本文選題：胃癌 + 食管癌�。� 參考：《南京醫(yī)科大學(xué)》2017年碩士論文

【摘要】：惡性腫瘤是嚴(yán)重影響人類健康,威脅生命的重要慢性非傳染性疾病,是全世界居民的主要死亡原因之一。據(jù)世界衛(wèi)生組織所屬的國際癌癥研究機(jī)構(gòu)的數(shù)據(jù)(GLOBOCAN 2012)顯示,2012年中國新發(fā)癌癥307萬例,死于癌癥的病人達(dá)221萬例,其中胃癌發(fā)病40萬例,死亡33萬例;食管癌發(fā)病22萬例,死亡20萬例。胃癌和食管癌在我國居民癌癥死因譜中分別位居第三位和第四位。江蘇省揚(yáng)中市是我國上消化道腫瘤高發(fā)地之一,當(dāng)?shù)匚赴⑹彻馨┑母甙l(fā)病率和高死亡率給居民帶來了極大的健康和經(jīng)濟(jì)負(fù)擔(dān)。目的收集揚(yáng)中市1991-2013年惡性腫瘤登記報告資料,描述胃癌、食管癌發(fā)病和死亡趨勢,為揚(yáng)中市制定上消化道癌防制對策和干預(yù)措施提供依據(jù):對揚(yáng)中市開展的上消化道癌胃鏡篩查及早診早治項(xiàng)目的有效性進(jìn)行評價。方法本論文包括兩個部分,第一部分以揚(yáng)中市1991-2013年上消化道癌癥監(jiān)測資料為基礎(chǔ),分析近20年來胃癌、食管癌發(fā)病與死亡現(xiàn)狀和流行趨勢,采用Joinpoint軟件計(jì)算年度變化百分比(APC)及其95%可信區(qū)間(CI),采用Graphpad Prism軟件繪制趨勢圖和生存曲線。第二部分通過收集揚(yáng)中市2006~2012年40-69參加上消化道癌早診早治項(xiàng)目的居民的相關(guān)資料,描述參加篩查的研究對象的基本特征、內(nèi)鏡篩查和病理檢查數(shù)據(jù),隨訪并觀察結(jié)局。同時,從腫瘤登記報告系統(tǒng)中選擇同期因癥就診而發(fā)現(xiàn)的胃癌、食管癌病人為對照組,比較兩組患者的生存率,評價內(nèi)鏡篩查項(xiàng)目對患者生存率的影響,組間生存率比較采用Log-rank 檢驗(yàn)。結(jié)果1.1991~2013年,揚(yáng)中市新登記報告胃癌8537例,其中男性5459例,女性3078例,粗發(fā)病率從1991年的172.0/10萬降至2013年的106.51/10萬,年齡標(biāo)化發(fā)病率從1991年的165.11/10萬下降至2013年的53.46/10萬,男性和女性胃癌的發(fā)病率 APC 分別為-3.6%(95%CI:-4.5%~-2.7%)和-4.8%(95%CI:-5.7%~-3.9%)。胃癌的發(fā)病率在45歲組以后快速上升,在70~74歲組達(dá)到高峰。標(biāo)化死亡率在1992~2001年間波動幅度不大,從2002年的66.43/10萬呈下降趨勢,2011 年時降至 17.37/10 萬,死亡率 APC=-13.5%(95%CI:-16.9%~-10.0%)。2.1991~2013年,揚(yáng)中市新登記食管癌6493例,其中男性3446例,女性3047例,粗發(fā)病率自1991年來保持穩(wěn)定,年齡標(biāo)化發(fā)病率從1991年的107.06/10萬下降至2013年的37.04/10萬。男性和女性食管癌的發(fā)病率APC分別為-2.5%(95%CI:-3.4%~-1.5%)和-4.9%(95%CI:-5.8%~-3.9%)。食管癌發(fā)病率在 40歲組以后快速上升,在75~79歲組達(dá)到高峰。標(biāo)化死亡率從1991年的25.12/10萬上升至1993年的62.94/10萬,在1994~2003年間標(biāo)化發(fā)病率保持穩(wěn)定,2004開始發(fā)病率呈下降趨勢,從2004年的45.32/10萬降至2011年的13.98/10萬,死亡率 APC 為-17.7%(95%CI:-26.2%~-8.3%)。3.2006~2012年,共篩查12453例40~69歲的當(dāng)?shù)鼐用?其中男性5334例,女性7119例,共檢出60例胃癌和106例食管癌病人,其中100%的胃癌和98.11%的食管癌病人為處于早期階段。查出的胃癌和食管癌病人1年、3年、5年生存率分別為98.0°%、90.0%和89.0%,顯著高于同期因癥就診發(fā)現(xiàn)的患者(Log-rank檢驗(yàn),X2=333.2,P0.001)。結(jié)論揚(yáng)中市胃癌和食管癌的發(fā)病率、死亡率均高于全國平均水平,但呈現(xiàn)明顯的下降趨勢。經(jīng)過內(nèi)鏡篩查診斷出的胃癌和食管癌病人的生存率顯著高于同期因癥就診獲得診斷的病人,篩查顯示良好的效果,但其成本和可接受性還需要進(jìn)一步探討。
[Abstract]:Malignant tumor is an important chronic non communicable disease which seriously affects human health and life. It is one of the main causes of death in the world. According to the data of International Cancer Research Institute of WHO (GLOBOCAN 2012), 3 million 70 thousand cases of new cancer in China were found in 2012, and 2 million 210 thousand cases of cancer died of cancer. There were 400 thousand cases of disease, 330 thousand cases of death, 220 thousand cases of esophageal cancer and 200 thousand cases of death. Gastric cancer and esophageal cancer were ranked third and fourth respectively in the cause of cancer death in our country. Yangzhong, Jiangsu Province, was one of the high incidence areas of upper digestive tract tumors in China, local gastric cancer, high incidence of esophageal cancer and high mortality brought great health to the residents. Objective to collect data on the registration of malignant tumor in Yangzhong for 1991-2013 years, to describe the trend of gastric cancer, the incidence and death of cancer of the esophagus, and to provide the basis for the prevention and control of the upper digestive tract cancer in Yangzhong: the evaluation of the effectiveness of the gastroscope screening for the early diagnosis and treatment of the upper digestive tract cancer in Yangzhong. The thesis consists of two parts. The first part, based on the data of cancer monitoring in the upper digestive tract of 1991-2013 years in