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论文题名(中文):

 全球结直肠癌发病死亡及中国结直肠癌预后研究    

姓名:

 徐梦圆    

论文语种:

 chi    

学位:

 硕士    

学位类型:

 学术学位    

学校:

 北京协和医学院    

院系:

 北京协和医学院肿瘤医院    

专业:

 公共卫生与预防医学-流行病与卫生统计学    

指导教师姓名:

 曾红梅    

论文完成日期:

 2025-05-30    

论文题名(外文):

 The global incidence and mortality of colorectal cancer and its prognosis in China    

关键词(中文):

 结直肠癌 发病 死亡 预后 亚部位    

关键词(外文):

 colorectal cancer incidence mortality prognosis subsite    

论文文摘(中文):

研究目的

基于国际癌症研究机构发布的全球GLOBOCAN 2020数据库,描述全球及中国结直肠癌、结肠癌、直肠癌发病和死亡负担情况。基于2016~2017年中国多中心结直肠癌患者诊疗数据库,描述中国结直肠及不同亚部位癌症患者的分期、治疗和预后情况,探索影响中国结直肠及不同亚部位癌症患者预后的关键因素。

材料与方法

基于国际癌症研究机构发布的2020年全球各国结直肠癌(ICD 10:C18~C21)、结肠癌(ICD 10:C18)、直肠癌(ICD 10:C19~C20)发病和死亡数据,提取新发病例数、死亡病例数、粗发病率、粗死亡率、世界人口标化发病率、世界人口标化死亡率等数据,描述全球和中国不同性别、年龄、地区、亚部位的结直肠癌发病和死亡负担差异。

以中国12个省份23家医院的8322例2016~2017年新发结直肠癌患者为研究对象,基于医院电子病历信息,收集患者社会人口学特征、生活方式、分期、一线治疗方式等信息。采用主动随访和被动随访相结合的方式,详细追踪结直肠癌患者的生存结局和死亡时间,随访截止日期为2023年12月31日。采用卡方检验比较中国23家医院结直肠癌患者在不同性别、年龄、地区、亚部位间的分期和治疗情况差异。采用寿命表法计算中国结直肠癌及亚部位癌症患者五年观察生存率,并采用多因素Cox回归揭示影响中国23家医院结直肠癌及不同亚部位癌症患者预后的潜在因素。

结果

2020年全球估计新发结直肠癌病例1 931 590例,粗发病率为24.8/10万,标化发病率为19.6/10万。2020年全球估计因结直肠癌死亡人数为935 173例,粗死亡率为12.0/10万,标化死亡率为9.0/10万。2020年全球新发结肠癌1 148 515例,因结肠癌死亡576 858例,标化发病率和死亡率为11.4/10万和5.4/10万;全球新发直肠癌732 210例,因直肠癌死亡339 022例,标化发病率和死亡率分别为7.6/10万和3.3/10万。2020年中国新发结肠癌306 078例,标化发病率为13.1/10万;因结肠癌死亡164 820例,标化死亡率为6.8/10万。2020年中国新发直肠癌244 550例,标化发病率为10.6/10万;因直肠癌死亡118 931例,标化死亡率为5.0/10万。

在7390例已知分期结直肠癌患者中,I、II、III、IV期比例分别为15.2%、32.9%、33.5%、18.3%。不同亚部位患者中,I期比例由高到低依次为直肠(19.9%)、远端结肠(12.4%)、近端结肠(8.4%)。结肠癌患者手术率和化疗率分别为88.0%和51.4%。直肠癌患者手术率、化疗率和放疗率分别为86.9%、50.8%和14.6%。分期结果显示,结肠癌患者手术率从高到低依次为II期(97.3%)、I期(97.1%)、III期(95.7%)、IV期(56.0%),差异有统计学意义(P<0.001)。I期、II期、III期、IV期结肠癌患者化疗率依次升高,分别为22.1%、39.8%、60.5%、73.5%,差异有统计学意义(P<0.001)。I期、II期、III期、IV期直肠癌患者手术率依次降低,分别为95.9%、93.4%、90.4%、53.1%,差异有统计学意义(P<0.001)。I期、II期、III期、IV期直肠癌患者化疗率从低到高依次为19.1%、43.4%、63.6%、75.9%,差异有统计学意义(P<0.001)。直肠癌患者放疗率从高到低依次为III期(21.2%)、IV期(18.4%)、II期(11.9%)、I期(3.3%),差异有统计学意义(P<0.001)。

