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Article(id=1240651447449219306, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240651438955754377, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202402032, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1706803200000, receivedDateStr=2024-02-02, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773723955261, onlineDateStr=2026-03-17, pubDate=1719244800000, pubDateStr=2024-06-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773723955261, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773723955261, creator=13701087609, updateTime=1773723955261, updator=13701087609, issue=Issue{id=1240651438955754377, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='12', pageStart='2113', pageEnd='2912', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773723953236, creator=13701087609, updateTime=1773723953236, updator=13701087609, preIssue=null, nextIssue=null, ext=null, issueFiles=null}, startPage=2300, endPage=2304, ext={EN=ArticleExt(id=1240651448451658025, articleId=1240651447449219306, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analyses of changes in the incidence and mortality of malignant tumors attributed to HPV infection, Sichuan, 2018-2022, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the incidence and mortality of malignant tumors attributed to HPV infection in Sichuan region from 2018 to 2022.

Methods

From January 2018 to December 2022, the population, tumor incidence rate and mortality in Sichuan were collected, and the population attributable fraction (PAF) attributable to HPV infection was calculated by age and sex.

Results

The population attributable proportions of HPV infection among residents in Sichuan region from 2018 to 2022 for the incidence and mortality of common malignant tumors were 65.0% and 59.2% respectively. The attribution of HPV (PAF) to the incidence of malignant tumors in the oropharynx, oral cavity, and throat of males was higher than that of females (χ2=78.904, P<0.001).The attributable HPV (PAF) of cervical, vulva, oral, and laryngeal malignant tumors in urban populations was higher than that in rural populations(χ2=119.03, P<0.001).In addition, there was a gender difference (P<0.05) in the relationship between the incidence of tumors attributed to HPV infection and age, indicating that males had earlier onset ages for various tumors. The attribution of HPV (PAF) to death in male oropharyngeal, oral, and laryngeal malignant tumors was higher than that in females(χ2=110.578, P<0.001).The mortality attributable HPV (PAF) of cervical, anal, oropharyngeal, oral, and laryngeal malignant tumors in urban populations was higher than that in rural populations(χ2=66.285, P<0.001).In addition, there was a gender difference (P<0.05) in the relationship between tumor mortality attributed to HPV infection and age, with males dying earlier for oral and oropharyngeal malignancies, and females dying earlier for anal malignancies.

Conclusion

From 2018 to 2022, the incidence and death of tumors attributed to HPV infection in Sichuan region are more, and the incidence and death show an increasing trend, among which timely screening of cervical cancer is the key to reduce the incidence and death of HPV tumors.

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目的

分析2018—2022年四川地区归因于人乳头瘤病毒（human papillomavirus, HPV）感染的恶性肿瘤发病及死亡情况。

方法

收集2018年1月—2022年12月四川地区人口数、肿瘤发病率、死亡率，分年龄、性别计算各恶性肿瘤发病、死亡归因于HPV感染的人群归因分值（Population Attributable Fraction, PAF）。

结果

2018—2022年四川地区居民HPV感染对常见恶性肿瘤发病和死亡的人口归因比例分别为65.0%和59.2%。男性口咽、口腔及喉恶性肿瘤发病归因HPV(PAF)均高于女性（χ2值=78.904，P<0.001）；城市人群宫颈、外阴、口腔及喉恶性肿瘤发病归因HPV(PAF)均高于农村人群（χ2值=119.03，P<0.001）；此外，归因于HPV感染的肿瘤发病与年龄的关系存在性别差异（P<0.05），即男性各个肿瘤发病年龄更为提前。男性口咽、口腔及喉恶性肿瘤死亡归因HPV(PAF)均高于女性（χ2值=110.578，P<0.001）；城市人群宫颈、肛门、口咽、口腔及喉恶性肿瘤死亡归因HPV(PAF)均高于农村人群（χ2值=66.285，P<0.001）；此外，归因于HPV感染的肿瘤死亡与年龄的关系存在性别差异（P<0.05），即男性口腔、口咽恶性肿瘤死亡年龄更为提前，而女性肛门恶性肿瘤死亡年龄更为提前。

