Cancer Statistics in China, 2015 汇报人：信息部 林雪君

目 录 杂志及作者介绍 背景知识 研究方法 结果与讨论 文献心得

一、杂志及作者介绍 中国国家癌症中心副主任，中国医学科学院肿瘤医院肿瘤研究所院所长赫捷 院士（通讯作者），陈万青教授 （第一作者）于2016年1月25日在CA-Cancer J Clin 发布了《2015年中国癌症统计》。

二、背景知识 Cancer incidence and mortality have been increasing in China, making cancer the leading cause of death since 2010 and a major public health problem in the country. Because of China’s large population size, approximately one-fifth of the world population, these Chinese data contribute significantly to the global burden of cancer: almost 22% of global new cancer cases and close to 27% of global cancer deaths occur in China.

Previous national incidence and mortality estimates have been limited to small samples of the population using data from the 1990s or based on a specific year. With high-quality data from an additional number of population-based registries now available through the National Central Cancer Registry of China, the authors analyzed data from 72 local, population- based cancer registries (2009-2011), representing 6.5% of the population, to estimate the number of new cases and cancer deaths for 2015. Data from 22 registries were used for trend analyses (2000-2011).

Statistical Analysis Temporal trends in incidence and mortality rates from 2000 to 2011 (22 registries) were examined by fitting joinpoint models. Trends were expressed as an annual percentage change (APC),and the Z test was used to assess whether the APC was statistically different from zero.

三、研究方法 时间趋势分析法： （一） 非定量描述：直观比较、图示法 （二） 定量描述：变化百分比、统计模型

Joinpoint 回归模型： 在计算出线性趋势（年度变化百分比）的方向和度量的同时，对线性连接点各分段线性趋势进行比较、统计学检验，得出有统计学差异的连接点。 利用肿瘤登记数据分析癌症发病率（死亡率）的趋势。

四、结果与讨论 Expected Cancer Incidence in 2015 It is predicted that there will be about 4292,000 newly diagnosed invasive cancer cases in 2015 in China, corresponding to almost 12,000 new cancer diagnoses on average each day. The 5 most commonly diagnosed cancers among men, in descending order, are: cancers of the lung and bronchus, stomach, esophagus, liver, and colorectum, accounting for about two-thirds of all cancer cases. The corresponding cancers among women are breast, lung and bronchus, stomach, colorectum, and esophagus, accounting for nearly 60% of all cases. Breast cancer alone is expected to account for 15% of all new cancers in women.

For all cancers combined, the age-standardized incidence rates per 100,000 population per year are higher in men than in women (234.9 vs 168.7 per 100,000) and are higher in rural areas than in urban areas (213.6 vs 191.5 per 100,000). The higher smoking prevalence in rural populations compared with those in urban areas likely plays a dominating role. The 12 cancers formally established as being caused by smoking account for about 75% of all cancers combined in China.Cigarette smoking is now causally associated with cancers of the oropharynx, larynx, esophagus, lung (including trachea and bronchus), stomach, liver, pancreas, kidney and ureter, bladder, cervix, and colorectum, as well as acute myeloid leukemia.

The cancer profile in China is markedly different from those of developed countries. The 4 most common cancers diagnosed in China were lung, stomach, liver, and esophageal cancer. These cancers account for 57% of cancers diagnosed in China, compared with 18% in the United States. Also, these cancers diagnosed in China comprise between one third and one-half of the global incidence burden from lung, stomach, liver, and esophageal cancers. In comparison, the most common cancers diagnosed in the United States are cancers of the lung, breast, prostate, and colorectum.

2.Expected Cancer Mortality in 2015 It is estimated that over 7500 cancer deaths on average per day. The 5 leading causes of cancer death among both men and women are cancers of the lung and bronchus, stomach, liver, esophagus, and colorectum, accounting for about three-quarters of all cancer deaths. Similar to the incidence rates, the age-standardized mortality rate for all cancers combined is substantially higher in men than in women and in rural areas than in urban areas (149.0 vs 109.5 per 100,000).

We found even greater geographic variations in cancer mortality and the survival proxies across China. It is likely that at least part of these geographic disparities could be explained by the more limited medical resources, lower levels of cancer care, and a larger proportion of patients diagnosed with cancer at a late stage in rural and underdeveloped areas in China.

