对75岁及以上的男性不进行PSA常规筛查,2012年,所有男性不进行PSA检测。

起初,PSA检测减少后,前列腺癌的诊断率迅速下降。但从2014年到2018年,局部性阶段疾病(无迹象表明癌症扩散到前列腺外)的发病率保持稳定,而区域性阶段疾病(癌症扩散到前列腺附近的结构或淋巴结)的发病率每年上升4%,远端阶段疾病(癌症已扩散到身体的远端,如大脑、骨骼、肝脏)的发病率每年上升6%。因此,在过去10年中,诊断为远端阶段前列腺癌的比例翻了一番多,从3.9%增至8.2%。

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1975年至2018年,美国按性别分类的选定癌症发病率趋势。 (来源:CA: A Cancer Journal for Clinicians)

ACS的研究人员指出,关于PSA检测在“通过早期检测来降低前列腺癌死亡率”方面未充分利用的潜力仍存在争议。

乳腺癌发病率缓慢增长  

自2000年代中期以来,女性乳腺癌发病率以每年约0.5%的速度缓慢增长。诊断率的上升部分是由于更多的女性患有肥胖症,生育的孩子更少,或者在30岁以后生育第一个孩子。近年来,乳腺癌死亡率的下降速度有所放缓,这可能与发病率的上升以及乳房X光检查率的不变有关。

儿童和青少年癌症死亡率大幅下降   

癌症是美国1至14岁儿童第二大常见死亡原因。事故是最常见的原因。

  • 2022年,估计将有10,470名儿童被诊断出癌症,1,050名儿童将死于癌症。

  • 尽管自20世纪70年代中期以来,儿童癌症发病率有所上升,但自1970年以来,儿童癌症死亡率下降了71%,这主要是由于治疗的改进以及更多儿童参与临床试验。

  • 白血病仍然是最常见的儿童癌症,占儿童所有癌症的28%。从1970年到2019年,白血病死亡率下降了84%。

  • 大脑和其他神经系统肿瘤是儿童癌症第二常见类型,占所有儿童癌症的26%。

癌症是15至19岁青少年的第四大最常见死因。

  • 2022年,估计有5,480名青少年被诊断为癌症,550人将死于癌症。

  • 与儿童类似,青少年癌症发病率几十年来略有上升,而癌症死亡率从1970年到2019年下降了61%。

  • 大脑和其他神经系统肿瘤是青少年癌症最常见的类型,约占青少年癌症的21%,其次是淋巴瘤(19%)。

由于复杂的原因,青少年癌症治疗的进步在一定程度上落后于儿童的。原因包括临床试验招募率较低、肿瘤生物学和治疗方案的差异以及治疗耐受性和依从性。

报告的其他要点
  • 根据ACS研究,至少42%的预计新癌症是可以避免的。这包括19%的癌症由吸烟引起,以及至少18%的癌症是由体重超标、酗酒、营养不良和缺乏体育运动共同引起的。

  • 转移性黑色素瘤(一种历史上难以治疗的癌症)的新联合免疫疗法已成为游戏规则改变者。2004年,100例被诊断为远端阶段黑色素瘤的患者中只有15例在5年后仍然活着。对于2011年至2017年期间确诊的患者,由于这些新疗法的出现,5年后存活的患者数量增加了一倍——100例中有30例。

  • 最致命的癌症之一肝癌的发病率终于稳定下来。就在几年前,它还是增长最快的癌症。

参考资料:
1# Rebecca L. Siegel MPH et al. Cancer statistics, 2022. CA: A Cancer Journal for Clinicians (2022)
2# Risk of Dying from Cancer Continues to Drop at an Accelerated Pace (ACS)

