重磅!柳叶刀子刊首次发布全球青少年癌症负担地图!乳腺癌发病死亡居首

2021-12-07 LILYMED MedSci原创

Lancet Oncol: 2019年青少年和年轻成人癌症的全球负担:对2019年全球疾病负担研究的系统分析

青少年和年轻成人是指一个由15-39岁的个体组成的异质性人口。人生的这段成长时期是独特的,伴随着一些身体、情感和心理的变化,以及个人可能开始或推进职业生涯、高等教育、人际关系和生育下一代。青少年和年轻成人的年龄范围的定义和界限各不相同,但这一年龄组通常被描述为处于童年和老年之间过渡的亚群体。青少年和年轻成人通常患上在儿科人群中常见和治疗的癌症,以及成人中更常见的癌症。此外,一些癌症在这个年龄段比年轻或年老的个体更普遍,如霍奇金淋巴瘤和性腺生殖细胞肿瘤。因此,从卫生保健服务的角度来看,青少年和年轻成年癌症患者可能很难找到最适合其癌症类型和与年龄相关的治疗需求的护理。

此外,青少年和年轻成年患者经常面临社会和经济挑战,这可能导致在获得适当护理,及时诊断和治疗方面存在不平等。癌症负担包括癌症的流行病学负担和经济负担两个方面。在估算全球癌症负担时,虽然青少年和年轻成年患者癌症患者是具有独特流行病学、临床医护需求和社会影响的不同亚组,但是经常被忽视。

全球疾病、伤害和风险因素负担研究(GBD)是唯一一个提供癌症残疾调整生命年(DALYs)估计数的全球疾病负担估计框架,作为补充发病率和死亡率数据的指标,用于制定国家和全球卫生政策。目前为止,尚未有对青少年和年轻成年人口的全球癌症负担进行过正式的GBD分析。本项研究旨在分析和报告青少年和年轻成人人癌症负担估计,对于为解决这一人群中健康差异和不平等的癌症控制策略提供信息至关重要。

2019年,全球15-39岁人群中估计有190万例(95% UI 1·11-1·28)癌症发病,396000例(37万- 425000)死亡(表)。年龄标准化发病率最高的是SDI(社会人口指数)高(每100000人年59·6[54·5-65·7])和SDI中高(每100000人年53·2[48·8-57·9])的国家。青少年和青年癌症的年龄标准化死亡率最高的地区是中等SDI地区(每100000人年13·6[12·6 - 14·8])和中低SDI地区(每100000人年14·2[12·9-15·6])。

2019年,青少年和青年成人癌症为全球疾病负担贡献了2350万个(21·9-25·2)残疾调整生命年(表),其中2.7%(1·9-3·6)来自YLD,97.3%(96.4-98·1)来自YLLs。全球青少年和青年成人癌症DALY绝对负担的大多数(94%[91·0-91·8])集中在非高SDI(低、低-中、中、高中SDI)五分位数上。总体而言,高SDI设置的年龄标准化发病率最高(59·6[54.5 - 65·7]/ 100000人年),但年龄标准化DALY率最低(564·3[542·8-590·1]/ 100000人年)。乳腺癌(10.6%[10·0 - 11·2]),其次是脑癌和中枢神经系统癌(7.4%[6·0 - 8·0]),结肠癌和直肠癌(7.0%[6·6 - 7·3])和胃癌(6.7%[6·5-7·0])是全球范围内对DALY负担贡献最大的四种单独分类的癌症(附录81)。如果将白血病视为一个单一的组,考虑到它们由血液学家-肿瘤学家治疗,并具有类似的诊断方法,而不是作为单个白血病亚型,白血病将是对全球癌症DALY负担贡献最大的分类癌症组(12.0%[10·9 - 12.8]),比乳腺癌的发病率更高。“其他恶性肿瘤”类别,即未在GBD框架中单独估计的癌症的综合癌症原因类别,在全球青少年和青年成人癌症DALY负担中所占比例最高(13.7% [12.8 - 14.5];附录81页)。