结论

2018—2022年四川地区归因于HPV感染的肿瘤发病、死亡人数较多，且发病、死亡呈现增高趋势，及时筛查宫颈癌是降低归因于HPV肿瘤发病、死亡率的关键。

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叶斌，E-mail:
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叶波（1979—），男，本科，主管技师，研究方向：临床化学及肿瘤分子诊断

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叶波（1979—），男，本科，主管技师，研究方向：临床化学及肿瘤分子诊断

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叶波（1979—），男，本科，主管技师，研究方向：临床化学及肿瘤分子诊断

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Study on the attributable burden of HPV-related tumors and appropriate techniques for Cervical cancer screening in HIV-infected women in China[D]. Beijing: Peking Union Medical College, 2021., articleTitle=Study on the attributable burden of HPV-related tumors and appropriate techniques for Cervical cancer screening in HIV-infected women in China, refAbstract=null), Reference(id=1240651461227508513, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, doi=null, pmid=null, pmcid=null, year=2023, volume=62, issue=8, pageStart=840, pageEnd=848, url=null, language=null, rfNumber=[15], rfOrder=19, authorNames=Kopp SA, Turk DE, journalName=Clinical Pediatrics, refType=null, unstructuredReference=Kopp SA, Turk DE. Humanpapillomavirus vaccinations: provider education to enhance vaccine uptake[J]. 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Zhonghua liu xing bing xue za zhi, 2022, 43(5): 702-708., articleTitle=[Analysis on cancer incidence and mortality attributed to human papillomavirus infection in China, 2016], refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1240651450200682932, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, xref=1., ext=[AuthorCompanyExt(id=1240651450204877237, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, companyId=1240651450200682932, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Laboratory Department, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1240651450209071543, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, companyId=1240651450200682932, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川省肿瘤医院检验科，四川 成都 610041)]), AuthorCompany(id=1240651450305540541, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, xref=2., ext=[AuthorCompanyExt(id=1240651450318123456, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, companyId=1240651450305540541, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.成都市第一人民医院呼吸科)])], figs=[ArticleFig(id=1240651454801834648, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, language=EN, label=Fig.1, caption=The incidence rate of women in different age groups, figureFileSmall=/Tc8kkF2bql+CPlYrUfykA==, figureFileBig=s/OyCtjvjVxaFfLsuGnB1A==, tableContent=null), ArticleFig(id=1240651454910886560, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, language=CN, label=图1, caption=不同年龄段女性人群的发病率, figureFileSmall=/Tc8kkF2bql+CPlYrUfykA==, figureFileBig=s/OyCtjvjVxaFfLsuGnB1A==, tableContent=null), ArticleFig(id=1240651455179322028, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, language=EN, label=Fig.2, caption=The incidence rate of men in different age groups, figureFileSmall=1ILbRmR7esdhpQqxlPix2g==, figureFileBig=0HHFybnWbx1ojhTmDBh0lQ==, tableContent=null), ArticleFig(id=1240651456710242993, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, language=CN, label=图2, caption=不同年龄段男性人群的发病率, figureFileSmall=1ILbRmR7esdhpQqxlPix2g==, figureFileBig=0HHFybnWbx1ojhTmDBh0lQ==, tableContent=null), ArticleFig(id=1240651456831877815, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, language=EN, label=Fig.3, caption=Mortality rate of female population in different age groups, figureFileSmall=uv2GXtiemWgWEwecEyyBkQ==, figureFileBig=OV4E+KKHr9t42lsvoY2Wug==, tableContent=null), ArticleFig(id=1240651456940929724, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, language=CN, label=图3, caption=不同年龄段女性人群的死亡率, figureFileSmall=uv2GXtiemWgWEwecEyyBkQ==, figureFileBig=OV4E+KKHr9t42lsvoY2Wug==, tableContent=null), ArticleFig(id=1240651457029010114, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, language=EN, label=Fig.4, caption=Mortality rate of male population in different age groups, figureFileSmall=hUoxBXlC1fYU1IOeBq1Bog==, figureFileBig=zg734/PrPow/Y5BG28GF3g==, tableContent=null), ArticleFig(id=1240651457142256328, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, language=CN, label=图4, caption=不同年龄段男性人群的死亡率, figureFileSmall=hUoxBXlC1fYU1IOeBq1Bog==, figureFileBig=zg734/PrPow/Y5BG28GF3g==, tableContent=null), ArticleFig(id=1240651457238725324, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, language=EN, label=Table 1, caption=