中国23家医院结直肠癌患者总体5年观察生存率为63.3%(62.2%~64.4%),I、II、III、IV期患者5年观察生存率分别为88.3%(86.5%~90.3%)、80.8%(79.3%~82.4%)、63.3%(61.4%~65.2%)、18.0%(16.0%~20.2%)。多因素Cox回归分析显示,与女性相比,男性结直肠癌患者死亡风险增加16%(HR=1.16,95% CI:1.06~1.27);与城市地区相比,居住地为农村的结直肠癌患者死亡风险增加10%(HR=1.10,95% CI:1.00~1.21);年龄≥70岁结直肠癌患者死亡风险是<50岁患者的1.65倍(95% CI:1.45~1.89);新农合结直肠癌患者死亡风险是城镇医保患者的1.29倍(95% CI:1.16~1.43);与I期患者相比,II期(HR=1.66,95% CI:1.38~1.99)、III期(HR=3.57,95% CI:2.99~4.26)、IV期(HR=13.04,95% CI:10.83~15.69)结直肠癌患者具有更高的死亡风险。手术治疗结直肠癌患者死亡风险比未手术患者降低52%(HR=0.48,95% CI:0.43~0.53)。化疗结直肠癌患者死亡风险比未化疗患者降低22%(HR=0.78,95% CI:0.72~0.86)。与近端结肠相比,远端结肠癌(HR=0.88,95% CI:0.78~0.99)和直肠癌(HR=0.85,95% CI:0.76~0.95)患者的预后风险更低。

结论

2020年全球结直肠癌负担沉重,我国结直肠癌、结肠癌、直肠癌标化发病率和死亡率均高于全球平均水平。男性、居住于农村地区、高龄、新农合、晚期、手术、化疗、近端结肠是结直肠癌患者的独立预后因素。研究结果为结直肠癌防控和个体化治疗提供了科学依据。

论文文摘(外文):

Objectives

Based on the GLOBOCAN 2020 database released by the International Agency for Research on Cancer (IARC), this study aimed to characterize the global and Chinese burden of colorectal cancer, colon cancer, and rectal cancer in terms of incidence and mortality. Utilizing a multicenter, hospital-based colorectal cancer patient diagnosis and treatment database in China from 2016-2017, we sought to describe the stage distribution, treatment patterns, and prognosis for colorectal cancer patients overall and by subsite in China, and to explore key factors influencing their prognosis.

Materials and methods

Using the GLOBOCAN 2020 database from IARC, we extracted the number of new cases, deaths, crude incidence rate, crude mortality rate, age-standardized incidence rate, and age-standardized mortality rate for colorectal cancer (ICD-10: C18-C21), colon cancer (ICD-10: C18), and rectal cancer (ICD-10: C19-C20) to characterize disparities in burden across sex, age, region, and subsites globally and in China.

We included a total of 8,322 newly diagnosed colorectal cancer patients (2016-2017) from 23 hospitals across 12 Chinese provinces. We collected data on sociodemographic characteristics, lifestyle, stage at diagnosis, and first-line treatments from electronic medical records. We used both active and passive follow-up methods to track survival outcomes and date of death until December 31, 2023. We used Chi-square tests to compare differences in staging and treatment modalities across sex, age, region, hospital level/type, and subsites. We applied the life-table method to calculate 5-year observed survival rates, while we used multivariable Cox regression models to identify prognostic factors for colorectal cancer overall and by subsite.

Results

In 2020, the global estimated number of new colorectal cancer cases was 1,931,590, with a crude incidence rate of 24.8 per 100,000 and an age-standardized incidence rate of 19.6 per 100,000. The global estimated number of deaths due to colorectal cancer in 2020 was 935,173, with a crude mortality rate of 12.0 per 100,000 and an age-standardized mortality rate of 9.0 per 100,000. Globally in 2020, there were 1,148,515 new colon cancer cases and 576,858 deaths due to colon cancer, with age-standardized incidence rate and age-standardized mortality rate of 11.4 per 100,000 and 5.4 per 100,000, respectively. Globally, there were 732,210 new rectal cancer cases and 339,022 deaths due to rectal cancer, with age-standardized incidence rate and age-standardized mortality rate of 7.6 per 100,000 and 3.3 per 100,000, respectively. In China in 2020, there were 306,078 new colon cancer cases (age-standardized incidence rate: 13.1 per 100,000) and 164,820 deaths due to colon cancer (age-standardized mortality rate: 6.8 per 100,000). China had 244,550 new rectal cancer cases (age-standardized incidence rate: 10.6 per 100,000) and 118,931 deaths due to rectal cancer (age-standardized mortality rate: 5.0 per 100,000).