2019年,以年龄标准化残疾调整年比率为代表的青少年和年轻成人癌症负担最重的地区集中在亚洲部分地区、南撒哈拉非洲和南美洲(图1A;附录84页)。青少年和年轻成人癌症导致的残疾调整生命年的分布不同于儿童(图1B)和老年人(图1C)。青少年和青壮年癌症的年龄标准化DALY五分位数的地理格局与高SDI国家儿童癌症的地理格局相似,也类似于低和中SDI国家成人癌症的分布(图1)。

在所有年龄组中,35-39岁的个体对青少年和年轻成人全球癌症DALY的贡献最大(840万[95% UI 7 8 - 9·0]),对应的DALY为1547·6[1441·3-1658·0]/ 10万人-年;图2A)。随着青少年和年轻成年人口年龄的增加,导致白血病的DALYs比例下降(占总年龄组DALYs的26.7%[24·8 - 28·8],对应于15-19岁年龄组的0.64万[0·56-0·72]DALYs,占总年龄组DALYs的6.2%[5·6 - 6·7]DALYs。35-39岁的DALYs为0·52万[0·46-0·58];附录107页)。在青少年和年轻成年人口中,由于癌症导致的DALYs的比例随着年龄的增加而增加(其中占总年龄组DALYs的18.1%[17·3 - 19·3]15-19岁年龄段DALYs对应0·43万[0·40-0·47]DALYs, 35-39岁年龄段DALYs对应6·200万[5·7-6·6]DALYs,占总DALYs的73.5%[72·7-75·2];图2B;附录107页)。在青少年和年轻成年人群体中,"其他恶性肿瘤"的比例显着,在15-19岁的人群中最高(占总年龄组DALYs的30.6%[28.6-32.2],相当于0.73百万[0·65-0·81]DALYs),在35-39岁的人群中最低(占DALY总年龄组的7.1%[6.5-7.5], 相当于0.59百万[0·54–0·65] DALYs;图2B)。直接比较15 - 29岁年龄组与30 - 39岁年龄组的DALY负担比例,发现主要原因从白血病和淋巴瘤转变为癌症,特别是乳腺癌和宫颈癌(附录p 122)。

通过SDI五分位数进行评估时,年龄标准化DALY比率和比例DALY负担因癌症类型而异(图3)。高SDI五分位数的个体具有较低的年龄标准化DALY比率(564·3 [95% UI 542·8-590·1]每100000人-年DALY;图3A),随着SDI五分位数的降低,宫颈癌造成的DALY负担的比例估计值增加,在高SDI设置下,其比例负担最低(4.1% [3.7 - 4];图3B),低SDI设置时负荷最高(12·1%[10·4 - 14·4];图3B)。与中低SDI(6·0–6·9])和低SDI(5·0–6·2])五分位数相比,归因于脑癌和中枢神经系统癌症的青少年和年轻成人癌症负担在高SDI(10.7%[8·8-11.6])和中高SDI(5·0-6.2])五分位数中最高。属于"其他恶性肿瘤"类别的青少年和年轻成人癌症比例在低SDI五分位数中最高(20.1%[18.7-22.2]),在中高SDI五分之一中最低(9.5-10.6])。

2019年全球女性DALY绝对负担排名前五位的是乳腺癌(2,4600万[95% UI 2·23-2·70]DALYs)、宫颈癌(1,5600万[1·32-1·78]DALYs)、“其他恶性肿瘤”(1,3500万[1·21-1·51]DALYs)、胃癌(732000 [653 000-814000]DALYs)和脑和CNS癌(722000 [536 000-827000]DALYs;图4;附录66 - 69页)。

男性DALY绝对负担最高的五种癌症是“其他恶性肿瘤”(188万[1·64-2·12]DALY);脑和中枢神经系统癌(103万[0·76-1·19]DALYs);结肠和直肠癌(973000 [887 - 1070000]DALYs);气管、支气管和肺癌(856 000 [766000-952000]DALYs);胃癌(842000 [767000 - 928000]DALYs;图4;附录62 - 65页)。

2019年,全球女性的总体癌症发病率高于男性(686000例[622000 - 751000]vs 509000例[469000 - 549000]),但绝对死亡率相似(202000 [184,000–222,000]对194000 [179,000–209,000]死亡;)。乳腺癌和宫颈癌在全球女性DALY负担中占相当大的比例(33.6%[32 - 35 . 1])。在非性别特异性的癌症原因中,全球27个癌症组中有24个男性具有更高的DALYs,总体DALY绝对数比女性高13.7%(3.5-25.1)。