Tumor incidence attributed to HPV infection in all population

, figureFileSmall=null, figureFileBig=null, tableContent=
肿瘤部位全人群
发病人数PAF(%)归因于HPV的发病人数ASIR(/10万）
宫颈5 895100.05 89511.230
肛门25888.02270.204
外阴16224.1390.066
阴道8578.0660.124
阴茎28448.01360.253
口咽41229.01190.106
口腔1 0254.3440.037
喉1 1234.6520.046
), ArticleFig(id=1240651457343582932, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, language=CN, label=表1, caption=

全人群归因于HPV感染的肿瘤发病情况

, figureFileSmall=null, figureFileBig=null, tableContent=
肿瘤部位全人群
发病人数PAF(%)归因于HPV的发病人数ASIR(/10万）
宫颈5 895100.05 89511.230
肛门25888.02270.204
外阴16224.1390.066
阴道8578.0660.124
阴茎28448.01360.253
口咽41229.01190.106
口腔1 0254.3440.037
喉1 1234.6520.046
), ArticleFig(id=1240651457452634843, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, language=EN, label=Table 2, caption=

Tumor incidence attributed to HPV infection in different gender or region

, figureFileSmall=null, figureFileBig=null, tableContent=
肿瘤部位女性男性
发病人数归因于HPV的发病人数ASIR(/10万）发病人数归因于HPV的发病人数ASIR(/10万）
宫颈5 8955 89511.23///
肛门132116.160.17126110.880.237
外阴162390.066///
阴道85660.124///
阴茎///2841360.253
口咽10530.450.0530789.030.162
口腔32513.9750.02570030.10.048
喉1637.4980.01996044.160.073
χ2值45.09133.653
P值<0.001<0.001
宫颈3 1253 12510.792 7702 77011.67
肛门1261110.191321160.217
外阴89210.0773180.058
阴道46360.1439300.113
阴茎144690.24140670.265
口咽225650.12187540.092
口腔566240.045459200.028
喉597270.055526240.037
χ2值40.10319.473
P值<0.001<0.001
), ArticleFig(id=1240651457557492446, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, language=CN, label=表2, caption=

不同性别、区域人群归因于HPV感染的肿瘤发病情况

, figureFileSmall=null, figureFileBig=null, tableContent=
肿瘤部位女性男性
发病人数归因于HPV的发病人数ASIR(/10万）发病人数归因于HPV的发病人数ASIR(/10万）
宫颈5 8955 89511.23///
肛门132116.160.17126110.880.237
外阴162390.066///
阴道85660.124///
阴茎///2841360.253
口咽10530.450.0530789.030.162
口腔32513.9750.02570030.10.048
喉1637.4980.01996044.160.073
χ2值45.09133.653
P值<0.001<0.001
宫颈3 1253 12510.792 7702 77011.67
肛门1261110.191321160.217
外阴89210.0773180.058
阴道46360.1439300.113
阴茎144690.24140670.265
口咽225650.12187540.092
口腔566240.045459200.028
喉597270.055526240.037
χ2值40.10319.473
P值<0.001<0.001
), ArticleFig(id=1240651457641378531, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, language=EN, label=Table 3, caption=

Tumor mortality attributed to HPV infection in all population

, figureFileSmall=null, figureFileBig=null, tableContent=
肿瘤部位全人群
死亡人数PAF(%)归因于HPV的死亡人数ASMR(/10万）
宫颈1 963100.01 9633.430
肛门14888.01300.090
外阴4824.1120.026
阴道2978.0230.058
阴茎7948.0380.072
口咽20729.0600.055
口腔5024.3220.016
喉6344.6290.034
), ArticleFig(id=1240651457750430440, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, language=CN, label=表3, caption=

