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《柳叶刀》权威报告:儿童癌症近一半被漏诊、越来越多年轻人患癌症

曼话 曼话 来源:医药魔方
2019-03-07
癌症
原文

以往对全球儿童癌症总发病率的估计主要是基于来自癌症登记处的数据,然而,世界上60%的国家没有这样的登记,即便是有,也只覆盖了总人口的一小部分。此外,很多患者由于没有得到诊断,因此未能“记录在案”。

 

微观模拟模型对全球儿童癌症年度确诊病例数的估计与来自权威癌症机构IARC的估计类似(图片来源:The Lancet Oncology)

 

为了提供关于全球儿童癌症总发病率的准确估计,来自哈佛大学陈曾熙公共卫生学院等机构的5位科学家开发了一个模拟全球200个国家和地区儿童(0-14岁)癌症发病率的全球儿童癌症微观模拟模型。


模型估计,2015年,全球儿童癌症的发病数(新增病例)为39.7万例,其中仅22.4万例被确诊。这表明,2015年,全球有43%(17.2万)的儿童癌症病例未被诊断出来,且各地区差异很大(图1)。

 

图1  2015年全球各地区儿童癌症总发病病例数以及确诊病例数(图片来源:The Lancet Oncology)

 

其中,西欧和北美未确诊的病例仅占各自总新增病例数的3%,而西非未确诊病例的占比高达57%(43000 of 76000)。

 

图2  2015年TOP15癌种的预测总发病数以及地区分布(图片来源:The Lancet Oncology)

 

从细分癌症来看,2015年,除撒哈拉以南非洲地区外,世界上大多数地区最常见的儿童癌症是急性淋巴细胞白血病(ALL),全球新增病例约7.5万例,其中,北欧近700例、西非近1700例、东非3500多例、南亚及中亚(South Central Asia)近3万例(图2)。全球范围内第二、第三常见的儿童癌症分别是非霍奇金淋巴瘤(估计约有2.2万例)、肾胚细胞瘤(约2.1万例)。在东非和西非,Burkitt淋巴瘤更为常见,东非有4000多例,西非有1万多例。

 

图3  2015-2030年各大洲新发儿童癌症病例建模预测(图片来源:The Lancet Oncology)

 

分析还显示,在世界上大多数地区,儿童癌症每年新增病例数呈下降趋势或保持稳定(图3),不过,非洲是一个显著的例外。该地区预计在2015-2030年间将有大量的人口增长,而这种增长将推动全球淋巴瘤病例的增加。此外,该研究估计,全球92%的儿童癌症新增病例来自低收入和中等收入国家,这一比例高于先前的估计。

 

图4  2015-2030年全球新发儿童癌症病例建模预测(图片来源:The Lancet Oncology)

 

考虑到人口增长,科学家们估计,2015-2030年,全球儿童癌症新增病例数将达670万。如果卫生系统得不到改善,其中将有290万(44%)病例被“遗漏”(图4)。

 

总结来说,该研究表明,目前,儿童癌症的诊断严重不足,尤其是在南亚和撒哈拉以南的非洲(包括西非、东非和南非);此外,将儿童癌症治疗集中在少数专业医院的医疗模式是不充分的。相关政府机构需要进一步强化卫生系统,在“准确诊断和有效护理患癌儿童”方面加强部署,减少未获确诊的癌症儿童的数量。

 

以上成果于2月27日发表在The Lancet Oncology杂志上。

 

领导该研究的Zachary Ward说:“我们的模型表明,近1/2的患癌儿童一直未被确诊,可能死于‘未经治疗’。对儿童癌症发病率的准确估计对于政策制定者至关重要,可帮助他们确定医疗保健优先事项,为实现所有癌症儿童的有效诊断和治疗制定计划。”

 

Ward还表示,随着儿童癌症的隐藏发病率开始凸显,需要更大的卫生系统来支持及时诊断、转诊和治疗。此外,扩大癌症登记也非常重要。

 

值得注意的是,除了儿童癌症发病率被“低估”,2月发表在The Lancet Public Health的一份报告还指出,美国20年的数据显示,在年轻成人中,癌症发病率正在增加。

 

该研究分析了美国30种常见癌症的年龄特异性当代发病率趋势,其中包括12种与肥胖相关的癌症。他们获得了美国25个州癌症登记处显示的1995-2014年25-84岁年龄段人群患侵袭性癌症的发病数据。

 

分析显示,20年间,被调查的30种癌症共出现了14672409例病例。

 

图5 1995-2014年12种肥胖相关癌症发病率的年龄特异性年变化百分比(图片来源:The Lancet Public Health)

 

