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Article(id=1190310109172564358, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1190243275249390089, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2096.2025.0401, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1734451200000, receivedDateStr=2024-12-18, revisedDate=null, revisedDateStr=null, acceptedDate=1740067200000, acceptedDateStr=2025-02-21, onlineDate=1761721644918, onlineDateStr=2025-10-29, pubDate=1748361600000, pubDateStr=2025-05-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1761721644918, onlineIssueDateStr=2025-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1761721644918, creator=13701087609, updateTime=1761721644918, updator=13701087609, issue=Issue{id=1190243275249390089, tenantId=1146029695717560320, journalId=1189873630562394117, year='2025', volume='50', issue='5', pageStart='505', pageEnd='640', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1761705710470, creator=13701087609, updateTime=1765784077922, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1207349188233372409, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1190243275249390089, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1207349188233372410, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1190243275249390089, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=513, endPage=522, ext={EN=ArticleExt(id=1190310109457777034, articleId=1190310109172564358, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Trends and prediction analysis of the disease burden of malignant tumors in China and the world from 1990 to 2021, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To compare the disease burden and evolving trends of major malignant tumors in China and globally from 1990 to 2021, and conduct predictive analysis, so as to provide a reference for formulating prevention and treatment policies for malignant tumor in China. Methods Based on the Global Burden of Disease Database 2021 (GBD 2021), descriptive research methods were used to analyze the incidence and mortality of major malignant tumors in China and globally, as well as the changes in their rankings. The Joinpoint log-linear model was applied to analyze trends in age-standardized incidence rates (ASIR) and age-standardized mortality rates (ASMR) of malignant tumors in China and globally from 1990-2021. A Bayesian age-period-cohort (BAPC) model was constructed using R 4.4.0 to predict the incidence trends of malignant tumor in China and globally from 2022 to 2035. Results In 2021, there were 17.2294 million new cases of malignant tumors (excluding non-melanoma skin cancer) and 9.7763 million deaths globally, with an ASIR of 201.06/100,000 and ASMR of 115.11/100,000. In China, 4.5375 million new cases and 2.7964 million deaths were reported, with ASIR and ASMR of 221.30/100,000 and 136.36/100,000, respectively. Lung cancer ranked first in both incidence and mortality of malignant tumors in China and globally. Female breast cancer had the second-highest ASIR in China. The number of incident cases and deaths from digestive system malignancies included in this study accounted for 42.0% of the total incident cases and 46.8% of the total deaths from all cancers in China, respectively. From 1990 to 2021, the average annual percentage change (AAPC) for overall ASIR of malignant tumors in China was 0.30, while ASMR declined (AAPC: -0.97). Globally, ASIR decreased slightly (AAPC: -0.10), and ASMR declined (AAPC: -0.78). The BAPC model predicted that by 2035, China's ASIR of malignant tumors may rise to 252.44/100,000, whereas the global ASIR is expected to decrease to 183.05/100,000. Conclusions China has achieved some success in cancer prevention and treatment, but still faces a heavy disease burden, with ASIR and ASMR exceeding global averages and ASIR persistently increasing. Cancer prevention and control work such as health education should be strengthened. Precise prevention and control measures should be taken for key cancer types, and preventive interventions should be focused on the elderly population.

, correspAuthors=Shuang Ma, authorNote=null, correspAuthorsNote=
E-mail:
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目的 比较1990-2021年中国和全球主要恶性肿瘤疾病负担、变化趋势并进行预测分析，为制定我国恶性肿瘤防治政策提供参考依据。方法 基于2021年全球疾病负担数据库(GBD 2021)，采用描述性研究方法分析中国和全球主要恶性肿瘤发病和死亡情况及顺位变化，使用Joinpoint对数线性模型分析1990-2021年中国和全球恶性肿瘤标化发病率和标化死亡率的变化趋势，采用R 4.4.0构建贝叶斯年龄-周期-队列模型(BAPC)预测2022-2035年中国和全球恶性肿瘤的发病趋势。结果 2021年全球新发恶性肿瘤(不包括非黑色素瘤皮肤癌)1722.94万例，死亡977.63万例，标化发病率201.06/10万，标化死亡率115.11/10万；中国新发恶性肿瘤453.75万例，死亡279.64万例，标化发病率221.30/10万，标化死亡率136.36/10万。肺癌高居中国和全球恶性肿瘤发病、死亡之首，中国乳腺癌(女)标化发病率居第2位。纳入本研究的消化系统恶性肿瘤的发病数与死亡数分别占中国全部癌症总发病数的42.0%和总死亡数的46.8%。1990-2021年我国恶性肿瘤总体标化发病率平均年度变化百分比(AAPC)为0.30，标化死亡率AAPC为-0.97；而全球恶性肿瘤总体标化发病率AAPC为-0.10，标化死亡率AAPC为-0.78。基于BAPC模型预测，到2035年，中国恶性肿瘤总体标化发病率可能升至252.44/10万，全球总体标化发病率或将下降至183.05/10万。结论 中国在恶性肿瘤防治方面取得了一定成效，但仍然面临沉重的疾病负担。恶性肿瘤标化发病率和标化死亡率均高于全球平均水平，且标化发病率仍持续增长。应加强癌症健康教育等防治工作，针对重点癌种采取精准防控，重点关注老年人群的预防干预。

, correspAuthors=马爽, authorNote=null, correspAuthorsNote=
马爽，E-mail：
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金心怡，主要从事医疗卫生政策方面的研究

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金心怡，主要从事医疗卫生政策方面的研究

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金心怡，主要从事医疗卫生政策方面的研究

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A. 中国发病例数构成比(n=453.75万)；B. 全球发病例数构成比(n=1722.94万)

, figureFileSmall=pMb5rPlc3nINLvWwW8d47g==, figureFileBig=rfzp5oNTfE7svJMUhVo7cg==, tableContent=null), ArticleFig(id=1190330564222750976, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190310109172564358, language=EN, label=Fig.2, caption=Mortality of malignant tumors in China and the world in 2021, figureFileSmall=gKpcpdBzC04v28I1oLw8fw==, figureFileBig=RiNEDWjpla/YbnRYlYQgZw==, tableContent=null), ArticleFig(id=1190330564294054146, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190310109172564358, language=CN, label=图2, caption=2021年中国和全球恶性肿瘤死亡情况

A. 中国死亡例数构成比(n=279.64万)；B. 全球死亡例数构成比(n=977.63万)

, figureFileSmall=gKpcpdBzC04v28I1oLw8fw==, figureFileBig=RiNEDWjpla/YbnRYlYQgZw==, tableContent=null), ArticleFig(id=1190330564373745924, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190310109172564358, language=EN, label=Fig.3, caption=Changes in the incidence and mortality order of malignant tumors in China and the world in 1990 and 2021, figureFileSmall=4k3hYcqMlIIeq3ApRqVTmg==, figureFileBig=ZXuR4ZE391gGtTLqDmw8rQ==, tableContent=null), ArticleFig(id=1190330564436660486, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190310109172564358, language=CN, label=图3, caption=1990年和2021年中国和全球恶性肿瘤发病和死亡顺位变化