全人群归因于HPV感染的肿瘤死亡情况

, figureFileSmall=null, figureFileBig=null, tableContent=
肿瘤部位全人群
死亡人数PAF(%)归因于HPV的死亡人数ASMR(/10万）
宫颈1 963100.01 9633.430
肛门14888.01300.090
外阴4824.1120.026
阴道2978.0230.058
阴茎7948.0380.072
口咽20729.0600.055
口腔5024.3220.016
喉6344.6290.034
), ArticleFig(id=1240651457834316524, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, language=EN, label=Table 4, caption=

Tumor mortality attributed to HPV infection in different gender or region

, figureFileSmall=null, figureFileBig=null, tableContent=
肿瘤部位女性男性
死亡人数归因于HPV的死亡人数ASMR(/10万）死亡人数归因于HPV的死亡人数ASMR(/10万）
宫颈1 9631 9633.43///
肛门66580.08582720.095
外阴48120.026///
阴道29230.058///
阴茎///79380.072
口咽78230.018129370.092
口腔16670.012336140.02
喉8640.018548250.05
χ2值22.37818.775
P值<0.001<0.001
肿瘤部位城市农村
死亡人数归因于HPV的死亡人数ASMR(/10万）死亡人数归因于HPV的死亡人数ASMR(/10万）
宫颈1 0231 0233.189409403.67
肛门80700.1268600.06
外阴2870.0162050.036
阴道18140.0451190.071
阴茎42200.06337180.081
口咽122350.06485250.046
口腔302130.02220090.01
喉380170.028254120.04
χ2值28.79237.004
P值<0.001<0.001
), ArticleFig(id=1240651457934979824, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651447449219306, language=CN, label=表4, caption=

不同性别、区域人群归因于HPV感染的肿瘤死亡情况

, figureFileSmall=null, figureFileBig=null, tableContent=
肿瘤部位女性男性
死亡人数归因于HPV的死亡人数ASMR(/10万）死亡人数归因于HPV的死亡人数ASMR(/10万）
宫颈1 9631 9633.43///
肛门66580.08582720.095
外阴48120.026///
阴道29230.058///
阴茎///79380.072
口咽78230.018129370.092
口腔16670.012336140.02
喉8640.018548250.05
χ2值22.37818.775
P值<0.001<0.001
肿瘤部位城市农村
死亡人数归因于HPV的死亡人数ASMR(/10万）死亡人数归因于HPV的死亡人数ASMR(/10万）
宫颈1 0231 0233.189409403.67
肛门80700.1268600.06
外阴2870.0162050.036
阴道18140.0451190.071
阴茎42200.06337180.081
口咽122350.06485250.046
口腔302130.02220090.01
喉380170.028254120.04
χ2值28.79237.004
P值<0.001<0.001
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2018—2022年四川地区归因于HPV感染的恶性肿瘤发病及死亡情况变化分析
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叶波 1 , 李玉苹 1 , 张开炯 1 , 王东生 1 , 叶斌 2
现代预防医学 | 临床与预防 2024,51(12): 2300-2304
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现代预防医学 | 临床与预防 2024, 51(12): 2300-2304
2018—2022年四川地区归因于HPV感染的恶性肿瘤发病及死亡情况变化分析
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叶波1, 李玉苹1, 张开炯1, 王东生1, 叶斌2
作者信息
  • 1.四川省肿瘤医院检验科，四川 成都 610041
  • 2.成都市第一人民医院呼吸科

    • 叶波（1979—），男，本科，主管技师，研究方向：临床化学及肿瘤分子诊断

通讯作者:

叶斌，E-mail:
Analyses of changes in the incidence and mortality of malignant tumors attributed to HPV infection, Sichuan, 2018-2022
Bo YE1, Yu-ping LI1, Kai-jiong ZHANG1, Dong-sheng WANG1, Bin YE2
Affiliations
  • Laboratory Department, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, China
出版时间: 2024-06-25 doi: 10.20043/j.cnki.MPM.202402032
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摘要
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目的

