云南地区2005年至2014年原发性肝癌临床流行病学调查研究  

Clinical epidemiological survey of primary liver cancer in Yunnan province from 2005 to 2014

作　　者：林艳苹[1] 周永春[1] 张强[2] 陆彦霓 梅泽超 岑泳村 周海[1] 袁中琴 谢琳[3] Lin Yanping;Zhou Yongchun;Zhang Qiang;Lu Yanni;Mei Zechao;Cen Yongcun;Zhou Hai;Yuan Zhongqin;Xie Lin(Cancer Center Office,Third Afliated Hospital of Kunming Medical University/Yunnan Cancer Hospital,Kunming 650118.China;Medical center,Third Affiliated Hospital of Kunming Medical University/Yinnan Cancer Hospital,Kunming 650118,China;Gastrointestinal Oncology Third Affiliated Hospital of Kurming Medical Universiy/Yiunnan Cancer Hospital,Kunming 650118,China)

机构地区：[1]昆明医科大学第三附属医院云南省肿瘤医院癌症中心办公室,昆明650118 [2]昆明医科大学第三附属医院云南省肿瘤医院体检中心,昆明650118 [3]昆明医科大学第三附属医院云南省肿瘤医院消化肿瘤内科,昆明650118

出　　处：《中华肝脏病杂志》2022年第6期606-611,共6页Chinese Journal of Hepatology

基　　金：云南省科技计划项目(基础研究专项)(202101AS070004)。

摘　　要：目的探讨云南地区2005年至2014年原发性肝癌临床特征及其变化趋势,以期为本地区的肝癌防治提供理论依据。方法采用回顾性调查研究、通过简单随机抽样抽取昆明医科大学第三附属医院2005年至2014年首诊首治肝癌住院病例,应用统一、规范的调查问卷提取患者的社会人口学和临床病理特征,并进行数据统计分析。结果共纳入1000例肝癌患者病例,年龄(53.2±11.2)岁,男女比例为5.99/1.00,近10年患者性别、年龄构成比无明显变化。受教育水平较低(小学或初中)患者的比例从21.8%增加到23.4%.受教育水平相对较高的患者比例从58.0%下降至38.2%(P<0.001)。吸烟患者从58.8%下降至44.4%,不吸烟人群从41.2%上升至55.6%(P<0.001)。饮酒患者占比从46.4%下降至35.2%。晚期肝癌(C期和D期)患者比例增高,而A期、B期患者比例呈下降趋势(P<0.001)。HBsAg阳性比例呈上升趋势,从2005年的69%上升至2014年的82%(P=0.043)。HBeAg阳性比例呈平稳趋势(P=0.008)。2005年至2014年,肝癌患者的超声检查应用率从91.0%下降到58.0%(P=0.001),X线计算机断层摄影术(CT)检查使用率从81.0%增加到84.0%(P=0.050),磁共振成像检查从0上升至22%(P<0.001),PET/CT检查从0增加至3%(P=0.026)。手术患者占比有所增加(P=0.005),介入治疗患者占比无明显变化(P=0.590)。手术治疗和介入治疗是最常用的治疗方式,且在过去10年间手术治疗患者占比呈上升趋势(P=0.005),介入治疗占比维持较高水平且无明显变化(P=0.590)。结论云南省肝癌患者发病年龄前移,男性占比是女性的近6倍,甲胎蛋白阳性率低,临床分期较晚等是目前云南地区肝癌防治面临的重大挑战。CT、磁共振成像、PET-CT等检查手段应用范围逐渐扩大,治疗方式仍以手术和介入治疗为主。Objective To investigatc the clinical characteristics and changing trends of primary liver cancer in Yunnan province from 2005 to 2014,in order to provide theoretical basis for the prevention and treatment of liver cancer in this region.Methods A retrospective survey was used to seleet inpatient cases of liver cancer who were itally diagnosed and treated in our hospital from 2005 to 2014 with simple random sampling.Patients socio-demographie and clinicopathological characteristics were extracted by a unified and standardized questionnaire,and the data were statistically analyzed.Results A total of 1000 cases with liver cancer were included,aged(53.2±11.2)years,with a male-to female ratio of 5.99/1.00 There was no significant change in the gender and age composition ratio of patients in the past 10 years.The proportion of patients with lower education level(primary or junior high school)were increased from 21.8%to 23.4%,and the proportion of patients with relatively higher education level were decreased from 58%to 38.2%(P<0.001).Smokers and non-smokers patients were decreased anc increased from 58.8%to 44.4%,and 41.2%to 55.6%(P<0.001).The proportion of drinker patients were decreased from 46.4%to 35.2%.The proportion of patients with advanced liver cancer(stage C and D)were increased,while the proportion of patients with stagc A and B showed a downward trend(P<0.001).The proportion of HBsAg positive patients showed an upward trend,that is,rising from 69%in 2005 to 82%in 2014(P=0.043).The proportion of HBcAg-positive patients showed a steady trend(P=0.008).The use rate of ultrasound cxamination in paticnts with liver cancer were decrcased from 91.0%to 58.0%(P=0.001),while the usc rate of computed tomography(CT),MRI,and PET/CT examinations were increased firom 81.0%to 84.0%(P=0.05),0 to 22%(P<0.001),and 0 to 3%(P 0.026)between 2005 to 2014.The proportion of surgical patients were increased(P=0.005).but the proportion of interventional patients did not change significantly(P=0.590).Surgery and interventional therapy

关 键 词：肝 肿瘤 流行病学 云南 

分 类 号：R735.7[医药卫生—肿瘤] R181.3[医药卫生—临床医学]