图5显示了在全球范围内和按SDI五分位数分列的15-39岁人群中,残疾调整生命年的绝对负担和青少年和年轻成人癌症造成的死亡与其他疾病相比的排名。在GBD层次结构中22个此层次的DALY原因中,青少年和年轻成人癌症的DALY负担在全球排名第十(2350万[95% UI 21·9-25·2]DALY;图5A)。类别间排名显示,与中低、中SDI五分位相比,癌症在高、中高和中SDI五分位数的DALYs排名高于其他突出原因。在青少年和年轻成人中,癌症死亡人数全球排名第四(396000 [370 - 425000];图5B),在GBD等级中这一层次的21种死亡原因中,与中低和低SDI区域相比高,中高和中等SDI区域的SDI内部排名更高。

相比之下,15岁以下人群中因癌症死亡的人数在全球排名第11位,在39岁以上人群中排名第二(附录105,106)。2019年,青少年和年轻成年人口因癌症死亡的人数低于交通伤害和心血管疾病的估计人数,但高于艾滋病毒/艾滋病、性传播感染、呼吸道感染和结核病以及意外伤害的估计人数(图5B)。

综上,在2019年全球15~39岁人口中,发病和死亡人数排名第一的癌症均为乳腺癌

  • 癌症总发病:119万

  • 癌症总死亡:39.6万

  • 乳腺癌发病:17万

  • 乳腺癌死亡:4.31万

年龄标准化发病率排名

  • 社会人口指数最高国家:每年10万分之59.6

  • 社会人口指数中高国家:每年10万分之53.2

  • 社会人口指数中等国家:每年10万分之38.3

  • 社会人口指数中低国家:每年10万分之29.4

  • 社会人口指数最低国家:每年10万分之25.0

年龄标准化死亡率排名:

  • SDI中低国家:每年10万分之14.2

  • SDI中等国家:每年10万分之13.6

  • SDI中高国家:每年10万分之13.4

  • SDI最低国家:每年10万分之13.3

  • SDI最高国家:每年10万分之9.2

2019年青少年癌症全球疾病负担为2350万(95%不确定区间:21.9~25.2)残疾调整生命年,其中:

  • 伤残寿命年:占2.7%

  • 损失寿命年:占97.3%

  • 白血病:占12.0%

  • 乳腺癌:占10.6%

  • 中枢神经系统肿瘤:占7.4%

  • 结直肠癌:占7.0%

  • 胃癌:占6.7%

2019年女性青少年癌症伤残校正后寿命年前五位:

  • 乳腺癌:246万

  • 宫颈癌:156万

  • 其他恶性肿瘤:135万

  • 胃癌:73.2万

  • 中枢神经系统肿瘤:72.2万

2019年男性青少年癌症伤残校正后寿命年前五位:

  • “其他恶性肿瘤”:188万

  • 中枢神经系统肿瘤:103万

  • 结肠和直肠癌:97万

  • 气管、支气管和肺癌:85万

  • 胃癌:84万

15~29岁年龄组与30~39岁年龄组相比,影响伤残校正后寿命年的主要病因由白血病和淋巴瘤转变为乳腺癌和宫颈癌。癌症是全球青少年死亡的第四大原因,也是影响伤残校正后寿命年的第十大原因。

总的来说,本研究首次表明,就残疾调整生命年(DALY)而言,青少年和年轻成人癌症的全球负担是巨大的。从描述性的角度来看,与儿童和成人癌症相比,青少年和年轻成人残疾调整生命年的年龄标准化分布是独特的,反映了从儿童到成人癌症流行模式的转变。此外,在包括青少年和年轻成人在内的年龄范围内横向研究总体疾病负担时,全球癌症负担对全球疾病负担的残疾调整年的贡献超过了一些引人注目的传染病,如艾滋病毒/艾滋病和性传播感染。