分析2018—2022年四川地区归因于人乳头瘤病毒（human papillomavirus, HPV）感染的恶性肿瘤发病及死亡情况。

方法

收集2018年1月—2022年12月四川地区人口数、肿瘤发病率、死亡率，分年龄、性别计算各恶性肿瘤发病、死亡归因于HPV感染的人群归因分值（Population Attributable Fraction, PAF）。

结果

2018—2022年四川地区居民HPV感染对常见恶性肿瘤发病和死亡的人口归因比例分别为65.0%和59.2%。男性口咽、口腔及喉恶性肿瘤发病归因HPV(PAF)均高于女性（χ2值=78.904，P<0.001）；城市人群宫颈、外阴、口腔及喉恶性肿瘤发病归因HPV(PAF)均高于农村人群（χ2值=119.03，P<0.001）；此外，归因于HPV感染的肿瘤发病与年龄的关系存在性别差异（P<0.05），即男性各个肿瘤发病年龄更为提前。男性口咽、口腔及喉恶性肿瘤死亡归因HPV(PAF)均高于女性（χ2值=110.578，P<0.001）；城市人群宫颈、肛门、口咽、口腔及喉恶性肿瘤死亡归因HPV(PAF)均高于农村人群（χ2值=66.285，P<0.001）；此外，归因于HPV感染的肿瘤死亡与年龄的关系存在性别差异（P<0.05），即男性口腔、口咽恶性肿瘤死亡年龄更为提前，而女性肛门恶性肿瘤死亡年龄更为提前。

结论

2018—2022年四川地区归因于HPV感染的肿瘤发病、死亡人数较多，且发病、死亡呈现增高趋势，及时筛查宫颈癌是降低归因于HPV肿瘤发病、死亡率的关键。

人乳头瘤病毒  /  恶性肿瘤  /  人群归因分值  /  发病  /  死亡
Objective

To analyze the incidence and mortality of malignant tumors attributed to HPV infection in Sichuan region from 2018 to 2022.

Methods

From January 2018 to December 2022, the population, tumor incidence rate and mortality in Sichuan were collected, and the population attributable fraction (PAF) attributable to HPV infection was calculated by age and sex.

Results

The population attributable proportions of HPV infection among residents in Sichuan region from 2018 to 2022 for the incidence and mortality of common malignant tumors were 65.0% and 59.2% respectively. The attribution of HPV (PAF) to the incidence of malignant tumors in the oropharynx, oral cavity, and throat of males was higher than that of females (χ2=78.904, P<0.001).The attributable HPV (PAF) of cervical, vulva, oral, and laryngeal malignant tumors in urban populations was higher than that in rural populations(χ2=119.03, P<0.001).In addition, there was a gender difference (P<0.05) in the relationship between the incidence of tumors attributed to HPV infection and age, indicating that males had earlier onset ages for various tumors. The attribution of HPV (PAF) to death in male oropharyngeal, oral, and laryngeal malignant tumors was higher than that in females(χ2=110.578, P<0.001).The mortality attributable HPV (PAF) of cervical, anal, oropharyngeal, oral, and laryngeal malignant tumors in urban populations was higher than that in rural populations(χ2=66.285, P<0.001).In addition, there was a gender difference (P<0.05) in the relationship between tumor mortality attributed to HPV infection and age, with males dying earlier for oral and oropharyngeal malignancies, and females dying earlier for anal malignancies.

Conclusion

From 2018 to 2022, the incidence and death of tumors attributed to HPV infection in Sichuan region are more, and the incidence and death show an increasing trend, among which timely screening of cervical cancer is the key to reduce the incidence and death of HPV tumors.