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  6. 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createdBy=aa0e14, createdName=lifestar, createdTime=Sat Dec 24 11:36:35 CST 2022, time=2022-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2045377, encodeId=47f520453e716, content=<a href='/topic/show?id=7e4de13990f' target=_blank style='color:#2F92EE;'>#癌症死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71399, encryptionId=7e4de13990f, topicName=癌症死亡)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6f7770, createdName=jeanqiuqiu, createdTime=Wed May 25 02:36:35 CST 2022, time=2022-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2079304, encodeId=9b1420e930448, content=<a href='/topic/show?id=659ce1280ee' target=_blank style='color:#2F92EE;'>#癌发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71280, encryptionId=659ce1280ee, topicName=癌发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1777154, createdName=chenhongpeng, createdTime=Sun Feb 20 13:36:35 CST 2022, time=2022-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1998414, encodeId=bb01199841402, content=<a href='/topic/show?id=90c9e14680b' target=_blank style='color:#2F92EE;'>#癌症统计#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71468, encryptionId=90c9e14680b, topicName=癌症统计)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8942242, createdName=jj000001, createdTime=Thu Jul 14 17:36:35 CST 2022, time=2022-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256876, encodeId=84b812568e6b2, content=<a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69009, encryptionId=43706900963, topicName=生存率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a6043, createdName=guoyibin, createdTime=Wed Jan 19 09:36:35 CST 2022, time=2022-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1473582, encodeId=999b14e3582bb, content=<a href='/topic/show?id=0e3be140052' target=_blank style='color:#2F92EE;'>#癌症死亡率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71400, encryptionId=0e3be140052, topicName=癌症死亡率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eba97230640, createdName=wenjie, createdTime=Wed Jan 19 09:36:35 CST 2022, time=2022-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1185542, encodeId=dcb611855427b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211124/541d4ed04fbb4cb59cff2b122436afb1/9264c3ce94314c098a45a7ead3be23f9.jpg, createdBy=91435744276, createdName=ms5000001159606604, createdTime=Tue Jan 18 10:35:51 CST 2022, time=2022-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1185323, encodeId=6a49118532324, content=很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=84f94874946, createdName=tyiutyu16, createdTime=Mon Jan 17 20:55:45 CST 2022, time=2022-01-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1185291, encodeId=97d11185291b5, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200807/fb49ede2bc714e14abb1a1024e3f6969/ca936d1263ab48ffba726dafc70bcdb2.jpg, createdBy=92c35391508, createdName=冷小落, createdTime=Mon Jan 17 19:45:31 CST 2022, time=2022-01-17, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1799921, encodeId=3da41e9992115, content=<a href='/topic/show?id=9e3fe127909' target=_blank style='color:#2F92EE;'>#癌发病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71279, encryptionId=9e3fe127909, topicName=癌发病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2c92500045, createdName=12498636m49(暂无昵称), createdTime=Fri Aug 26 16:36:35 CST 2022, time=2022-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1823791, encodeId=d7de1823e9150, content=<a href='/topic/show?id=b2873e9220e' target=_blank style='color:#2F92EE;'>#发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37922, encryptionId=b2873e9220e, topicName=发病率)], attachment=null, authenticateStatus=null, createdAvatar=, 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encryptionId=659ce1280ee, topicName=癌发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1777154, createdName=chenhongpeng, createdTime=Sun Feb 20 13:36:35 CST 2022, time=2022-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1998414, encodeId=bb01199841402, content=<a href='/topic/show?id=90c9e14680b' target=_blank style='color:#2F92EE;'>#癌症统计#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71468, encryptionId=90c9e14680b, topicName=癌症统计)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8942242, createdName=jj000001, createdTime=Thu Jul 14 17:36:35 CST 2022, time=2022-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256876, encodeId=84b812568e6b2, content=<a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69009, encryptionId=43706900963, topicName=生存率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a6043, createdName=guoyibin, createdTime=Wed Jan 19 09:36:35 CST 2022, time=2022-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1473582, encodeId=999b14e3582bb, content=<a href='/topic/show?id=0e3be140052' target=_blank style='color:#2F92EE;'>#癌症死亡率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71400, encryptionId=0e3be140052, topicName=癌症死亡率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eba97230640, createdName=wenjie, createdTime=Wed Jan 19 09:36:35 CST 2022, time=2022-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1185542, encodeId=dcb611855427b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211124/541d4ed04fbb4cb59cff2b122436afb1/9264c3ce94314c098a45a7ead3be23f9.jpg, createdBy=91435744276, createdName=ms5000001159606604, createdTime=Tue Jan 18 10:35:51 CST 2022, time=2022-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1185323, encodeId=6a49118532324, content=很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=84f94874946, createdName=tyiutyu16, createdTime=Mon Jan 17 20:55:45 CST 2022, time=2022-01-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1185291, encodeId=97d11185291b5, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200807/fb49ede2bc714e14abb1a1024e3f6969/ca936d1263ab48ffba726dafc70bcdb2.jpg, createdBy=92c35391508, createdName=冷小落, createdTime=Mon Jan 17 19:45:31 CST 2022, time=2022-01-17, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1799921, encodeId=3da41e9992115, content=<a href='/topic/show?id=9e3fe127909' target=_blank style='color:#2F92EE;'>#癌发病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71279, encryptionId=9e3fe127909, topicName=癌发病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2c92500045, createdName=12498636m49(暂无昵称), createdTime=Fri Aug 26 16:36:35 CST 2022, time=2022-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1823791, encodeId=d7de1823e9150, content=<a href='/topic/show?id=b2873e9220e' target=_blank style='color:#2F92EE;'>#发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37922, encryptionId=b2873e9220e, topicName=发病率)], attachment=null, authenticateStatus=null, createdAvatar=, 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beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211124/541d4ed04fbb4cb59cff2b122436afb1/9264c3ce94314c098a45a7ead3be23f9.jpg, createdBy=91435744276, createdName=ms5000001159606604, createdTime=Tue Jan 18 10:35:51 CST 2022, time=2022-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1185323, encodeId=6a49118532324, content=很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=84f94874946, createdName=tyiutyu16, createdTime=Mon Jan 17 20:55:45 CST 2022, time=2022-01-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1185291, encodeId=97d11185291b5, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200807/fb49ede2bc714e14abb1a1024e3f6969/ca936d1263ab48ffba726dafc70bcdb2.jpg, createdBy=92c35391508, createdName=冷小落, createdTime=Mon Jan 17 19:45:31 CST 2022, time=2022-01-17, status=1, ipAttribution=)]
    2022-01-18 ms5000001159606604

