中国归因于人乳头瘤病毒感染的癌症发病率的地理和时间变化：一项基于人群的研究

文献信息

中文摘要

背景： 目前关于中国归因于人乳头瘤病毒（HPV）感染的癌症发病率的流行病学数据仍不明确。本研究提供了2013-2017年中国归因于HPV的癌症发病规模及地理变异性的最新评估，以及1988年至2017年的时间趋势和至2032年的预测。
方法： 数据提取自《五大洲癌症发病率》第七至十二卷。人群归因分数通过将各解剖部位的高危HPV感染率乘以HPV阳性病例中特定生物标志物的阳性率计算得出。采用Joinpoint回归和年龄-时期-队列模型分别量化年龄标化发病率（ASR）的时间趋势以及年龄和出生队列效应。构建贝叶斯年龄-时期-队列模型以预测至2032年归因于HPV的癌症发病率。
结果： 2013-2017年中国女性和男性中估计分别观察到68,955例和3463例归因于HPV的癌症病例，ASR分别为每10万人11.20（95%置信区间[CI]：10.98-11.41）和0.52（0.20-0.82）。最常见的归因于HPV的癌症为宫颈癌（女性；ASR [95% CI]：每10万人10.92 [10.83-11.00]）和喉癌（男性；0.21 [0.03-0.37]）。在纳入的25个省份中，归因于HPV的宫颈癌ASR从北京的每10万人6.15（5.88-6.42）到湖南的每10万人17.43（15.84-19.03）不等（相差2.8倍）。在多变量线性生态回归分析中，省级人类发展指数与宫颈癌发病率呈负相关。从1988年到2017年，归因于HPV的宫颈癌（女性；平均年度变化百分比[AAPC]及95% CI：5.89% [2.82-9.06]）以及阴茎癌和口咽癌（男性；分别为1.98% [0.82-3.15]和9.65% [5.81-13.62]）的ASR均上升。在1908年至1978年出生的连续世代中，女性归因于HPV的宫颈癌和两性口咽癌均观察到显著增加的风险。在反事实假设历史趋势持续至2017年、未纳入后续疫苗接种或筛查扩大的情况下，归因于HPV的宫颈癌ASR预计在2028-2032年达到每10万人19.53（95%不确定性区间[UI]：9.99-34.36），而2013-2017年为每10万人10.92（95% CI：10.83-11.00）。
结论： 在中国，归因于HPV的癌症发病率因癌症类型和地理区域而存在显著差异。这些发现凸显了制定区域特异性HPV疫苗接种和癌症筛查策略的必要性，尤其是在发病率高的地区。

英文摘要

BACKGROUND: Current epidemiological data on cancer incidence attributable to human papillomavirus (HPV) infection in China remain unclear. This study provides an updated assessment of the magnitude of and geographic variability in the incidence of HPV-attributable cancer in China in 2013-2017, temporal trends from 1988 to 2017 and projections to 2032.
METHODS: Data were extracted from the Cancer Incidence in Five Continents Volumes VII-XII. The population-attributable fraction was calculated by multiplying the high-risk HPV prevalence at each anatomical site by the specific biomarker positivity rate in HPV-positive cases. Joinpoint regression and age-period-cohort models were used to quantify temporal age-standardized incidence rate (ASR) trends and age and birth cohort effects, respectively. Bayesian age-period-cohort models were constructed to project the HPV-attributable cancer incidence through 2032.
RESULTS: An estimated 68,955 and 3463 HPV-attributable cancer cases were observed among females and males in China in 2013-2017, respectively, with ASRs of 11.20 (95% confidence interval [CI]: 10.98-11.41) and 0.52 (0.20-0.82) per 100,000. The most common HPV-attributable cancers were cervical cancer (females; ASR [95% CI]: 10.92 [10.83-11.00] per 100,000) and laryngeal cancer (males; 0.21 [0.03-0.37] per 100,000). Among the 25 provinces included, the ASRs of HPV-attributable cervical cancer ranged from 6.15 (5.88-6.42) per 100,000 in Beijing to 17.43 (15.84-19.03) per 100,000 in Hunan (2.8-fold difference). The provincial Human Development Index was inversely associated with the cervical cancer incidence in multivariable linear ecological regression analyses. From 1988 to 2017, the ASRs increased for HPV-attributable cervical cancer (females; average annual percent change [AAPC] and 95% CI: 5.89% [2.82-9.06]) and penile and oropharyngeal cancers (males; 1.98% [0.82-3.15] and 9.65% [5.81-13.62], respectively). Substantial increasing risks across successive generations born between 1908 and 1978 were observed for HPV-attributable cervical cancer among females and oropharyngeal cancer in both sexes. Under a counterfactual continuation of historical trends through 2017, without incorporating subsequent vaccination or screening expansion, the ASR of HPV-attributable cervical cancer is projected to reach 19.53 (95% uncertainty interval [UI]: 9.99-34.36) per 100,000 in 2028-2032, compared with 10.92 (95% CI: 10.83-11.00) per 100,000 in 2013-2017.
CONCLUSIONS: In China, the incidence of HPV-attributable cancer varies considerably according to cancer type and geography. These findings highlight the need for region-specific HPV vaccination and cancer screening strategies, particularly in areas with high incidence rates.