Human papillomavirus  /  Malignant tumor  /  Population attribution score  /  Onset of disease  /  Death
叶波, 李玉苹, 张开炯, 王东生, 叶斌. 2018—2022年四川地区归因于HPV感染的恶性肿瘤发病及死亡情况变化分析. 现代预防医学, 2024 , 51 (12) : 2300 -2304 . DOI: 10.20043/j.cnki.MPM.202402032
Bo YE, Yu-ping LI, Kai-jiong ZHANG, Dong-sheng WANG, Bin YE. Analyses of changes in the incidence and mortality of malignant tumors attributed to HPV infection, Sichuan, 2018-2022[J]. Modern Preventive Medicine, 2024 , 51 (12) : 2300 -2304 . DOI: 10.20043/j.cnki.MPM.202402032
正文
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人乳头瘤病毒 （human papillomavirus, HPV）的持续感染是导致宫颈癌变的独立危险因素，近年来流行病学研究证实，HPV持续感染还能导致阴道、外阴、肛门等部位癌变[1-2]，因此临床筛查HPV并积极开展干预措施具有重要意义。大量研究表明[3-4]，HPV疫苗可有效预防宫颈及其他部位癌变，且随着临床需求的不断提高以及世界卫生组织（World Health Organization, WHO）积极倡导，适龄女性接种HPV疫苗至关重要。尽管我国HPV感染率低于国际水平，但由于人口基数较大，实际感染人数不容忽视[5]，卫生部门制定符合我国国情、经济的HPV疫苗接种策略时需要评估经济效益，因此需要了解各地HPV感染情况，以及归因于HPV感染的恶性肿瘤发病及死亡情况。基于此，本研究通过全国以及四川地区肿瘤登记中心收集的2018-2022年HPV相关肿瘤发病、死亡数据，分析2018-2022年四川地区归因于HPV感染的肿瘤发病、死亡情况，从而为HPV相关疾病的防控以及HPV疫苗接种策略制定提供参考。
1　资料与方法
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1.1　一般资料
从国家统计局发布的《中国人口和就业统计年鉴》中获得2018-2022年四川地区分性别、年龄组人口占比。从国家癌症中心发布的2019年、2021年、2023年《中国肿瘤登记年报》中获取2018-2022年四川地区口咽癌(C01,C09~10)、口腔癌(C02~06)、肛门癌(C21)、喉癌(C32)、外阴癌(C51)、阴道癌(C52)、宫颈癌(C53)、阴茎癌(C60) 分性别、年龄的发病率、死亡率。
1.2　统计学分析
发病人数=发病率×相应人口数，死亡人数=死亡率×相应人口数。口咽癌、阴茎癌使用我国人群归因分值(Population Attributable Fraction, PAF)[6]，因我国缺乏口腔癌、肛门癌、阴道癌、喉癌数据，则使用国际PAF[7-9]。根据PAF得到HPV感染的肿瘤在不同性别、年龄人群中的发病数和死亡数。归因于HPV感染的发病数和死亡数除以相应人口数计算各年龄组粗发病率和粗死亡率，使用SegiI世界人口结构作为标准计算年龄标化发病率(age-standardized incidence rate, ASIR)和年龄标化死亡率(Age standardized mortality rate, ASMR)。定性数据采用百分比（%）表示，卡方检验进行两组间率的比较，认为P<0.05则组间存在差异。
2　结果
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2.1　归因于HPV感染的肿瘤发病情况
2018—2022年四川地区与HPV感染相关的肿瘤新发病人数为14 222例，其中9 244例(65.0%)归因于HPV感染，主要肿瘤类型为宫颈癌5 895例、喉癌1 123例、口腔癌1 025例。其中，男性口咽、口腔及喉恶性肿瘤发病归因于HPV(PAF)均高于女性（χ2值=78.904，P<0.001）；城市人群宫颈、外阴、口腔及喉恶性肿瘤发病归因于HPV(PAF)均高于农村人群（χ2值=119.03，P<0.001）。见表1,表2。
2.2　归因于HPV感染的肿瘤发病与年龄的关系