Among the 7,390 patients with known-stage colorectal cancer, the proportions of stage I, II, III, and IV disease were 15.2%, 33.9%, 33.5%, and 18.3%, respectively. Analysis by subsite revealed progressively decreasing stage I proportions from rectal cancer (19.9%) to distal colon cancer (12.4%) and proximal colon cancer (8.4%). Surgery and chemotherapy rates for colon cancer patients were 88.0% and 51.4%, respectively, while corresponding rates for rectal cancer patients were 86.9% for surgery, 50.8% for chemotherapy, and 14.6% for radiotherapy. Stratified analyses demonstrated significant variations by stage: Colon cancer surgery rates decreased significantly from stage II (97.3%) to stage I (97.1%), stage III (95.7%), and stage IV (56.0%) (P<0.001). Colon cancer chemotherapy rates increased progressively from stage I (22.1%) to stage II (39.8%), stage III (60.5%), and stage IV (73.5%) (P<0.001). Rectal cancer surgery rates decreased significantly across stages I (95.9%), II (93.4%), III (90.4%), and IV (53.1%) (P<0.001). Rectal cancer chemotherapy rates showed a significant ascending gradient from stage I (19.1%) to stage II (43.4%), stage III (63.6%), and stage IV (75.9%) (P<0.001). Radiotherapy utilization in rectal cancer patients decreased significantly from stage III (21.2%) to stage IV (18.4%), stage II (11.9%), and stage I (3.3%) (P<0.001).

The overall 5-year observed survival rate of colorectal cancer patients in the 23 Chinese hospitals was 63.3% (95% CI: 62.2%-64.4%). The 5-year observed survival rates for patients in stages I, II, III, and IV were 88.3% (95% CI: 86.5%-90.3%), 80.8% (95% CI: 79.3%-82.4%), 63.3% (95% CI: 61.4%-65.2%), and 18.0% (95% CI: 16.0%-20.2%), respectively. Multivariable Cox regression analysis showed that compared with females, male colorectal cancer patients had a 16% increased risk of death (HR=1.16, 95% CI: 1.06-1.27). Compared with urban residence, patients living in rural areas had a 10% increased risk of death (HR=1.10, 95% CI: 1.00-1.21). Patients aged ≥70 years had a 1.65 times higher risk of death than those aged <50 years (HR=1.65, 95% CI: 1.45-1.89). Patients enrolled in the New Rural Cooperative Medical Scheme had a 29% increased risk of death than those with urban medical insurance (HR=1.29, 95% CI: 1.16-1.43). Compared with stage I, patients with stage II (HR=1.66, 95% CI: 1.38-1.99), stage III (HR=3.57, 95% CI: 2.99-4.26), and stage IV (HR=13.04, 95% CI: 10.83-15.69) had significantly higher risks of death. Patients who underwent surgery had a 52% lower risk of death compared to those who did not (HR=0.48, 95% CI: 0.43-0.53). Patients who received chemotherapy had a 22% lower risk of death compared to those who did not (HR=0.78, 95% CI: 0.72-0.86). Compared with proximal colon cancer, patients with distal colon cancer (HR=0.88, 95% CI: 0.78-0.99) and rectal cancer (HR=0.85, 95% CI: 0.76-0.95) had a significantly lower risk of death.

Conclusion

In 2020, the global burden of colorectal cancer remained substantial, with the age-standardized incidence and mortality rates of colorectal cancer, colon cancer, and rectal cancer in China all exceeding the global average. Male sex, rural residence, older age, enrollment in the New Rural Cooperative Medical Scheme, advanced stage at diagnosis, surgery, chemotherapy, and proximal colon subsite were identified as independent prognostic factors for colorectal cancer patients. These findings provide evidence for colorectal cancer prevention and control as well as personalized treatment strategies.

开放日期:

 2025-06-13    

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