非高SDI环境下,青少年和年轻成人的绝对死亡率负担最高,因此需要全球努力,通过区域和国家一级以及政府、机构、学术团体等之间的合作,改善这一人群的结局。从历史上看,在年轻和老年患者中,青少年和年轻成人肿瘤学一直不如癌症学科优先。全面估计全球青少年和青年癌症负担是至关重要的第一步。研究结果还强调有必要制定一项全球战略来解决这一人群的癌症负担,其中应包括将青少年和青壮年癌症纳入总体癌症控制规划和全民健康覆盖计划。

原文来源:

GBD 2019 Adolescent and Young Adult Cancer Collaborators. The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Oncol 2021. Published Online December 3, 2021.https://doi.org/10.1016/S1470-2045(21)00581-7

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1957900, encodeId=bb05195e90042, content=<a href='/topic/show?id=5430e14872e' target=_blank style='color:#2F92EE;'>#癌症负担#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71487, encryptionId=5430e14872e, topicName=癌症负担)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Mon Oct 31 11:10:33 CST 2022, time=2022-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1799917, encodeId=90291e9991793, 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=Thu Feb 10 06:10:33 CST 2022, time=2022-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549746, encodeId=0c091549e4656, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Wed Dec 08 12:10:33 CST 2021, time=2021-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077693, encodeId=ed6d10e7693ff, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/02/28/889a1910ded7780f3c049b354f1648b7.jpg, createdBy=2a791737770, createdName=mswert122, createdTime=Tue Dec 07 11:02:45 CST 2021, time=2021-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077669, encodeId=8c8d10e766999, content=好好学, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210628/d028dd72803b466fbec4fbb95fb69ab8/36dc5ab269ac424d983ff54da9dc4e15.jpg, createdBy=37881573320, createdName=liuyingying35, createdTime=Tue Dec 07 09:54:03 CST 2021, time=2021-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077668, encodeId=022310e766897, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210628/d028dd72803b466fbec4fbb95fb69ab8/36dc5ab269ac424d983ff54da9dc4e15.jpg, createdBy=37881573320, createdName=liuyingying35, createdTime=Tue Dec 07 09:53:17 CST 2021, time=2021-12-07, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1957900, encodeId=bb05195e90042, content=<a href='/topic/show?id=5430e14872e' target=_blank style='color:#2F92EE;'>#癌症负担#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71487, encryptionId=5430e14872e, topicName=癌症负担)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Mon Oct 31 11:10:33 CST 2022, time=2022-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1799917, encodeId=90291e9991793, 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=Thu Feb 10 06:10:33 CST 2022, time=2022-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549746, encodeId=0c091549e4656, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Wed Dec 08 12:10:33 CST 2021, time=2021-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077693, encodeId=ed6d10e7693ff, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/02/28/889a1910ded7780f3c049b354f1648b7.jpg, createdBy=2a791737770, createdName=mswert122, createdTime=Tue Dec 07 11:02:45 CST 2021, time=2021-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077669, encodeId=8c8d10e766999, content=好好学, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210628/d028dd72803b466fbec4fbb95fb69ab8/36dc5ab269ac424d983ff54da9dc4e15.jpg, createdBy=37881573320, createdName=liuyingying35, createdTime=Tue Dec 07 09:54:03 CST 2021, time=2021-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077668, encodeId=022310e766897, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210628/d028dd72803b466fbec4fbb95fb69ab8/36dc5ab269ac424d983ff54da9dc4e15.jpg, createdBy=37881573320, createdName=liuyingying35, createdTime=Tue Dec 07 09:53:17 CST 2021, time=2021-12-07, status=1, ipAttribution=)]
    2021-12-08 xxxx1054
  4. [GetPortalCommentsPageByObjectIdResponse(id=1957900, encodeId=bb05195e90042, content=<a href='/topic/show?id=5430e14872e' target=_blank style='color:#2F92EE;'>#癌症负担#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71487, encryptionId=5430e14872e, topicName=癌症负担)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Mon Oct 31 11:10:33 CST 2022, time=2022-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1799917, encodeId=90291e9991793, 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=Thu Feb 10 06:10:33 CST 2022, time=2022-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549746, encodeId=0c091549e4656, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Wed Dec 08 12:10:33 CST 2021, time=2021-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077693, encodeId=ed6d10e7693ff, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/02/28/889a1910ded7780f3c049b354f1648b7.jpg, createdBy=2a791737770, createdName=mswert122, createdTime=Tue Dec 07 11:02:45 CST 2021, time=2021-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077669, encodeId=8c8d10e766999, content=好好学, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210628/d028dd72803b466fbec4fbb95fb69ab8/36dc5ab269ac424d983ff54da9dc4e15.jpg, createdBy=37881573320, createdName=liuyingying35, createdTime=Tue Dec 07 09:54:03 CST 2021, time=2021-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077668, encodeId=022310e766897, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210628/d028dd72803b466fbec4fbb95fb69ab8/36dc5ab269ac424d983ff54da9dc4e15.jpg, createdBy=37881573320, createdName=liuyingying35, createdTime=Tue Dec 07 09:53:17 CST 2021, time=2021-12-07, status=1, ipAttribution=)]
    2021-12-07 mswert122