宫颈癌新发病例主要集中在40~70岁，以50~60岁发病率最高（41.2/10万），非宫颈部位肿瘤主集中在50~80岁，以70~80岁发病率最高（4.8/10万）。此外，归因于HPV感染的肿瘤发病与年龄的关系存在性别差异（P<0.05），即男性各个肿瘤发病年龄更为提前。见图1~2。
2.3　归因于HPV感染的肿瘤死亡情况
2018—2022年四川地区与HPV感染相关的肿瘤死亡人数为6 096例，其中3 610例(59.2%)归因于HPV感染，主要肿瘤类型为宫颈癌1 963例、喉癌634例、口腔癌502例。其中，男性口咽、口腔及喉恶性肿瘤死亡归因HPV(PAF)均高于女性（χ2值=110.578，P<0.001）；城市人群宫颈、肛门、口咽、口腔及喉恶性肿瘤死亡归因HPV(PAF)均高于农村人群（χ2=66.285，P<0.001）。见表3,表4。
2.4　归因于HPV感染的肿瘤死亡与年龄的关系
宫颈癌、非宫颈部位肿瘤死亡病例均主要集中在50~80岁，均以70~80岁死亡率最高（18.4/10万、4.2/10万），见图1。此外，归因于HPV感染的肿瘤死亡与年龄的关系存在性别差异（P<0.05），即男性口腔、口咽恶性肿瘤死亡年龄更为提前，而女性肛门恶性肿瘤死亡年龄更为提前。见图3~4。
3　讨论
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HPV属于乳头状瘤病毒科，是一类小型、无包膜的双链DNA病毒，可通过摩擦接触、性交、自体种植等方式传播[10]。HPV感染广泛存在，只有少数感染高危型人乳头瘤病毒（High-Risk human papillomavirus, HR-HPV）者会发展为浸润性癌[11]。HR-HPV常见的分支为α-7（主要包括HPV 18、45、59、39型）和α-9（主要包括HPV16、31、33、35、52、58型），可导致子宫颈癌、外阴癌、阴道癌、阴茎癌、肛门癌、头颈部癌等[12-13]。
本研究显示，2018—2022年四川地区与HPV感染对常见恶性肿瘤发病人口归因比例分为65.0%,且宫颈癌发病归因于HPV感染的人口归因比例最高，为100%。而这远高于发达国家人口归因比例数值，这可能是发达国家医疗体系更为完善，宫颈癌筛查已成为常态，积极干预治疗癌前病变可显著降低宫颈癌发病风险[14]。消除宫颈癌已成为全球共识，WHO呼吁35~45岁女性接受筛查比例达到70%[15]，我医疗资源分配不均衡，农村经济、医疗、文化水平均较低，使得农村女性宫颈癌筛查比例低于城市女性，这可能是本次研究城市宫颈癌发病归因于HPV感染的人口归因比例高于农村的原因。值得注意的是，本研究结果发现，男性口咽、口腔及喉恶性肿瘤发病归因HPV(PAF)均高于女性，这与Tan等[16]研究结果相似，这可能是男性更不注意口腔卫生，由此增加了HPV感染的概率。同时，本研究结果显示，2018-2022年四川地区HPV感染对常见恶性肿瘤死亡人口归因比例为59.2%,相似于Yuan等[17]研究结果（60.19%）。提示，四川地区肿瘤死亡归因于HPV感染带来的疾病负担较大，需引起重视。本研究还发现，归因于HPV感染的肿瘤死亡与年龄的关系存在性别差异，即男性口腔、口咽恶性肿瘤死亡年龄更为提前，而女性肛门恶性肿瘤死亡年龄更为提前。提示，需加强男性HPV感染者的口腔定期筛查，增加女性HPV感染者的肛门定期筛查，并需将筛检起始年龄调整为40岁左右，以期更早的发现患者。
综上所述，2018-2022年四川地区归因于HPV感染的肿瘤发病、死亡人数较多，且发病、死亡呈现增高趋势，男性居民高于女性居民，且年龄差异较大。应根据具体情况，合理分配资源，定制防控方案降低恶性肿瘤归因于HPV感染的疾病负担。
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2024年第51卷第12期
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doi: 10.20043/j.cnki.MPM.202402032
  • 接收时间：2024-02-02
  • 首发时间：2026-03-17
  • 出版时间：2024-06-25
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  • 收稿日期：2024-02-02
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    1.四川省肿瘤医院检验科，四川 成都 610041
    2.成都市第一人民医院呼吸科

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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