A. 中国恶性肿瘤发病顺位；B. 全球恶性肿瘤发病顺位；C. 中国恶性肿瘤死亡顺位；D. 全球恶性肿瘤死亡顺位

, figureFileSmall=4k3hYcqMlIIeq3ApRqVTmg==, figureFileBig=ZXuR4ZE391gGtTLqDmw8rQ==, tableContent=null), ArticleFig(id=1190330564507963656, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190310109172564358, language=EN, label=Fig.4, caption=Prediction of the number of cases and standardized incidence rate of all cancers in China and the world from 2022 to 2035, figureFileSmall=hg8wE5/iUSKVE/C1Oi8K6A==, figureFileBig=/wAiaM7rkjFSuD+Y2H9b/w==, tableContent=null), ArticleFig(id=1190330564625404170, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190310109172564358, language=CN, label=图4, caption=2022-2035年中国和全球全部癌症发病例数和标化发病率预测

深蓝色柱为中国全部癌症发病例数预测；浅蓝色柱为全球全部癌症发病例数预测；红色线条为中国全部癌症标化发病率预测；粉色线条为全球全部癌症标化发病率预测

, figureFileSmall=hg8wE5/iUSKVE/C1Oi8K6A==, figureFileBig=/wAiaM7rkjFSuD+Y2H9b/w==, tableContent=null), ArticleFig(id=1190330564700901644, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190310109172564358, language=EN, label=Fig.5, caption=Prediction of standardized incidence rate of major malignant tumors in China and the world from 2022 to 2035, figureFileSmall=I9c/fajChHQtb8ICS9Vbhw==, figureFileBig=xvncTWGdrDRhvgzeSvjPLg==, tableContent=null), ArticleFig(id=1190330564780593422, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190310109172564358, language=CN, label=图5, caption=2022-2035年中国和全球主要恶性肿瘤标化发病率预测

A. 中国发病数；B. 中国标化发病率；C. 全球发病数；D. 全球标化发病率

, figureFileSmall=I9c/fajChHQtb8ICS9Vbhw==, figureFileBig=xvncTWGdrDRhvgzeSvjPLg==, tableContent=null), ArticleFig(id=1190330564864479503, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190310109172564358, language=EN, label=Tab.1, caption=

Number of cases and standardized incidence rates of major malignant tumors in China and the world in 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
癌症种类中国全球
发病例数(万例, 95%UI)标化发病率(/10万, 95%CI)发病例数(万例, 95%UI)标化发病率(/10万, 95%CI)
全部癌症a453.75(381.42, 539.77)221.30(186.83, 262.29)1722.94(1608.15, 1833.33)201.06(187.38, 213.75)
肺癌93.47(75.00, 113.69)44.01(35.45, 53.35)228.07(206.33, 250.97)26.43(23.90, 29.07)
结直肠癌65.83(53.20, 79.81)31.44(25.53, 37.97)219.41(200.13, 235.94)25.61(23.32, 27.52)
胃癌61.18(47.20, 76.56)29.05(22.42, 36.20)123.02(105.24, 141.00)14.33(12.23, 16.41)
乳腺癌(女)38.58(29.41, 48.90)37.00(28.23, 46.95)208.27(194.04, 222.51)46.40(43.26, 49.56)
食管癌32.08(25.61, 39.48)15.04(12.04, 18.43)57.65(50.95, 64.56)6.65(5.88, 7.45)
肝癌19.66(15.83, 24.36)9.52(7.72, 11.78)52.92(48.03, 59.38)6.15(5.58, 6.90)
宫颈癌13.28(9.60, 17.26)6.67(4.80, 8.72)66.74(61.30, 72.64)7.79(7.16, 8.48)
胰腺癌11.87(9.46, 14.47)5.64(4.52, 6.84)50.85(46.21, 54.72)5.96(5.39, 6.42)
非霍奇金淋巴瘤11.09(8.69, 13.52)5.53(4.36, 6.68)60.46(55.82, 64.87)7.14(6.58, 7.66)
膀胱癌10.58(8.32, 13.67)5.14(4.08, 6.62)54.03(49.47, 58.26)6.35(5.80, 6.85)
白血病10.57(7.53, 13.22)7.21(4.93, 9.05)46.14(39.75, 50.44)5.63(4.83, 6.17)
脑癌10.55(8.14, 13.35)6.12(4.76, 7.67)35.75(31.05, 40.74)4.28(3.71, 4.88)
前列腺癌8.86(6.32, 12.10)4.22(3.01, 5.73)132.44(121.73, 140.02)15.37(14.13, 16.25)
子宫癌7.20(5.33, 10.00)3.35(2.48, 4.65)47.36(42.99, 51.37)5.41(4.90, 5.87)
鼻咽癌6.59(5.33, 8.14)3.42(2.77, 4.23)11.89(10.48, 13.59)1.38(1.22, 1.58)
肾癌6.58(5.37, 7.97)3.32(2.73, 3.98)38.78(36.54, 40.66)4.52(4.26, 4.75)
甲状腺癌4.81(3.87, 6.01)2.47(1.99, 3.09)24.95(22.33, 27.46)2.91(2.61, 3.21)
卵巢癌4.12(3.03, 5.45)2.03(1.49, 2.69)29.89(27.07, 32.45)3.48(3.15, 3.78)
), ArticleFig(id=1190330564944171281, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190310109172564358, language=CN, label=表1, caption=

2021年中国和全球主要恶性肿瘤的发病例数和标化发病率

, figureFileSmall=null, figureFileBig=null, tableContent=
癌症种类中国全球
发病例数(万例, 95%UI)标化发病率(/10万, 95%CI)发病例数(万例, 95%UI)标化发病率(/10万, 95%CI)
全部癌症a453.75(381.42, 539.77)221.30(186.83, 262.29)1722.94(1608.15, 1833.33)201.06(187.38, 213.75)
肺癌93.47(75.00, 113.69)44.01(35.45, 53.35)228.07(206.33, 250.97)26.43(23.90, 29.07)
结直肠癌65.83(53.20, 79.81)31.44(25.53, 37.97)219.41(200.13, 235.94)25.61(23.32, 27.52)
胃癌61.18(47.20, 76.56)29.05(22.42, 36.20)123.02(105.24, 141.00)14.33(12.23, 16.41)
乳腺癌(女)38.58(29.41, 48.90)37.00(28.23, 46.95)208.27(194.04, 222.51)46.40(43.26, 49.56)
食管癌32.08(25.61, 39.48)15.04(12.04, 18.43)57.65(50.95, 64.56)6.65(5.88, 7.45)
肝癌19.66(15.83, 24.36)9.52(7.72, 11.78)52.92(48.03, 59.38)6.15(5.58, 6.90)
宫颈癌13.28(9.60, 17.26)6.67(4.80, 8.72)66.74(61.30, 72.64)7.79(7.16, 8.48)
胰腺癌11.87(9.46, 14.47)5.64(4.52, 6.84)50.85(46.21, 54.72)5.96(5.39, 6.42)
非霍奇金淋巴瘤11.09(8.69, 13.52)5.53(4.36, 6.68)60.46(55.82, 64.87)7.14(6.58, 7.66)
膀胱癌10.58(8.32, 13.67)5.14(4.08, 6.62)54.03(49.47, 58.26)6.35(5.80, 6.85)
白血病10.57(7.53, 13.22)7.21(4.93, 9.05)46.14(39.75, 50.44)5.63(4.83, 6.17)
脑癌10.55(8.14, 13.35)6.12(4.76, 7.67)35.75(31.05, 40.74)4.28(3.71, 4.88)
前列腺癌8.86(6.32, 12.10)4.22(3.01, 5.73)132.44(121.73, 140.02)15.37(14.13, 16.25)
子宫癌7.20(5.33, 10.00)3.35(2.48, 4.65)47.36(42.99, 51.37)5.41(4.90, 5.87)
鼻咽癌6.59(5.33, 8.14)3.42(2.77, 4.23)11.89(10.48, 13.59)1.38(1.22, 1.58)
肾癌6.58(5.37, 7.97)3.32(2.73, 3.98)38.78(36.54, 40.66)4.52(4.26, 4.75)
甲状腺癌4.81(3.87, 6.01)2.47(1.99, 3.09)24.95(22.33, 27.46)2.91(2.61, 3.21)
卵巢癌4.12(3.03, 5.45)2.03(1.49, 2.69)29.89(27.07, 32.45)3.48(3.15, 3.78)
), ArticleFig(id=1190330565032251667, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190310109172564358, language=EN, label=Tab.2, caption=