    感谢分享

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1957900, encodeId=bb05195e90042, content=<a href='/topic/show?id=5430e14872e' target=_blank style='color:#2F92EE;'>#癌症负担#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71487, encryptionId=5430e14872e, topicName=癌症负担)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Mon Oct 31 11:10:33 CST 2022, time=2022-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1799917, encodeId=90291e9991793, 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=Thu Feb 10 06:10:33 CST 2022, time=2022-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549746, encodeId=0c091549e4656, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Wed Dec 08 12:10:33 CST 2021, time=2021-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077693, encodeId=ed6d10e7693ff, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/02/28/889a1910ded7780f3c049b354f1648b7.jpg, createdBy=2a791737770, createdName=mswert122, createdTime=Tue Dec 07 11:02:45 CST 2021, time=2021-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077669, encodeId=8c8d10e766999, content=好好学, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210628/d028dd72803b466fbec4fbb95fb69ab8/36dc5ab269ac424d983ff54da9dc4e15.jpg, createdBy=37881573320, createdName=liuyingying35, createdTime=Tue Dec 07 09:54:03 CST 2021, time=2021-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077668, encodeId=022310e766897, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210628/d028dd72803b466fbec4fbb95fb69ab8/36dc5ab269ac424d983ff54da9dc4e15.jpg, createdBy=37881573320, createdName=liuyingying35, createdTime=Tue Dec 07 09:53:17 CST 2021, time=2021-12-07, status=1, ipAttribution=)]
    2021-12-07 liuyingying35

    好好学

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1957900, encodeId=bb05195e90042, content=<a href='/topic/show?id=5430e14872e' target=_blank style='color:#2F92EE;'>#癌症负担#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71487, encryptionId=5430e14872e, topicName=癌症负担)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Mon Oct 31 11:10:33 CST 2022, time=2022-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1799917, encodeId=90291e9991793, 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=Thu Feb 10 06:10:33 CST 2022, time=2022-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1549746, encodeId=0c091549e4656, content=<a href='/topic/show?id=f7879600061' target=_blank style='color:#2F92EE;'>#重磅#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96000, encryptionId=f7879600061, topicName=重磅)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3acc14121561, createdName=xxxx1054, createdTime=Wed Dec 08 12:10:33 CST 2021, time=2021-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077693, encodeId=ed6d10e7693ff, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/02/28/889a1910ded7780f3c049b354f1648b7.jpg, createdBy=2a791737770, createdName=mswert122, createdTime=Tue Dec 07 11:02:45 CST 2021, time=2021-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077669, encodeId=8c8d10e766999, content=好好学, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210628/d028dd72803b466fbec4fbb95fb69ab8/36dc5ab269ac424d983ff54da9dc4e15.jpg, createdBy=37881573320, createdName=liuyingying35, createdTime=Tue Dec 07 09:54:03 CST 2021, time=2021-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1077668, encodeId=022310e766897, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210628/d028dd72803b466fbec4fbb95fb69ab8/36dc5ab269ac424d983ff54da9dc4e15.jpg, createdBy=37881573320, createdName=liuyingying35, createdTime=Tue Dec 07 09:53:17 CST 2021, time=2021-12-07, status=1, ipAttribution=)]
    2021-12-07 liuyingying35

    0

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