从全球趋势看我国结直肠癌防控:挑战与策略  

Global trend of colorectal cancer,prevention,and control in China:challenges and strategies

作　　者：陈海宁[1,2,3] 王自强 于永扬[1] 邱萌[1] 杨烈[2,3] 孟文建[1] 王存[1] 李园[3] 李立[1,2] 许恒[3] 黄灿华[3] 周总光 CHEN HaiNing;WANG ZiQiang;YU YongYang;QIU Meng;YANG Lie;MENG WenJian;WANG Cun;LI Yuan;LI Li;XU Heng;HUANG CanHua;ZHOU ZongGuang(Colorectal Cancer Center,Department of General Surgery,West China Hospital of Sichuan University,Chengdu 610041,China;Division of Gastrointestinal Surgery,Department of General Surgery,West China Hospital of Sichuan University,Chengdu 610041,China;Institute of Digestive Surgery&State Key Laboratory of Biotherapy,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院结直肠肿瘤中心,成都610041 [2]四川大学华西医院胃肠外科,成都610041 [3]四川大学消化外科研究所,生物治疗国家重点实验室,成都610041

出　　处：《中国科学：生命科学》2022年第11期1612-1625,共14页Scientia Sinica(Vitae)

基　　金：国家自然科学基金创新研究群体项目(批准号:81821002);国家自然科学基金面上项目(批准号:82073246);四川省科技厅科技创新人才项目(批准号:2022JDRC0049);四川大学华西医院学科卓越发展1·3·5工程(批准号:ZYGD20006,2016105)资助。

摘　　要：结直肠癌(colorectal cancer,CRC)是全球第三大常见癌症,也是癌症第二大死亡原因.全球CRC负担持续加剧,发病率急剧增长,2020年有193万CRC新发病例,94万CRC死亡病例,占全球新发癌症总数的10%,死亡癌症总数的9.4%,仅次于肺癌.早发性CRC的发病率在全球范围快速增长.中国CRC防控形势严峻,2020年中国新增CRC病例56万例,占全球CRC的28.8%;死亡29万,占全球CRC的30.6%;预测2040年中国CRC新增数量从2020年的56万增至91万,增长64%.我国面临癌症登记处人口覆盖比例低、筛查项目的人口覆盖率低、生活方式危险因素增多、民众对CRC可以预防的理念匮乏等严峻挑战.基于以上背景,结合中国国情,我们提出以下应对策略:(ⅰ)国家政策向预防倾斜,增大财政投入,加快我国区域高质量癌症监测点的建设速度;(ⅱ)高度重视CRC的二级预防,增加国家层面的筛查项目,扩大项目覆盖的人口比例,优化筛查效益和人口水平上的资源配置,包括低收入人群的初级预防和高收入环境的早期筛查;(ⅲ)重视CRC的初级预防,鼓励各类有益的娱乐健身运动,倡导健康饮食模式;(ⅳ)推进基于分子生物学特征的CRC亚型分层模式与CRC根治个体化微创精准模式的临床实践,实现CRC患者治疗获益的最大化.As the third most common malignancy worldwide and the second most deadly cancer,the global burden of colorectal cancer(CRC)is substantial and growing.It induced 1.93 million cases and 0.94 million deaths worldwide in 2020,accounting for 10%of the global cancer incidence and 9.4%of cancer deaths,just lower than lung cancer.With an alarming increase in cases of early-onset CRC,the situation of CRC in China is grim.In 2020,China recorded 560,000 new cases of CRC,accounting for 28.8%of global CRC cases,and 290,000 CRC deaths,accounting for 30.6%of global CRC deaths.The estimated number of CRC incident cases in China increased by 64%,from 0.56 million in 2020 to 0.91 million in 2040.CRC prevention and control in China faced severe challenges,such as the low population coverage ratio of the cancer registry,low population coverage of the screening programs,increased exposure to lifestyle risk factors,and a lack of public belief that CRC can be prevented.Coping strategies include the following:(1)The national policy is to tilte toward prevention,increase financial investment,and rapidly construct regional high-quality cancer monitoring sites in China.(2)Resource-based targeted interventions,including primary prevention among low-income people and early screening detection in high-income settings,are necessary.(3)All kinds of recreational physical activity should be encouraged,and healthy dietary patterns should be promoted.(4)The clinical practice of stratified CRC subtype mode should be promoted based on molecular biological characteristics and individualized minimally invasive precise CRC radical mode to maximize the treatment benefit of patients with CRC.

关 键 词：结直肠癌 发病率 死亡率 CRC筛查 CRC初级预防 

分 类 号：R735.34[医药卫生—肿瘤]