Mortality and standardized mortality rates of major malignant tumors in China and the world in 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
癌症种类中国全球
死亡例数(万例, 95%UI)标化死亡率(/10万, 95%CI)死亡例数(万例, 95%UI)标化死亡率(/10万, 95%CI)
全部癌症a279.64(232.99, 333.67)136.36(114.15, 162.18)977.63(902.19, 1046.80)115.11(106.01, 123.23)
肺癌81.44(65.26, 98.78)38.98(31.40, 47.06)201.65(182.05, 221.84)23.50(21.22, 25.85)
胃癌44.50(34.47, 55.58)21.51(16.66, 26.61)95.44(82.18, 108.96)11.20(9.62, 12.73)
食管癌29.64(23.66, 36.28)14.13(11.36, 17.18)53.86(47.59, 60.34)6.25(5.53, 7.00)
结直肠癌27.51(22.34, 33.10)13.64(11.09, 16.31)104.41(95.02, 112.02)12.40(11.24, 13.31)
肝癌17.21(13.96, 21.25)8.35(6.80, 10.29)48.39(44.04, 54.02)5.65(5.13, 6.30)
胰腺癌11.96(9.57, 14.52)5.72(4.59, 6.91)50.58(46.12, 54.39)5.95(5.40, 6.41)
乳腺癌(女)8.81(6.82, 11.03)8.24(6.37, 10.33)66.10(60.92, 70.72)14.55(13.45, 15.56)
脑癌6.89(5.21, 8.83)3.63(2.74, 4.60)25.86(22.22, 29.61)3.06(2.62, 3.50)
白血病5.89(4.36, 7.40)3.42(2.51, 4.26)32.03(27.50, 34.90)3.89(3.34, 4.25)
宫颈癌4.98(3.69, 6.44)2.39(1.77, 3.08)29.67(27.21, 32.19)3.44(3.16, 3.73)
膀胱癌4.51(3.63, 5.73)2.34(1.89, 2.94)22.19(20.06, 24.23)2.68(2.42, 2.93)
非霍奇金淋巴瘤4.29(3.36, 5.17)2.13(1.68, 2.57)26.71(24.61, 28.87)3.19(2.93, 3.44)
前列腺癌3.74(2.79, 5.04)1.99(1.47, 2.68)43.25(38.19, 46.36)5.26(4.65, 5.64)
鼻咽癌3.13(2.55, 3.84)1.51(1.23, 1.84)7.54(6.75, 8.37)0.87(0.78, 0.97)
卵巢癌2.51(1.85, 3.29)1.18(0.87, 1.55)18.56(16.80, 20.10)2.16(1.95, 2.34)
肾癌2.49(2.04, 2.98)1.25(1.03, 1.48)16.12(15.03, 16.93)1.91(1.78, 2.01)
子宫癌1.36(0.99, 1.86)0.64(0.47, 0.88)9.77(8.65, 10.81)1.14(1.01, 1.26)
甲状腺癌0.77(0.61, 0.94)0.39(0.31, 0.47)4.48(3.99, 4.85)0.53(0.47, 0.57)
), ArticleFig(id=1190330565111943445, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190310109172564358, language=CN, label=表2, caption=

2021年中国和全球恶性肿瘤的死亡例数和标化死亡率

, figureFileSmall=null, figureFileBig=null, tableContent=
癌症种类中国全球
死亡例数(万例, 95%UI)标化死亡率(/10万, 95%CI)死亡例数(万例, 95%UI)标化死亡率(/10万, 95%CI)
全部癌症a279.64(232.99, 333.67)136.36(114.15, 162.18)977.63(902.19, 1046.80)115.11(106.01, 123.23)
肺癌81.44(65.26, 98.78)38.98(31.40, 47.06)201.65(182.05, 221.84)23.50(21.22, 25.85)
胃癌44.50(34.47, 55.58)21.51(16.66, 26.61)95.44(82.18, 108.96)11.20(9.62, 12.73)
食管癌29.64(23.66, 36.28)14.13(11.36, 17.18)53.86(47.59, 60.34)6.25(5.53, 7.00)
结直肠癌27.51(22.34, 33.10)13.64(11.09, 16.31)104.41(95.02, 112.02)12.40(11.24, 13.31)
肝癌17.21(13.96, 21.25)8.35(6.80, 10.29)48.39(44.04, 54.02)5.65(5.13, 6.30)
胰腺癌11.96(9.57, 14.52)5.72(4.59, 6.91)50.58(46.12, 54.39)5.95(5.40, 6.41)
乳腺癌(女)8.81(6.82, 11.03)8.24(6.37, 10.33)66.10(60.92, 70.72)14.55(13.45, 15.56)
脑癌6.89(5.21, 8.83)3.63(2.74, 4.60)25.86(22.22, 29.61)3.06(2.62, 3.50)
白血病5.89(4.36, 7.40)3.42(2.51, 4.26)32.03(27.50, 34.90)3.89(3.34, 4.25)
宫颈癌4.98(3.69, 6.44)2.39(1.77, 3.08)29.67(27.21, 32.19)3.44(3.16, 3.73)
膀胱癌4.51(3.63, 5.73)2.34(1.89, 2.94)22.19(20.06, 24.23)2.68(2.42, 2.93)
非霍奇金淋巴瘤4.29(3.36, 5.17)2.13(1.68, 2.57)26.71(24.61, 28.87)3.19(2.93, 3.44)
前列腺癌3.74(2.79, 5.04)1.99(1.47, 2.68)43.25(38.19, 46.36)5.26(4.65, 5.64)
鼻咽癌3.13(2.55, 3.84)1.51(1.23, 1.84)7.54(6.75, 8.37)0.87(0.78, 0.97)
卵巢癌2.51(1.85, 3.29)1.18(0.87, 1.55)18.56(16.80, 20.10)2.16(1.95, 2.34)
肾癌2.49(2.04, 2.98)1.25(1.03, 1.48)16.12(15.03, 16.93)1.91(1.78, 2.01)
子宫癌1.36(0.99, 1.86)0.64(0.47, 0.88)9.77(8.65, 10.81)1.14(1.01, 1.26)
甲状腺癌0.77(0.61, 0.94)0.39(0.31, 0.47)4.48(3.99, 4.85)0.53(0.47, 0.57)
), ArticleFig(id=1190330565208412439, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190310109172564358, language=EN, label=Tab.3, caption=

