背景:胃癌是全球范围内的主要健康问题,在老年人中发病率较高。鉴于总体人口老龄化,了解老年胃癌的当前负担和未来趋势至关重要.本研究旨在分析发病率的时间趋势,死亡率,2010年至2019年中国胃癌风险最高地区的老年胃癌和生存率,并预测到2024年老年胃癌的未来负担。
方法:本研究在甘肃省进行,中国胃癌发病率和死亡率最高的地区。2010年至2019年胃癌发病率和死亡率的登记数据汇集于甘肃省肿瘤登记系统的登记处,虽然生存数据来自兰州大学第一医院,兰州大学第二医院,甘肃省肿瘤医院。应用2000年的中国标准人口和Segi的世界标准人口来计算年龄标准化率。使用Joinpoint回归分析癌症发病率和死亡率的平均年百分比变化(AAPC)。使用自回归综合移动平均(ARIMA)模型来预测2020年至2024年的发病率和死亡率。
结果:根据2010年至2019年的注册数据,老年人胃癌的发病率和死亡率保持稳定。发病率从2010年的439.65/10万下降到2019年的330.40/10万,AAPC为-2.59%(95%置信区间[CI],-5.14至0.04,P=0.06)。同样,死亡率从2010年的366.98/10万变为2019年的262.03/10万,AAPC为-2.55%(95%CI,-8.77-4.08%,P=0.44)。在以医院为基础的队列中,据报道,在中国胃癌风险最高的地区,老年胃癌患者的生存率下降,3年总生存率(OS)从2010年的58.5%(95%CI,53.5-63.2%)降至2019年的34.4%(95CI,32.1-36.7%),3年无进展生存期(PFS)从2010年的51.3%(95CI,47.5-55.1%)降至2019年的34.2%(95CI,32.0-36.3%).此外,ARIMA模型预测显示,从2020年到2024年,中国老年胃癌的发病率和死亡率显著下降。具体来说,老年胃癌的发病率预计将从2020年的317.94/100,000下降至2024年的205.59/100,000,而预期死亡率预计将从2020年的222.52/100,000下降至2024年的186.22/100,000.
结论:2010-2019年,在中国胃癌高发区,老年胃癌的发病率和死亡率保持稳定,而存活率则呈下降趋势。基于ARIMA模型,预计未来5年中国高危地区老年胃癌发病率和死亡率可能会持续下降.
BACKGROUND: Gastric cancer is a major health problem worldwide, with a high incidence among older adults. Given the aging overall population, it was crucial to understand the current burden and prospective trend of older gastric cancer. This study aimed to analyze the temporal trends of the incidence, mortality, and survival of older gastric cancer in the highest gastric cancer risk area in China from 2010 to 2019, and to predict the future burden of older gastric cancer up to 2024.
METHODS: The study was conducted in Gansu province, an area characterized by the highest gastric cancer incidence and mortality in China. The registration data of gastric cancer incidence and mortality from 2010 to 2019 were pooled from registries in the Gansu Cancer Registration System, while survival data were collected from the First Hospital of Lanzhou University, Lanzhou University Second Hospital, and Gansu Cancer Hospital. Chinese standard population in 2000 and the Segi\'s world standard population were applied to calculate the age-standardized rate. Joinpoint regression was used to analyze the average annual percentage change (AAPC) in cancer incidence and mortality. Autoregressive Integrated Moving Average (ARIMA) models were employed to generate forecasts for incidence and mortality from 2020 to 2024.
RESULTS: Based on registry data from 2010 to 2019, the incidence and mortality rates of gastric cancer among older adults remained stable. The incidence rates declined from 439.65 per 100,000 in 2010 to 330.40 per 100,000 in 2019, with an AAPC of -2.59% (95% confidence interval[CI], -5.14 to 0.04, P = 0.06). Similarly, the mortality rate changed from 366.98 per 100,000 in 2010 to 262.03 per 100,000 in 2019, with an AAPC of -2.55% (95% CI, -8.77-4.08%, P = 0.44). In the hospital-based cohort, the decline in survival rates was reported among older patients with gastric cancer in the highest gastric cancer risk area in China, with the 3-year overall survival (OS) decreasing from 58.5% (95% CI, 53.5-63.2%) in 2010 to 34.4% (95%CI, 32.1-36.7%) in 2019, and the 3-year progression-free survival (PFS) decreasing from 51.3% (95%CI, 47.5-55.1%) in 2010 to 34.2% (95%CI, 32.0-36.3%) in 2019, respectively. Moreover, forecasts generated by ARIMA models revealed a significant decline in the incidence and mortality of older gastric cancer in China from 2020 to 2024. Specifically, the incidence rate of older gastric cancer was expected to decrease from 317.94 per 100,000 population in 2020 to 205.59 per 100,000 population in 2024, while the anticipated mortality rate was estimated to decrease from 222.52 per 100,000 population in 2020 to 186.22 per 100,000 population in 2024.
CONCLUSIONS: From 2010 to 2019, the incidence and mortality of older gastric cancer remained stable in the highest gastric cancer risk area in China, while the survival rates showed a decline. Based on the ARIMA models, it was anticipated that there might be a continued decline in older gastric cancer incidence and mortality in the highest-risk area in China over the next five years.