【作者】 孙悦；

【导师】 朱彩蓉；

【作者基本信息】 四川大学 ， 公共卫生， 2023， 硕士

【摘要】 目的:(1)描述全球41个国家2008-2012年肾癌发病情况,了解其发病率的地理分布差异和性别差异。(2)描述全球41个国家1988-2012年肾癌的变化趋势,估计其年龄、时期和队列效应,初步探索其可能的潜在危险因素。(3)预测全球各国2013-2032年不同性别的肾癌发病趋势,估计目前各国尤其是我国的发病规模,为中国肾癌防控政策制定提供参考依据。方法:(1)从五大洲肿瘤发病数据库第Ⅶ卷-第Ⅺ卷获取发病数据,采用世界标准人口通过直接标准化法对发病率进行标准化。(2)采用Joinpoint回归模型对1988-2012年各国肾癌标化发病率变化趋势进行分析,并计算年度变化百分比及平均年度变化百分比。(3)利用年龄-时期-队列模型(APC模型)对各国肾癌发病趋势进行分析,通过估计年龄、时期和队列效应探索潜在危险因素。(4)采用BAPC模型预测2013-2032年肾癌标化发病率和发病例数,估计各国未来肾癌发病规模。结果:(1)全球41个国家中,37个国家(90.2%)的男性以及34个国家(82.9%)的女性在1988-2012年的肾癌粗/标化发病率均呈持续上升趋势,少部分国家包括冰岛、德国、奥地利、印度等的标化发病率维持在比较稳定的趋势;巴西以及非洲三个国家的发病率较为波动。其中中国无论是男性群体还是女性群体的肾癌标化发病率都在随着时间迅速的增加,男性的肾癌标化发病率从1988-1992年的3.6/10万上升至了2008-2012年的9.0/10万,而女性的肾癌标化发病率从1988-1992年的1.9/10万上升至2008-2012年的4.4/10万,20年间中国男性和女性群体的肾癌标化发病率均增加了一倍多。(2)全球肾癌标化发病率地域差异明显。肾癌发病率较高的国家集中在大洋洲、北美洲和欧洲,尤其是欧洲的捷克、爱沙尼亚、奥地利、德国、冰岛等。其中捷克在每一时期的粗发病率和标化发病率均排全球第一位,2008-2012年男性肾癌标准化发病率高达41.3/10万,而女性的肾癌标准化发病率为17.6/10万。而发病率相对较低的国家集中在非洲和亚洲,尤其是非洲的阿尔及利亚、乌干达和津巴布韦,发病率只相当于捷克等国家的十分之一。中国各时期肾癌的标化发病率属于中等水平。(3)男性与女性的肾癌发病率差异均较大。全球的男女肾癌标化发病率比均在2 左右。亚洲和欧洲部分国家的男女发病率比较高,其中日本、韩国、法国、意大利、波兰、瑞士、西班牙和瑞士这8个国家的最高男女发病率比都大于2。需要注意的是,从1988-1992年到2008-2012年,5卷数据中有4卷数据的肾癌男女发病率比最高的国家是日本,其最高的男女发病率比高达3.0,最低值也高达2.7。中国的男女肾癌发病率比稳定在2左右。(4)根据Joinpoint回归模型拟合结果看出1988-2012年全球大部分国家的男性和女性肾癌的标化发病率整体呈上升趋势。其中上升最快的几个国家分别为中国、韩国、白俄罗斯、拉脱维亚、阿尔及利亚等,并且中国男性和女性的肾癌标化发病率上升速度在全球均排前6名。只有少部分国家的肾癌发病率呈下降趋势,但所有下降趋势的AAPC均没有统计学意义。(5)根据APC结果可得,对于所有的国家而言,发病率均会随着年龄的增加而显著上升,某些国家的发病率在高年龄阶段有小幅度的波动。由中国男性和女性肾癌发病的年龄、时期、队列效应估计图可知无论是男性还是女性,肾癌发病率都随着出生队列显著的增加。而从全球角度来看,绝大多数国家肾癌发病的队列效应均呈现持续上升的趋势,印度、瑞士两个国家肾癌发病的队列效应整体呈平稳的趋势,奥地利、菲律宾、科威特的肾癌发病队列效应整体呈轻微下降的趋势,而德国肾癌发病率随不同出生队列的趋势则比较波动,1930年以前出生的队列随着出生队列越年轻发病风险逐渐升高,1930年后出生的队列中发病风险则逐渐下降,到了1960年-1970年后随着出生队列越年轻发病风险略有上升。(6)根据预测结果,2013-2032年中国肾癌标化发病率与2008-2012年相比呈上升趋势,预计男性肾癌标化发病率在2032年会达到11.0/10万;女性肾癌标化发病率预计在2032年达到5.4/10万。同样的在全球其他40个国家中,绝大部分国家肾癌标化发病率均呈上升趋势。只有包括奥地利、德国、菲律宾、科威特几个国家2013-2032年男性或女性的肾癌发病率将呈轻微下降的趋势。结论:(1)全球41个国家中,37个国家(90.2%)的男性以及34个国家(82.9%)的女性在1988-2012年的肾癌粗/标化发病率均呈持续上升趋势,只有奥地利等4 个国家的男性以及菲律宾等6个国家的女性肾癌发病率未上升。(2)肾癌的发病率在全球存在地域差异,标化发病率相差超过40倍;所有国家的肾癌发病率均存在性别差异,男女标化发病率比为2左右。(3)中国男性和女性1988-2012年肾癌发病率的上升速度均是所有国家中的前6位,中国肾癌的预防与控制工作应该得到重视。(4)人口老龄化是全球肾癌发病负担增长的重要原因。(5)危险因素的变化对肾癌发病负担增加具有非常重要的影响。绝大多数国家肾癌发病的队列效应持续上升;印度、瑞士队列效应较平稳,奥地利等3个国家队列效应轻微下降,而德国则较为波动。各个国家糖尿病和肥胖患病率随队列变化趋势与其肾癌发病的队列效应趋势高度一致,应采取相应策略措施来降低肾癌的发病率。更多还原

【Abstract】 OBJECTIVES:(1)To describe the incidence of kidney cancer in 41 countries worldwide from 2008 to 2012,and to understand the differences in its geographical distribution and gender differences in incidence rates.(2)To describe the trends of kidney cancer in 41 countries worldwide from 1988-2012,estimate its age,period and cohort effects,and preliminarily explore its possible underlying risk factors.(3)To predict the global trends of kidney cancer incidence by gender in each country from2013-2032,to estimate the current incidence scale in each country,especially in China,and to provide a reference basis for the formulation of kidney cancer prevention and control policies in China.METHODS:(1)Incidence data were obtained from Volume VII-DD of the Five Continents Tumor Incidence Database,and the incidence rates were standardized by direct standardization method using the world standard population.(2)A Joinpoint regression model was used to analyze the trend of the standardized incidence rate of kidney cancer in each country from 1988 to 2012,and the annual percentage change and mean annual percentage change were calculated.