Trends in the burden of malignant tumors in China and the world from 1990 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
癌症种类标化发病率AAPC(95%CI)标化死亡率AAPC(95%CI)
中国全球中国全球
全部癌症a0.30(0.17~0.43)**-0.10(-0.15~-0.06)**-0.97(-1.16~-0.78)**-0.78(-0.88~-0.68)**
鼻咽癌-0.98(-1.17~-0.79)**-0.73(-0.82~-0.63)**-3.21(-3.36~-3.07)**-1.78(-1.86~-1.70)**
食管癌-1.60(-1.78~-1.42)**-0.94(-1.06~-0.82)**-1.98(-2.19~-1.77)**-1.19(-1.36~-1.01)**
胃癌-1.61(-1.73~-1.48)**-1.76(-1.89~-1.64)**-2.44(-2.62~-2.26)**-2.17(-2.28~-2.06)**
结直肠癌1.67(1.53~1.81)**0.20(0.16~0.25)**-0.42(-0.58~-0.25)**-0.72(-0.81~-0.63)**
肝癌-0.31(-0.39~-0.23)**0.11(0.07~0.16)**-0.79(-1.18~-0.41)**-0.11(-0.23~0.01)
胰腺癌0.72(0.5~0.94)**0.28(0.17~0.39)**0.56(0.44~0.68)**0.16(0.04~0.28)**
肺癌0.94(0.75~1.13)**-0.27(-0.36~-0.17)**0.38(0.15~0.61)**-0.54(-0.66~-0.42)**
乳腺癌(女)2.49(2.25~2.73)**0.46(0.37~0.55)**-0.19(-0.31~-0.08)**-0.48(-0.56~-0.39)**
宫颈癌0.46(0.17~0.75)**-0.56(-0.63~-0.49)**-1.27(-1.51~-1.02)**-1.24(-1.31~-1.18)**
子宫癌0.61(0.42~0.79)**0.44(0.22~0.67)**-2.14(-2.28~-1.99)**-0.77(-0.88~-0.65)**
卵巢癌0.01(-0.12~0.14)-0.28(-0.33~-0.23)**-0.39(-0.53~-0.26)**-0.56(-0.62~-0.51)**
前列腺癌2.37(2.07~2.66)**0.40(0.29~0.51)**0.26(<0.01~0.53)*-0.59(-0.65~-0.53)**
肾癌2.03(1.61~2.45)**0.49(0.42~0.56)**0.22(-0.11~0.55)-0.13(-0.22~-0.04)**
膀胱癌0.27(0.02~0.52)*-0.27(-0.32~-0.22)**-1.30(-1.63~-0.97)**-0.84(-0.91~-0.77)**
脑癌0.86(0.68~1.05)**0.42(0.33~0.50)**-0.34(-0.47~-0.21)**0.01(-0.04~0.06)
甲状腺癌2.24(2.11~2.37)**1.14(1.04~1.24)**-0.65(-0.82~-0.48)**-0.23(-0.29~-0.17)**
非霍奇金淋巴瘤1.69(1.35~2.02)**0.55(0.42~0.69)**-0.71(-0.81~-0.61)**-0.40(-0.48~-0.32)**
白血病-0.01(-0.23~0.21)-0.66(-0.75~-0.57)**-2.03(-2.17~-1.89)**-1.15(-1.24~-1.06)**
), ArticleFig(id=1190330565309075737, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1190310109172564358, language=CN, label=表3, caption=

1990-2021年中国和全球恶性肿瘤疾病负担变化趋势

, figureFileSmall=null, figureFileBig=null, tableContent=
癌症种类标化发病率AAPC(95%CI)标化死亡率AAPC(95%CI)
中国全球中国全球
全部癌症a0.30(0.17~0.43)**-0.10(-0.15~-0.06)**-0.97(-1.16~-0.78)**-0.78(-0.88~-0.68)**
鼻咽癌-0.98(-1.17~-0.79)**-0.73(-0.82~-0.63)**-3.21(-3.36~-3.07)**-1.78(-1.86~-1.70)**
食管癌-1.60(-1.78~-1.42)**-0.94(-1.06~-0.82)**-1.98(-2.19~-1.77)**-1.19(-1.36~-1.01)**
胃癌-1.61(-1.73~-1.48)**-1.76(-1.89~-1.64)**-2.44(-2.62~-2.26)**-2.17(-2.28~-2.06)**
结直肠癌1.67(1.53~1.81)**0.20(0.16~0.25)**-0.42(-0.58~-0.25)**-0.72(-0.81~-0.63)**
肝癌-0.31(-0.39~-0.23)**0.11(0.07~0.16)**-0.79(-1.18~-0.41)**-0.11(-0.23~0.01)
胰腺癌0.72(0.5~0.94)**0.28(0.17~0.39)**0.56(0.44~0.68)**0.16(0.04~0.28)**
肺癌0.94(0.75~1.13)**-0.27(-0.36~-0.17)**0.38(0.15~0.61)**-0.54(-0.66~-0.42)**
乳腺癌(女)2.49(2.25~2.73)**0.46(0.37~0.55)**-0.19(-0.31~-0.08)**-0.48(-0.56~-0.39)**
宫颈癌0.46(0.17~0.75)**-0.56(-0.63~-0.49)**-1.27(-1.51~-1.02)**-1.24(-1.31~-1.18)**
子宫癌0.61(0.42~0.79)**0.44(0.22~0.67)**-2.14(-2.28~-1.99)**-0.77(-0.88~-0.65)**
卵巢癌0.01(-0.12~0.14)-0.28(-0.33~-0.23)**-0.39(-0.53~-0.26)**-0.56(-0.62~-0.51)**
前列腺癌2.37(2.07~2.66)**0.40(0.29~0.51)**0.26(<0.01~0.53)*-0.59(-0.65~-0.53)**
肾癌2.03(1.61~2.45)**0.49(0.42~0.56)**0.22(-0.11~0.55)-0.13(-0.22~-0.04)**
膀胱癌0.27(0.02~0.52)*-0.27(-0.32~-0.22)**-1.30(-1.63~-0.97)**-0.84(-0.91~-0.77)**
脑癌0.86(0.68~1.05)**0.42(0.33~0.50)**-0.34(-0.47~-0.21)**0.01(-0.04~0.06)
甲状腺癌2.24(2.11~2.37)**1.14(1.04~1.24)**-0.65(-0.82~-0.48)**-0.23(-0.29~-0.17)**
非霍奇金淋巴瘤1.69(1.35~2.02)**0.55(0.42~0.69)**-0.71(-0.81~-0.61)**-0.40(-0.48~-0.32)**
白血病-0.01(-0.23~0.21)-0.66(-0.75~-0.57)**-2.03(-2.17~-1.89)**-1.15(-1.24~-1.06)**
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1990-2021年中国和全球恶性肿瘤疾病负担变化趋势和预测分析
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金心怡 1 , 张颖 2 , 钟悦欣 1 , 马爽 1, *
解放军医学杂志 | 临床研究 2025,50(5): 513-522
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解放军医学杂志 | 临床研究 2025, 50(5): 513-522
1990-2021年中国和全球恶性肿瘤疾病负担变化趋势和预测分析
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金心怡1, 张颖2, 钟悦欣1, 马爽1, *
作者信息
  • 1北京中医药大学管理学院，北京 100029
  • 2中国医学科学院/北京协和医学院医学信息研究所公共卫生战略与情报研究室，北京 100020

    • 金心怡，主要从事医疗卫生政策方面的研究

通讯作者:

马爽，E-mail：
Trends and prediction analysis of the disease burden of malignant tumors in China and the world from 1990 to 2021
Xin-Yi Jin1, Ying Zhang2, Yue-Xin Zhong1, Shuang Ma1, *
Affiliations
  • 1School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
  • 2Department of Public Health Strategy Research, Institute of Medical Information, Chinese Academy of Medical Science/Peking Union Medical College, Beijing 100020, China
出版时间: 2025-05-28 doi: 10.11855/j.issn.0577-7402.2096.2025.0401
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摘要
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目的 比较1990-2021年中国和全球主要恶性肿瘤疾病负担、变化趋势并进行预测分析，为制定我国恶性肿瘤防治政策提供参考依据。方法 基于2021年全球疾病负担数据库(GBD 2021)，采用描述性研究方法分析中国和全球主要恶性肿瘤发病和死亡情况及顺位变化，使用Joinpoint对数线性模型分析1990-2021年中国和全球恶性肿瘤标化发病率和标化死亡率的变化趋势，采用R 4.4.0构建贝叶斯年龄-周期-队列模型(BAPC)预测2022-2035年中国和全球恶性肿瘤的发病趋势。结果 2021年全球新发恶性肿瘤(不包括非黑色素瘤皮肤癌)1722.94万例，死亡977.63万例，标化发病率201.06/10万，标化死亡率115.11/10万；中国新发恶性肿瘤453.75万例，死亡279.64万例，标化发病率221.30/10万，标化死亡率136.36/10万。肺癌高居中国和全球恶性肿瘤发病、死亡之首，中国乳腺癌(女)标化发病率居第2位。纳入本研究的消化系统恶性肿瘤的发病数与死亡数分别占中国全部癌症总发病数的42.0%和总死亡数的46.8%。1990-2021年我国恶性肿瘤总体标化发病率平均年度变化百分比(AAPC)为0.30，标化死亡率AAPC为-0.97；而全球恶性肿瘤总体标化发病率AAPC为-0.10，标化死亡率AAPC为-0.78。基于BAPC模型预测，到2035年，中国恶性肿瘤总体标化发病率可能升至252.44/10万，全球总体标化发病率或将下降至183.05/10万。结论 中国在恶性肿瘤防治方面取得了一定成效，但仍然面临沉重的疾病负担。恶性肿瘤标化发病率和标化死亡率均高于全球平均水平，且标化发病率仍持续增长。应加强癌症健康教育等防治工作，针对重点癌种采取精准防控，重点关注老年人群的预防干预。

恶性肿瘤  /  发病  /  死亡  /  变化趋势  /  预测分析

Objective To compare the disease burden and evolving trends of major malignant tumors in China and globally from 1990 to 2021, and conduct predictive analysis, so as to provide a reference for formulating prevention and treatment policies for malignant tumor in China. Methods Based on the Global Burden of Disease Database 2021 (GBD 2021), descriptive research methods were used to analyze the incidence and mortality of major malignant tumors in China and globally, as well as the changes in their rankings. The Joinpoint log-linear model was applied to analyze trends in age-standardized incidence rates (ASIR) and age-standardized mortality rates (ASMR) of malignant tumors in China and globally from 1990-2021. A Bayesian age-period-cohort (BAPC) model was constructed using R 4.4.0 to predict the incidence trends of malignant tumor in China and globally from 2022 to 2035. Results In 2021, there were 17.2294 million new cases of malignant tumors (excluding non-melanoma skin cancer) and 9.7763 million deaths globally, with an ASIR of 201.06/100,000 and ASMR of 115.11/100,000. In China, 4.5375 million new cases and 2.7964 million deaths were reported, with ASIR and ASMR of 221.30/100,000 and 136.36/100,000, respectively. Lung cancer ranked first in both incidence and mortality of malignant tumors in China and globally. Female breast cancer had the second-highest ASIR in China. The number of incident cases and deaths from digestive system malignancies included in this study accounted for 42.0% of the total incident cases and 46.8% of the total deaths from all cancers in China, respectively. From 1990 to 2021, the average annual percentage change (AAPC) for overall ASIR of malignant tumors in China was 0.30, while ASMR declined (AAPC: -0.97). Globally, ASIR decreased slightly (AAPC: -0.10), and ASMR declined (AAPC: -0.78). The BAPC model predicted that by 2035, China's ASIR of malignant tumors may rise to 252.44/100,000, whereas the global ASIR is expected to decrease to 183.05/100,000. Conclusions China has achieved some success in cancer prevention and treatment, but still faces a heavy disease burden, with ASIR and ASMR exceeding global averages and ASIR persistently increasing. Cancer prevention and control work such as health education should be strengthened. Precise prevention and control measures should be taken for key cancer types, and preventive interventions should be focused on the elderly population.