3.Expected Cancer Survival in 2015 It is predicted that, for all cancers combined, 36.9% of cancer patients in China will survive at least 5 years after diagnosis around 2015, with women having much better survival than men (47.3% vs 29.3%) ; rural patients have much lower survival than their city counterparts(30.3% vs 42.8%). The most common cancers in China are those associated with rather poor survival; whereas those in the United States, with the exception of lung cancer, are dominated by cancers with a good to excellent prognosis, and, for prostate and breast cancers, the incidence may be inflated by diagnostic activities linked to early detection and screening.

4.Trends in Cancer Incidence and Mortality For all cancers combined, the incidence rates were stable during 2000 through 2011 for males, whereas they increased significantly among females. In contrast, the mortality rates since 2006 have decreased significantly for both males and females. Despite this favorable trend, however, the number of cancer deaths substantially increased during the corresponding period (from 2000 to 2011) because of the aging and growth of the population.

There has been a marked increase in the numbers of cancers diagnosed in China between 2000 and 2011. Much of this is explained by the aging and growth of the population. Other factors that may have contributed to the increase in the burden of cancer include increases in the prevalence of unhealthy behaviors or cancer-related lifestyle and improvements in disease awareness, detection services, and data completeness.

Among the 10 most common cancers considered in the temporal trend analyses for men, incidence rates from 2000 to 2011 increased for 6 cancer types (pancreas, colorectum, brain and central nervous system, prostate, bladder, and leukemia), whereas the rates decreased for cancers of the stomach, esophagus, and liver. A stable trend was observed for cancer of the lung.

For women, 6 of the 10 most common cancers had a significant upward trend in age-standardized incidence rates (cancers of the colorectum, lung, breast, cervix, uterine corpus, and thyroid). As with men, a downward trend was seen for cancers of the stomach, esophagus, and liver.

五、文献心得 关于样本量 1. 适量样本的重要性 2. 样本量估算需要考虑以下几点

第一，制定统计分析计划 首先要明确资料类型：是计数资料还是计量资料。 若是计数资料，就涉及到率的可信区间、单个率的比较、多个率的比较。若是计量资料，就涉及到均值的可信区间、单个均值的比较、多个均值的比较。 比如，欲研究两种药物降压效果有无差别，以血压下降值为评价指标，如何制定统计分析计划呢？研究中资料类型属于计量资料（血压下降值），涉及两组之间的比较，也就是说，要比较两组均值有无差异。

第二，寻找重要参数值 明确了比较均值还是率，确定了是单组还是多组，接下来，找到相应的样本量估算公式，参照公式，去寻找重要的参数值。 比如，想比较两个独立样本的均值，知道每组样本的均值、标准差也就够了。至于，这些参数值的获得，总是有方法的，我们可以查询最相关的文献，可以通过预实验，根据经验猜测获得……

α是检验水准，一般双侧为0. 05，单侧为0.025；1-β是检验功效， 一般取β为0.1或者0.2。 第三，定义α和β 如果你查询了样本量的公式，那你肯定发现α和β频频出现。 α是检验水准，一般双侧为0. 05，单侧为0.025；1-β是检验功效， 一般取β为0.1或者0.2。 横断面研究（普查、抽样调查） 病例对照研究 队列研究 实验研究 诊断研究

第四，确定组间的比例 如果研究中有分组，就涉及到组间比例的问题。组间比例可以是1:1， 但并不要求必须是1:1。比如，按照1:1的比例，假设算出每组至少需要95人，但是，根本找不到这么多病例，怎么办呢? 可以看到，1:1时至少需要95人，1:2时可能71人就够了呢……需要提醒大家注意的是，组间比例不宜过大，从质量控制和总体样本量来看均不划算。推荐组间比例最好在1:4之内。

第五，估算样本量，考虑失访等其他因素，适当增加样本量。 这时候，可谓是万事俱备，只需把参数值、α和β、组间比例代入公式， 样本量就来了。需要注意的是，临床研究过程中由于失访，资料不合格等 会造成样本量的消耗，所以，研究设计之初应考虑到这些因素，在估算的 样本量基础上，适当增加10%~20%样本量。

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