(3)The trend of kidney cancer incidence in each country was analyzed using the age-period-cohort model(APC model),and potential risk factors were explored by estimating age,period and cohort effects.(4)The BAPC model was used to predict the standardized incidence rate and number of cases of kidney cancer from 2013-2032 and to estimate the current incidence size in each country.RESULTS:(1)The crude/standardized incidence rates in most countries worldwide,including China,were increasing in both males and females from 1988-2012,and a small number of countries,including Iceland,Germany,Austria,and India,maintained a relatively stable trend in standardized incidence rates;incidence rates in Brazil and three countries in Africa were more volatile.In China,the standardized incidence rate of kidney cancer in both male and female groups has been increasing rapidly over time,from 3.6/100,000 in 1988-1992 to 9.0/100,000 in 2008-2012 for males,and from1.9/100,000 in 1988-1992 to 4.4/100,000 in 2008-2012 for females.The standardized incidence rate of kidney cancer among women increased from 1.9/100,000 in 1988-1992 to 4.4/100,000 in 2008-2012,more than doubling the standardized incidence rate of kidney cancer in both male and female groups in China in 20 years.(2)There are significant geographical differences in the global standardized incidence rate of kidney cancer.Countries with high incidence of kidney cancer were concentrated in Oceania,North America and Europe,especially the Czech Republic,Estonia,Austria,Germany and Iceland in Europe.Among them,the Czech Republic ranks first globally in both crude and standardized incidence rates in each period.In contrast,countries with relatively low incidence rates are concentrated in Africa and Asia,especially Algeria,Uganda,and Zimbabwe in Africa,where the incidence rates are only one-tenth of those in countries such as the Czech Republic.The standardized incidence rates of kidney cancer in China for all periods are moderate,and the standardized incidence rates of kidney cancer in men and women from 2008 to 2012were 9.0/100,000 and 4.4/100,000,respectively.(3)The incidence of renal cell carcinoma varies greatly between men and women.The standardized incidence of renal cell carcinoma in men and women worldwide is about2.The incidence of men and women in some countries in Asia and Europe is relatively high.The highest incidence of men and women in Japan,South Korea,France,Italy,Poland,Switzerland,Spain and Switzerland is greater than 2.It should be noted that from 1988-1992 to 2008-2012,the country with the highest male-to-female incidence ratio of kidney cancer in four of the five volumes of data is Japan,with the highest male-to-female incidence ratio of 3.0 and the lowest value of 2.7.The incidence ratio of male to female renal cell carcinoma in China is stable at about 2.(4)According to the results of the Joinpoint regression model,the standardized incidence rates of kidney cancer in men and women in most countries worldwide showed an overall increasing trend from 1988 to 2012.The fastest increasing countries were China,Korea,Belarus,Latvia,Algeria,etc.,and the rate of increase in the standardized incidence of kidney cancer in both males and females in the Middle Ages ranked the top 6 in the world.Only a small number of countries have a decreasing trend in the incidence of kidney cancer,but all the decreasing trend of AAPC are not statistically significant.