Yangzhong, analyzes the status and trend of cancer and death in the last 20 years, uses the Joinpoint software to calculate the annual change percentage (APC) and its 95% reliable interval (CI), and uses the Graphpad Prism software to draw the trend map. And the survival curve. The second part, by collecting data from the residents of the early diagnosis and early treatment of upper digestive tract cancer in the city of Yangzhong, 40-69 2006~2012, describes the basic features of the subjects involved in the screening, the endoscopic screening and the pathological examination data, follow-up and observation of the outcome. The survival rate of the two groups of patients was compared and the survival rate of the two groups was compared. The survival rate of the patients was evaluated by the endoscopic screening program. The survival rate of the group was compared with the Log-rank test. Results in 1.1991~2013 years, 8537 cases of gastric cancer were reported in Yangzhong, including 5459 men and 3078 women, and the crude incidence was from 172.0/10 million in 1991. To 106.51/10 million in 2013, the incidence of age standardization decreased from 165.11/10 million in 1991 to 53.46/10 million in 2013. The incidence of gastric cancer in men and women was -3.6% (95%CI:-4.5%~-2.7%) and -4.8% (95%CI:-5.7%~-3.9%) respectively. The incidence of gastric cancer increased rapidly after 45 years of age, and reached the peak in the group of 70~74 years. The standardized mortality rate was 1. During the period of 992~2001, the fluctuation was not significant, from the decline trend of 66.43/10 million in 2002, to 17.37/10 million in 2011, the death rate of APC=-13.5% (95%CI:-16.9%~-10.0%).2.1991~2013, 6493 cases of newly registered esophageal cancer in Yangzhong, including 3446 males and 3047 females. The crude incidence rate remained stable since 1991, and the age standardized incidence rate was from 1991. The incidence of 107.06/10 million in 2013 was 37.04/10 million. The incidence of esophageal cancer in men and women was -2.5% (95%CI:-3.4%~-1.5%) and -4.9% (95%CI:-5.8%~-3.9%). The incidence of esophageal cancer increased rapidly after 40 years of age and reached the peak in the group 75~79 years. The standardized mortality rate increased from 25.12/10 million in 1991 to 62.94/10 million in 1993, at 1994. The incidence of the standardized incidence was stable during the period of ~2003. The incidence of the 2004 onset was decreased from 45.32/10 million in 2004 to 13.98/10 million in 2011. The mortality rate was -17.7% (95%CI:-26.2%~-8.3%).3.2006~2012, and 12453 40~69 years old were screened, including 5334 males and 7119 females. 60 cases of gastric cancer and 106 cases of esophageal cancer were detected. Patients, of which 100% of gastric cancer and 98.11% of the patients with esophageal cancer were in the early stage. The 1, 3, and 5 year survival rates were 98 and 90% and 89%, respectively, compared to those found in the same period (Log-rank test, X2=333.2, P0.001). Conclusion the incidence and mortality of gastric and esophageal cancer in Yangzhong are all It was higher than the national average, but showed a significant downward trend. The survival rate of the patients with gastric and esophageal cancer diagnosed by endoscopic screening was significantly higher than that of the patients diagnosed with the same period. The screening showed good results, but the cost and acceptability need to be further discussed.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735

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