malignant tumor  /  incidence  /  morality  /  change trend  /  predictive analysis
金心怡, 张颖, 钟悦欣, 马爽. 1990-2021年中国和全球恶性肿瘤疾病负担变化趋势和预测分析. 解放军医学杂志, 2025 , 50 (5) : 513 -522 . DOI: 10.11855/j.issn.0577-7402.2096.2025.0401
Xin-Yi Jin, Ying Zhang, Yue-Xin Zhong, Shuang Ma. Trends and prediction analysis of the disease burden of malignant tumors in China and the world from 1990 to 2021[J]. Medical Journal of Chinese People’s Liberation Army, 2025 , 50 (5) : 513 -522 . DOI: 10.11855/j.issn.0577-7402.2096.2025.0401
正文
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恶性肿瘤已经成为全球重大的公共卫生和经济问题，严重影响居民健康和社会发展。2019年世界卫生组织(World Health Organization，WHO)统计数据表明，恶性肿瘤是目前112个国家(或地区)的第一或第二大死因[1]，成为本世纪延长预期寿命的主要障碍。由于吸烟、饮酒、缺乏体力活动等不良生活方式广泛存在[2]，环境问题[3]、人口老龄化等多种因素的影响，使恶性肿瘤高居我国居民死因第２位[4]，防癌治癌亦成为我国公共卫生领域亟待解决的重大难题。目前有关恶性肿瘤疾病负担的研究多聚焦于某个单一种类、特定人群和局部地区，较少涉及对我国恶性肿瘤整体疾病负担特点和变化趋势的统计描述，以及未来发展动向的预测分析。同时将中国置于全球背景，对比分析二者恶性肿瘤疾病负担情况的研究更为缺乏。因此，本研究主要基于2021年全球疾病负担数据库(Global Burden of Disease，GBD 2021)对1990-2021年中国和全球的恶性肿瘤疾病负担情况和流行趋势进行描述与比较分析，并对2022-2035年中国和全球全部癌症(不包括非黑色素瘤皮肤癌)及主要恶性肿瘤发病趋势进行预测，进而深入探讨中国和全球重点恶性肿瘤的防治策略，为我国制定肿瘤综合防控措施提供参考。
1 资料与方法
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1.1 数据来源
本研究数据来源于GBD 2021数据库。GBD 2021囊括了1990-2021年全球204个国家(或地区)的371种疾病(或伤害)和88种风险因素的疾病负担评估结果，该公开数据统一、可比[5-6]。本研究从中选取1990-2021年中国和全球所有癌症(不包括非黑色素瘤皮肤癌)及各类恶性肿瘤的发病例数、标化发病率、死亡例数及标化死亡率等相关指标以评价疾病负担情况。
1.2 疾病分类与编码
根据《国际疾病分类》第10版(ICD-10)对疾病的归类和编码，纳入研究的主要恶性肿瘤包括18种，即鼻咽癌、食管癌、胃癌、结直肠癌、肝癌、胰腺癌、肺癌、乳腺癌(女)、宫颈癌、子宫癌、卵巢癌、前列腺癌、肾癌、膀胱癌、脑癌、甲状腺癌、非霍奇金淋巴瘤和白血病，其对应的ICD-10编码分别为C11、C15、C16、C18-21、C22、C25、C33-34、C50、C53、C54、C56、C61、C64、C67、C70-72、C73、C82-86、C91-95[7]。
1.3 统计学处理
使用Excel 2019软件对数据进行初步整理。通过发病例数、标化发病率、死亡例数和标化死亡率等指标的最终估计值及其95%不确定区间(95% uncertainty interval，95%UI)[4]，对中国和全球主要恶性肿瘤发病和死亡现况、顺位变化进行描述统计。采用Joinpoint Regression Program 5.2.0软件，选用对数线性模型对1990-2021年中国和全球主要恶性肿瘤标化发病率、标化死亡率的平均年度变化百分比(average annual percent change，AAPC)及其95%置信区间(95% confidence interval，95%CI)进行变化趋势分析[8]，双侧检验水准为α=0.05。当AAPC的值及其95%CI均>0时，表示上升趋势；AAPC的值及其95%CI均<0时，表示下降趋势[9]。采用R 4.4.0中的贝叶斯年龄-时期-队列分析(Bayesian age-period-cohort analysis，BAPC)包和集成嵌套拉普拉斯近似(integrated nested Laplace approximation，LNLA)包，基于1990-2021年中国和全球主要恶性肿瘤的标化发病率，对2022-2035年中国和全球主要恶性肿瘤的标化发病率进行预测。图形预测采用R的ggplot2包完成。
2 结果
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2.1 中国和全球恶性肿瘤发病和死亡现状
2021年，全球204个国家(或地区)总体恶性肿瘤发病例数为1722.94万例，标化发病率201.06/10万；中国居民总体恶性肿瘤发病例数为453.75万例，占全球总发病例数的26.3%，标化发病率221.30/10万，明显高于全球平均水平。
2021年中国发病例数居于首位的恶性肿瘤为肺癌(n=93.47万)，占全癌种发病例数的20.6%；其次为结直肠癌(n=65.83万)，占全癌种发病例数的14.5%；胃癌(n=61.18万)新发病数居第3位，发病占比为13.5%；随后是乳腺癌(女)(n=38.58万)和食管癌(n=32.08万)，发病占比分别为8.5%和7.1%。发病例数前5位的恶性肿瘤已占中国全癌种发病例数的64.2%。2021年全球新发病例前2位与中国相同，均为肺癌(n=228.07万)、结直肠癌(n=219.41万)，但两类癌种(尤其是肺癌)在中国的发病占比更高；随后是乳腺癌(女)(n=208.27万)和前列腺癌(n=132.44万)；胃癌(n=123.02万)新发病数在全球居第5位。值得注意的是，纳入研究的消化系统恶性肿瘤占中国全部癌症的42.0%，而全球占比为29.2%；中国乳腺癌(女)发病例数占全球总数的18.5%；胰腺癌发病例数在中国居第8位，发病占比为2.6%，而全球恶性肿瘤发病例数前10位无该癌种(表1，图1)。
2021年中国标化发病率最高的恶性肿瘤仍为肺癌(标化发病率=44.01/10万)，其次是乳腺癌(女)(标化发病率=37.00/10万)，随后依次为结直肠癌(标化发病率=31.44/10万)、胃癌(标化发病率=29.05/10万)、食管癌(标化发病率=15.04/10万)。而2021年全球标化发病率最高的恶性肿瘤是乳腺癌(女)(标化发病率=46.40/10万)，肺癌(标化发病率=26.43/10万)则居第2位，随后依次为结直肠癌(标化发病率=25.61/10万)、前列腺癌(标化发病率=15.37/10万)和胃癌(标化发病率=14.33/10万)。同时，纳入的18种恶性肿瘤中，中国标化发病率高于全球的恶性肿瘤包括鼻咽癌、食管癌、胃癌、结直肠癌、肝癌、肺癌、脑癌和白血病(表1)。
2021年全球204个国家(或地区)总体恶性肿瘤死亡977.63万例，标化死亡率115.11/10万；中国居民总体恶性肿瘤死亡279.64万例，占全球总死亡例数的28.6%，标化死亡率136.36/10万，明显高于全球平均水平。