12种与肥胖相关的癌症中,有6种(多发性骨髓瘤、结直肠癌、子宫癌、胆囊癌、肾癌和胰腺癌)发病率在年轻成人中(25–49岁)显著上升,而且在更年轻的一代中发病率上升幅度更大(图5)。举例来说,在45-49岁人群中,胰腺癌发病率平均年增长率为0.77%;在30-34岁人群中,这一比例为2.47%;在25-29岁人群中,这一比例高达4.34%。同样的,肾癌、胆囊癌、子宫癌、结直肠癌发病率的年增长率也在25–29岁这个年龄段最大,分别为6.23%、3.71%、3.34%和2.41%。

 

不过,其它18种癌症并没有显示出“年轻化”的趋势,只有两种癌症(胃非贲门癌和白血病)在年轻成人中的发病率随年纪减少而增大;此外,有8种癌症在年轻成人中的发病率下降了,包括与吸烟和HIV感染相关的癌症。

 

同期发表的一篇评论文章称,尽管从历史上看,癌症一直被认为是一种衰老疾病,但早前有报道显示,从上世纪80(70)年代中期开始,结(直)肠癌的发病率在≤54岁的成年人中急剧上升。这促使科学家们探索癌症年轻化的趋势及其背后的原因。

 

研究者们推测,美国肥胖的流行推动了部分癌症的“年轻化”。1980-2014年间,美国的肥胖患病率增加了一倍多。不过,他们并没有在论文中解释,为什么并不是所有12种与肥胖相关的癌症都呈现“年轻化”的趋势。显然,这背后的原因还需要进一步的研究,一些其它因素发挥着不可忽视的作用。

 

尽管如此,这依然是一份值得关注的报告。这些发现表明,有必要进一步密切监测年轻成人的癌症发病率趋势,并且对可能导致这一趋势的原因进行及时的研究。


相关论文:

[1]Zachary J Ward, MPH et al. Estimatingthe total incidence of global childhood cancer: a simulation-based analysis.The Lancet Oncology(2019).

[2] HyunaSung, PhD et al. Emerging cancer trends among young adults in the USA: analysisof a population-based cancer registry. The Lancet Public Health(2019).

 

参考资料:

1# How can global incidence estimatessupport childhood cancer control?

2# Worldwide estimates suggest that nearly 1in 2 children with cancer are left undiagnosed and untreated

3# Rising cancer incidence in youngeradults: is obesity to blame?

4# 年轻人得癌越来越多,这个因素不容忽视!柳叶刀子刊发表20年大数据


机器翻译

In the past, estimates of the overall incidence of childhood cancer worldwide were based primarily on data from the Cancer Registry. However, 60% of countries in the world do not have such registrations, and if they do, they cover only a small portion of the total population. In addition, many patients have not been “documented” because they have not been diagnosed.

The micro-simulation model estimates and reports on the annual number of confirmed cases of childhood cancer worldwide. The authoritative cancer agency IARC estimates are similar (Source: The Lancet Oncology)

To provide an accurate estimate of the global incidence of childhood cancer, from Harvard University Chen Zengxi Public Health Five scientists from institutions such as the College have developed a global microscopic simulation model of childhood cancer that simulates the incidence of cancer among children (0-14 years) in 200 countries and regions around the world.

Model estimates, 2015, global children The number of cancer cases (new cases) was 397,000, of which only 224,000 were diagnosed. This indicates that in 2015, 43% (172,000) of the world's childhood cancer cases were not diagnosed, and the differences between the regions were very different. Big (Figure 1).

Figure 1. Number of total cancer cases and confirmed cases in children worldwide by 2015 (Source: The Lancet Oncology)

< Among them, undiagnosed cases in Western Europe and North America accounted for only 3% of the total number of new cases, while the proportion of undiagnosed cases in West Africa was as high as 57% (43000 of 76000).

/p>

Figure 2. Total predicted incidence and regional distribution of TOP15 cancer species in 2015 (Source: The Lancet Oncology)

From segmentation of cancer In 2015, except for sub-Saharan Africa, the most common childhood cancer in most parts of the world is acute lymphoblastic leukemia (ALL), with approximately 75,000 new cases worldwide, including nearly 700 in Northern Europe. West Africa Nearly 1700 cases. More than 3,500 cases in East Africa. Nearly 30,000 cases in South Asia and South Asia (Figure 2). The second largest in the world. The third common childhood cancer is non-Hodgkin's lymphoma (estimated 22,000 cases). Renal blastoma (approximately 21,000 cases). Burkitt lymphoma is more common in East and West Africa, with more than 4,000 cases in East Africa and more than 10,000 cases in West Africa.