(5)Based on the APC results,it can be concluded that for all countries,the incidence rate increases significantly with age,with small fluctuations in incidence rates at higher ages in certain countries.The estimated age,period,and cohort effects of kidney cancer incidence in China for both men and women are shown to increase significantly with birth cohort for both men and women.From a global perspective,the cohort effect of kidney cancer incidence in most countries showed a continuous increasing trend,while the overall cohort effect of kidney cancer incidence in India and Switzerland showed a stable trend,and the overall cohort effect of kidney cancer incidence in Austria and the Philippines showed a slight decreasing trend,while the trend of kidney cancer incidence in Germany fluctuated with different birth cohorts,and the cohort born before 1930 showed a gradually increasing risk with younger birth cohort.The risk of incidence gradually increased with younger birth cohorts before 1930,decreased in cohorts born after 1930,and increased slightly with younger birth cohorts after 1960-1970.(6)According to the predicted results,the standardized incidence of kidney cancer in China showed an increasing trend from 2013 to 2032 compared with 2008-2012.Similarly,in the other 40 countries worldwide,the majority of countries showed an increasing trend in the standardized incidence of kidney cancer.Only a few countries,including Austria,Germany,and the Philippines,will show a slight downward trend in the incidence of kidney cancer in men or women from 2013-2032.Conclusions:(1)Among 41 countries worldwide,the crude/standardized incidence rates of kidney cancer in 37(90.2%)men and 34(82.9%)women showed a continuous increasing trend from 1988 to 2012,while the incidence rates of kidney cancer in men in only 4 countries,including Austria,and in women in 6 countries,including the Philippines,did not increase.(2)There are geographical differences in the incidence of kidney cancer globally,with a more than 40-fold difference in the standardized incidence rate;there are gender differences in the incidence of kidney cancer in all countries,with a standardized incidence rate ratio of about 2 for men and women.(3)The rate of increase of kidney cancer incidence in both men and women in China from1988 to 2012 is among the top 6 in all countries,and the prevention and control of kidney cancer in China should be taken seriously.(4)Population aging is an important reason for the increasing burden of kidney cancer incidence globally.(5)Changes in risk factors have a very important impact on the increasing burden of kidney cancer incidence.The cohort effect of kidney cancer incidence continues to increase in the vast majority of countries;the cohort effects are more stable in India and Switzerland,slightly decreasing in three countries,including Austria,and more volatile in Germany.The cohort trends of diabetes and obesity prevalence in each country were highly consistent with the cohort effects of kidney cancer incidence,and strategic measures should be taken to reduce the incidence of kidney cancer.更多还原