    学习了

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1799921, encodeId=3da41e9992115, content=<a href='/topic/show?id=9e3fe127909' target=_blank style='color:#2F92EE;'>#癌发病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71279, encryptionId=9e3fe127909, topicName=癌发病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2c92500045, createdName=12498636m49(暂无昵称), createdTime=Fri Aug 26 16:36:35 CST 2022, time=2022-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1823791, encodeId=d7de1823e9150, content=<a href='/topic/show?id=b2873e9220e' target=_blank style='color:#2F92EE;'>#发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37922, encryptionId=b2873e9220e, topicName=发病率)], attachment=null, authenticateStatus=null, createdAvatar=, 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beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211124/541d4ed04fbb4cb59cff2b122436afb1/9264c3ce94314c098a45a7ead3be23f9.jpg, createdBy=91435744276, createdName=ms5000001159606604, createdTime=Tue Jan 18 10:35:51 CST 2022, time=2022-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1185323, encodeId=6a49118532324, content=很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=84f94874946, createdName=tyiutyu16, createdTime=Mon Jan 17 20:55:45 CST 2022, time=2022-01-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1185291, encodeId=97d11185291b5, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200807/fb49ede2bc714e14abb1a1024e3f6969/ca936d1263ab48ffba726dafc70bcdb2.jpg, createdBy=92c35391508, createdName=冷小落, createdTime=Mon Jan 17 19:45:31 CST 2022, time=2022-01-17, status=1, ipAttribution=)]
    2022-01-17 tyiutyu16

    很好

    0

  10. 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    2022-01-17 冷小落

    学习了

    0

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