Figure 3. Modeling predictions for new childhood cancer cases on all continents in 2015-2030 (Source: The Lancet Oncology)

The analysis also shows that in most parts of the world, the number of new cases of childhood cancer is declining or stable each year (Figure 3), but Africa is a notable exception. The region is expected to be between 2015-2030 There will be a large population growth, and this growth will drive an increase in global lymphoma cases. In addition, the study estimates that 92% of new cases of childhood cancer worldwide come from low- and middle-income countries, which is higher than previous Estimate.

Figure 4. 2015-2030 Global New Childhood Cancer Case Modeling Forecast (Source: The Lancet Oncology)

Considering population growth, scientists estimate that the number of new cases of childhood cancer worldwide will reach 6.7 million in 2015-2030. If the health system is not improved, there will be 2.9 million (44%). Cases are "missing" (Figure 4).

In summary, the study shows that at present, the diagnosis of childhood cancer is serious. Foot, especially in South Asia and sub-Saharan Africa (including West Africa, East Africa and South Africa). In addition, the medical model that focuses on the treatment of childhood cancer in a few specialized hospitals is inadequate. Relevant government agencies need to further strengthen the health system, Increased deployment of “accurate diagnosis and effective care for children with cancer” to reduce the number of undiagnosed cancer children.

The above results were published on February 27th in The Lancet Oncology.

Zachary Ward, who led the study, said: "Our model shows that nearly one in two children with cancer have not been diagnosed and may die. 'Untreated'. Accurate estimates of childhood cancer incidence are critical for policy makers to help them identify health care priorities and plan for effective diagnosis and treatment of all cancer children."

Ward also said that as the hidden incidence of childhood cancer begins to emerge, a larger health system is needed to support timely diagnosis. Referral and treatment. In addition, expanding cancer registration is also very Important.

Worth note In addition to the “underestimation of childhood cancer incidence”, a report published in The Lancet Public Health in February also pointed out that 20 years of US data show that cancer incidence is increasing among young adults.

This study analyzed age-specific contemporary morbidity trends in 30 common cancers in the United States, including 12 obesity-related cancers. They obtained 25 state cancer registries in the United States. The data on the incidence of invasive cancer in the 25-84 age group from 1995 to 2014.

The analysis showed that 30 cancers were investigated in 20 years. There were 14672409 cases.

Figure 5 Age-specific annual change in the incidence of 12 obesity-related cancers from 1995 to 2014 (Source: The Lancet Public Health

6 of 12 kinds of obesity-related cancers (multiple myeloma. Colorectal cancer. Uterine cancer. Gallbladder cancer. Kidney cancer and pancreatic cancer) The incidence rate has increased significantly among young adults (25–49 years) and has increased more in the younger generation (Figure 5). For example, In the 45-49 year old population, the average annual growth rate of pancreatic cancer is 0.77%. Among the 30-34 year olds, this ratio is 2.47%. In the 25-29 age group, this proportion is as high as 4.34%. Similarly, kidney cancer. Gallbladder cancer. Uterine cancer. The annual growth rate of colorectal cancer is also the largest in the age group of 25–29 years old, respectively 6.23%.3. 71%.3. 34% and 2.41%.

However, the other 18 cancers did not show a trend of “aging”, only two types of cancer (stomach non-cardia cancer and leukemia) in young adults Incidence increases with age. In addition, the incidence of eight cancers in young adults has decreased, including cancers associated with smoking and HIV infection.

A review article published during the same period stated that although cancer has always been considered as an aging disease, it has been reported earlier that from the middle of the 80s (70s), the knot (straight) bowel cancer The incidence has risen sharply among adults ≤54 years old. This has prompted scientists to explore the trend of cancer rejuvenation and the reasons behind it.

The researchers pushed The prevalence of obesity in the United States has promoted the “youngerization” of some cancers. The prevalence of obesity in the United States more than doubled between 1980 and 2014. However, they did not explain in the paper why not all 12 Obesity-related cancers are showing a trend of “rejuvenation.” Obviously, the reasons behind this need further research, and some other factors play a non-negligible role.

Nevertheless, this is still a report worthy of attention. These findings indicate the need to further closely monitor trends in cancer incidence among young adults and to conduct timely research on the reasons that may lead to this trend.

< p>Related papers:

1]Zachary J Ward, MPH et al. Estimating the total incidence of global childhood cancer: a simulation-based analysis. The Lancet Oncology (2019).

2] .HyunaSung, PhD et al. Emerging cancer trends among young adults in the USA: analysisof a population-based cancer registry. The Lancet Public Health (2019).

References:

1# .How can global Incidence estimatessupport childhood cancer control?

2# .Worldwide recommendations suggest that nearly 1in 2 children with cancer are .left undiagnosed and untreated

3# .Rising cancer incidence in youngeradults: is obesity To blame?

4# . Young people get more and more cancer, this factor can not be ignored! The Lancet is published in 20 years of big data

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