2021年中国死亡例数和标化死亡率前5位的恶性肿瘤位序一致，肺癌(n=81.44万，标化死亡率=38.98/10万)位居第一，死亡占比高达29.1%；随后依次为胃癌(n=44.50万，标化死亡率=21.51/10万)、食管癌(n=29.64万，标化死亡率=14.13/10万)、结直肠癌(n=27.51万，标化死亡率=13.64/10万)和肝癌(n=17.21万，标化死亡率=8.35/10万)(表2)。需要指出的是，第2~5位均为消化系统恶性肿瘤，死亡占比共计42.5%，而纳入的所有消化系统恶性肿瘤占比更是高达46.8%；中国乳腺癌(女)死亡例数占全球总数的13.3%；同时脑癌在中国死亡数中居于第8位，死亡占比2.5%，而全球恶性肿瘤死亡例数前10位无该癌种(图2)。
肺癌(n=201.65万，标化死亡率=23.50/10万)也是2021年全球癌症的首要死因。从死亡数来看，全球第2~5位依次为结直肠癌(n=104.41万)、胃癌(n=95.44万)、乳腺癌(女)(n=66.10万)和食管癌(n=53.86万)(图2)。全球第2~5位标化死亡率依次为乳腺癌(女)(标化死亡率=14.55/10万)、结直肠癌(标化死亡率=12.40/10万)、胃癌(标化死亡率=11.20/10万)和食管癌(标化死亡率=6.25/10万)。纳入的18种恶性肿瘤中，中国标化死亡率高于全球的癌种包括鼻咽癌、食管癌、胃癌、结直肠癌、肝癌、肺癌和脑癌(表2)。
2.2 1990-2021年中国和全球恶性肿瘤发病率和死亡率变化趋势
1990-2021年，中国与全球的恶性肿瘤标化发病率变化趋势呈现明显差异。根据表3，中国的恶性肿瘤总体发病率稳步上升，标化发病率AAPC为0.30，而全球呈下降趋势(AAPC=-0.10)，中国恶性肿瘤发病负担更为明显。纳入的18种恶性肿瘤中，除卵巢癌、白血病的变化趋势无统计学差异外，中国对鼻咽癌、食管癌、肝癌的预防工作取得较大成效，标化发病率AAPC低于全球平均水平；而胃癌、结直肠癌、胰腺癌、肺癌、乳腺癌(女)、宫颈癌、子宫癌、前列腺癌、肾癌、膀胱癌、脑癌、甲状腺癌、非霍奇金淋巴瘤共计13种恶性肿瘤的标化发病率AAPC均高于全球平均水平。其中结直肠癌、乳腺癌(女)、前列腺癌、肾癌、甲状腺癌和非霍奇金淋巴瘤的发病率增幅明显。
1990-2021年，中国和全球恶性肿瘤的标化死亡率普遍呈现下降趋势，反映出全球范围内癌症控制和治疗方面的进步。具体来看，中国恶性肿瘤总体标化死亡率AAPC为-0.97，降幅略高于全球平均水平(AAPC=-0.78)，表明中国在降低恶性肿瘤死亡率方面取得了较大成效。纳入的18种恶性肿瘤中，除肾癌的变化趋势在统计学上差异不明显外，中国的结直肠癌、胰腺癌、肺癌、乳腺癌(女)、卵巢癌、前列腺癌共计6种恶性肿瘤的标化死亡率AAPC高于全球平均水平。其中，胰腺癌、肺癌、前列腺癌、肾癌的标化死亡率在中国呈现出上升趋势。中国胰腺癌的标化死亡率AAPC为0.56，高于全球的0.16；肺癌的标化死亡率AAPC为0.38，而全球则呈下降趋势(AAPC=-0.54)。
2.3 1990年和2021年中国和全球恶性肿瘤发病与死亡顺位变化
本研究以发病例数或死亡例数确定中国和全球主要恶性肿瘤的发病或死亡顺位。与1990年相比，2021年中国居民主要恶性肿瘤发病顺位变化较大，肺癌、结直肠癌、乳腺癌(女)、宫颈癌、胰腺癌、膀胱癌、非霍奇金淋巴瘤、前列腺癌和甲状腺癌的发病顺位上升，肺癌成为发病首位，除宫颈癌、肾癌保持不变外，其余恶性肿瘤发病顺位均下降(图3A)。与中国相比，1990年和2021年全球主要恶性肿瘤发病顺位变化幅度相对较小，结直肠癌、乳腺癌(女)、前列腺癌、非霍奇金淋巴瘤、肝癌、胰腺癌、子宫癌和肾癌发病顺位上升，其他主要恶性肿瘤发病顺位保持平稳或下降(图3B)。
相较于1990年，2021年中国居民主要恶性肿瘤死亡顺位总体变化较小，肺癌超过胃癌成为死因首位，胰腺癌、宫颈癌、膀胱癌、前列腺癌和肾癌死亡顺位上升，胃癌、白血病、鼻咽癌、卵巢癌和子宫癌死亡顺位下降(图3C)。与1990年相比，2021年全球主要恶性肿瘤死亡顺位变化主要集中在前9位，结直肠癌、乳腺癌(女)和胰腺癌死亡顺位上升，其余主要恶性肿瘤死亡顺位均保持不变或下降(图3D)。
2.4 2022-2035年中国和全球恶性肿瘤发病预测
2.4.1 中国和全球全部恶性肿瘤发病预测
BAPC模型预测结果显示，2022-2035年中国全部恶性肿瘤新发病例数预计从479.31万例上升至704.45万例，标化发病率可能呈持续上升态势，预计从2022年的226.67/10万波动增高到2035年的252.44/10万；全球恶性肿瘤新发病例数可能由1778.76万例增长至2214.54万例，标化发病率总体可能呈下降趋势，模型预测值或将从2022年的200.49/10万逐步下降到2035年的183.05/10万(图4)。
2.4.2 中国和全球主要恶性肿瘤发病预测
本研究分别选取2021年中国和全球标化发病率前5位的恶性肿瘤数据进行发病预测。BAPC模型预测结果显示，2022-2035年，中国主要恶性肿瘤标化发病率可能呈现差异化发展趋势。其中胃癌标化发病率或呈现先降后升的波动模式，预计在2033年降至谷底(标化发病率=26.97/10万)后有所回升，其余恶性肿瘤标化发病率整体呈上升趋势。具体而言，乳腺癌(女)标化发病率增幅最大，可能从2022年的37.81/10万增高到2035年的57.51/10万，增幅约为52.1%；结直肠癌标化发病率可能升至47.61/10万，较2022年增高约42.2%；肺癌标化发病率预计增高至51.02/10万，增幅约12.1%；食管癌标化发病率可能从15.32/10万平缓上升到17.13/10万，增幅约11.9%。在全球范围内，肺癌、前列腺癌和胃癌标化发病率在未来可能趋于下降，其中胃癌预计到2035年降至11.98/10万，降幅约15.1%；其他主要恶性肿瘤标化发病率变化趋势相对平缓，其增长幅度可能低于中国同期水平(图5)。
3 讨论
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3.1 中国恶性肿瘤疾病负担增长更为显著，但死亡率有所降低
本研究基于GBD 2021数据分析了1990-2021年中国和全球恶性肿瘤疾病负担的变化趋势。结果显示，2021年，全球全部癌症的发病例数为1722.94万例，标化发病率为201.06/10万；中国全部癌症的发病例数为453.75万例，占全球总发病例数的26.3%，标化发病率为221.30/10万，明显高于全球标化发病率。在死亡情况方面，2021年，全球全部癌症的死亡例数为977.63万例，标化死亡率为115.11/10万；中国全部癌症的死亡例数为279.64万例，占全球总死亡例数的28.6%，标化死亡率为136.36/10万，明显高于全球标化死亡率。GLOBOCAN 2022和GBD 2021数据库是目前两个主要的全球在线癌症数据库，对资源分配与政策制定具有重要影响[10]。经查阅，GLOBOCAN 2022[11]数据显示，2022年全球全部癌症新发病例1874.20万例，死亡967.44万例，标化发病率186.5/10万，标化死亡率91.1/10万；中国全部癌症新发病例477.54万例，死亡256.06万例，标化发病率199.7/10万，标化死亡率137.48/10万。本研究结果与之基本一致，当前中国恶性肿瘤总体疾病负担高于全球平均水平。
1990-2021年中国恶性肿瘤标化发病率持续上升(AAPC=0.30)，远高于全球水平(AAPC=-0.10)，中国恶性肿瘤负担增长更为明显；但标化死亡率普遍呈现下降趋势，且中国降幅(AAPC=-0.97)略高于全球平均水平(AAPC=-0.78)，表明中国在降低恶性肿瘤死亡方面取得了较大成效，与范文凭等[12]和高蓓等[13]对1990-2019年中国恶性肿瘤疾病负担的研究结论一致。基于上述结果，本研究提出以下政策建议：首先，加强癌症预防与筛查，通过健康教育提高公众认知，扩大早期筛查项目覆盖范围，特别是针对高风险人群；建议政府增加资金投入，确保筛查服务的可及性和公平性。其次，完善癌症诊疗体系，提升基层医疗机构诊疗能力，建立质量控制体系，鼓励新技术研发与应用。同时，加强癌症患者的康复与长期照护，建立康复体系，提供心理支持、物理治疗等，推动长期照护保险制度。第三，推动跨学科合作与科研创新，鼓励多学科交叉合作，加大对癌症研究的资金投入，建立数据共享平台。最后，制定针对性癌症防控策略，根据肿瘤类型差异制定防控措施，加强对高危地区和高危人群的监测与干预，定期评估防控效果，确保科学性和有效性。
3.2 我国部分恶性肿瘤形势严峻，应加强重点监测
第一，肺癌是呼吸系统最常见的恶性肿瘤，预后差，生存率低，严重影响患者劳动力及生活质量[14]，一直是中国恶性肿瘤发病和死亡的主要类型，同时也是全球恶性肿瘤死亡的主要原因[15]。本研究发现，肺癌是2021年中国居民恶性肿瘤发病例数和标化发病率(93.47万例，44.01/10万)、死亡例数和标化死亡率(81.44万例，38.98/10万)均排名第一的恶性肿瘤，且1990-2021年中国肺癌标化发病率和标化死亡率依然均呈增高趋势，全球死因首位也是肺癌。GLOBOCAN 2022数据库也显示，2022年中国肺癌发病例数和标化发病率(106.06万例，40.8/10万)、死亡例数和标化死亡率(73.33万例，26.7/10万)均高居首位[11]，表明中国肺癌的防治形势依然非常严峻。预计到2035年，肺癌标化发病率将达到51.02/10万，较2022年增高12.1%。既往研究表明，80.3%的肺癌死亡可归因于危险因素暴露，其中，吸烟、环境颗粒物污染和职业石棉暴露是肺癌的前三大危险因素[16]。肺癌标化发病率和标化死亡率的增高可能与肺癌危险因素增加有关[12]。例如，中国仍是全球吸烟人数最多的国家，尽管近年来吸烟率有所下降，但吸烟的累积效应可能对肺癌的发病和死亡起到延迟作用，且中国公共场所和家庭内的二手烟暴露问题依然严重，尤其对女性和儿童构成潜在危害。此外，长期暴露于大气污染(尤其是PM2.5和PM10)也与肺癌的发病密切相关。
第二，2021年全球乳腺癌(女)新发病例208.27万例，标化发病率为46.40/10万，居于标化发病率首位，死亡负担亦较高；我国乳腺癌(女)新发病例38.58万例，死亡约8.81万例，分别占全球的18.5%和13.3%。与1990年相比，2021年中国居民乳腺癌(女)发病顺位上升至第4位，标化发病率更是仅次于肺癌居第2位；全球主要恶性肿瘤发病顺位变化幅度相对较小，但乳腺癌(女)发病仍顺位上升。在GLOBOCAN 2022中乳腺癌(女)标化发病率同样位于全球第一(46.8/10万)、中国第二(标化发病率=33/10万)。我国于2009年开展了全国农村妇女“两癌筛查”项目和2012年开展了城市癌症早诊早治项目，明显提高了乳腺癌的早期检出率，取得了一定的社会效益[17]，1990-2021年中国乳腺癌标化死亡率有所下降。但本研究结果显示，1990-2021年中国乳腺癌(女)标化发病率增幅仍旧较大，且高于全球平均水平。既往研究表明，乳腺癌发病率增高可能与高内源性雌激素、肥胖和不良生活方式(如饮酒、吸烟)等多种危险因素有关[18]。此外，乳腺癌的发病率随年龄增长而增高，尤其在绝经后的女性中更为明显[19]，可能是随着中国人口老龄化加速，中老年女性群体的扩大直接推动了乳腺癌发病人数的增加。
第三，中国消化系统恶性肿瘤疾病负担严重。2021年，食管癌、胃癌、结直肠癌、肝癌和胰腺癌约占中国全部恶性肿瘤发病的42.0%，死亡的46.8%，接近半数。在GLOBOCAN 2022中，除肺癌外，中国恶性肿瘤死亡数和标化死亡率第2~5位均为肝癌、胃癌、结直肠癌和食管癌。尽管随着居民经济水平的提高和生活条件的改善，营养缺乏和亚硝酸盐污染[20]等致病因素得到有效解决，同时我国持续推进幽门螺杆菌的预防与根除、乙肝疫苗接种等措施，使得食管癌、胃癌、肝癌标化发病率和死亡率均呈下降趋势，但其绝对数值依旧较高，处于疾病负担前列。而1990-2021年中国结直肠癌标化发病率呈现增高趋势，并明显高于全球。研究表明，我国居民肥胖、低体力活动、吸烟、高脂肪和高红肉摄入、低蔬菜摄入[2,21]等饮食和行为方式成为导致结直肠癌发病率增高的重要原因；值得关注的是，中国胰腺癌标化发病率和标化死亡率均呈增高趋势，且AAPC高于全球平均水平；而且胰腺癌起病隐匿，目前仍未找到早期筛查和治疗的有效手段[22]，需要进一步重视和加强预防工作。
3.3 预测2022-2035年我国恶性肿瘤发病数和标化发病率可能维持增高态势
本研究基于BAPC模型对2022-2035年中国和全球恶性肿瘤发病趋势进行预测分析。结果显示，中国全部癌症标化发病率可能呈现增高趋势，2035年预计达到252.44/10万，而全球标化发病率或呈现下降趋势，2035年预测值为183.05/10万。发病数方面，预测数据显示中国恶性肿瘤新发病例数可能从2022年的479.31万例增加至2035年的704.45万例，同期全球发病数或由1778.76万例增加至2214.54万例。同时GLOBOCAN 2022预测2022-2035年中国全部癌症发病数为(477.54~621.90)万例，全球全部癌症发病数为(1874.20~2518.95)万例，我国恶性肿瘤未来发病数增加较明显[10]。在2021年标化发病率前5位的恶性肿瘤中，模型预测提示中国乳腺癌(女)、肺癌、结直肠癌的标化发病率可能呈现增高态势，胃癌的标化发病率或出现下降趋势；全球范围内则显示肺癌、前列腺癌和胃癌的标化发病率可能下降。这可能与我国人口老龄化加剧导致老年肿瘤问题突出，医疗技术提升、就医人数增多促使癌症检出率增高[23]，以及吸烟、不合理饮食等不良行为习惯和生活方式诱导致病因素增加等原因有关。
综上所述，2021年中国恶性肿瘤总体标化发病率和标化死亡率均高于全球平均水平，纳入的18种癌中接近半数的恶性肿瘤标化发病率或死亡率较全球平均水平高。1990-2021年我国恶性肿瘤总体标化发病率呈增高趋势，标化死亡率呈下降趋势，而全球恶性肿瘤总体标化发病率和标化死亡率均呈下降趋势；中国癌谱正在经历转变，肺癌、乳腺癌(女)、消化系统癌症的疾病负担日益沉重。人口统计学预测结果显示，中国恶性肿瘤总体标化发病率或将于2035年达到252.44/10万，而同期全球总体标化发病率可能下降至183.05/10万。因而，需根据中国癌症模式，做好健康教育、计划免疫、肿瘤筛查等基础而关键性的防治工作；针对部分形势严峻的恶性肿瘤实施精准防控策略；建立完善老年群体恶性肿瘤防治体系，以积极应对人口老龄化问题。然而，本研究也存在一定的局限性：GBD 2021数据多为模型估计结果，并非实际观测值，与现实情况存在一定偏差[24]，如预测的恶性肿瘤发病数与GLOBOCAN数据库的预测值存在一定差异。同时由于受到数据可获得性限制，本研究尚未对中国各省市恶性肿瘤疾病负担进行细化分析，未来将结合区域癌症登记数据开展更精细化的流行病学研究。
基金
收起
  • 北京市社会科学基金青年项目(24GLC055)
  • 中央高校基本科研业务费专项资金资助(2024-JYB-PY-004)
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2025年第50卷第5期
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doi: 10.11855/j.issn.0577-7402.2096.2025.0401
  • 接收时间：2024-12-18
  • 首发时间：2025-10-29
  • 出版时间：2025-05-28
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  • 收稿日期：2024-12-18
  • 录用日期：2025-02-21
基金
Beijing Municipal Social Science Foundation(24GLC055)
北京市社会科学基金青年项目(24GLC055)
Fundamental Research Funds for Central Universities(2024-JYB-PY-004)
中央高校基本科研业务费专项资金资助(2024-JYB-PY-004)
作者信息
    1北京中医药大学管理学院，北京 100029
    2中国医学科学院/北京协和医学院医学信息研究所公共卫生战略与情报研究室，北京 100020

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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