Global burden of cancer attributable to infections in 2018: a worldwide incidence analysis
Global burden of cancer attributable to infections in 2018: a worldwide incidence analysis
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DOI：
10.1016/s2214-109x(19)30488-7
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发表时间：
2020-02-01
影响因子：
34.3
通讯作者：
Clifford, Gary M.
中科院分区：
文献类型：
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作者：
de Martel, Catherine;Georges, Damien;Clifford, Gary M.
背景感染性病原体是导致癌症的强烈和可改变的原因。这项研究的目的是改进对全球和地区感染可归因性癌症负担的估计，以确定研究重点并促进预防工作。方法我们使用2018年GLOBOCAN癌症发病率和死亡率数据库，估计已知与人类致癌物10种感染性病原体相关的特定解剖癌症部位、亚部位或组织亚型的归属比例和全球发病率。我们计算了国家一级可归因于感染的癌症的绝对数量和年龄标准化发病率(ASIR)。估计按性别、年龄组和国家分层，并根据地理区域和世界银行收入组进行汇总。结果我们发现，2018年，全球约有220万感染可归因于癌症病例被诊断，相当于每10万人年感染可归因性癌症病例为25.0例。主要病因为幽门螺杆菌(810000例，8.7例/10万人/年)、人乳头瘤病毒(69万例/10万人/年)、乙肝病毒(36万例/10万人年)、丙型肝炎病毒(16万例/10万人/年)。可归因于感染的急性呼吸道感染在东亚(每10万人年37.9例)和撒哈拉以南非洲(33.1例)最高，在北欧(13.6例)和西亚(13.8例)最低。中国占全球癌症病例的三分之一，可归因于感染，这是由高水平的幽门螺杆菌(15.6)和乙肝病毒(11.7)感染引起的。可归因于人类乳头瘤病毒的癌症负担与国家收入水平的关系最为明显(从高收入国家的每10万人年6.9例到低收入国家的16.1例)。除了病例的绝对数量之外，解释感染可归因于癌症的发病率还有助于对感染相关癌症负担较高的人群进行精细的地理分析和识别。当癌症预防在很大程度上被放在非传染性疾病的背景下考虑时，迫切需要将资源用于针对感染的癌症预防方案，特别是在高危人群中。这种干预措施可以显著减少癌症负担的增加和相关的死亡率。版权所有(C)2019年国际癌症研究机构；被许可人爱思唯尔。
Background Infectious pathogens are strong and modifiable causes of cancer. The aim of this study was to improve estimates of the global and regional burden of infection-attributable cancers to inform research priorities and facilitate prevention efforts.Methods We used the GLOBOCAN 2018 database of cancer incidence and mortality rates and estimated the attributable fractions and global incidence for specific anatomical cancer sites, subsites, or histological subtypes known to be associated with ten infectious pathogens classified as human carcinogens. We calculated absolute numbers and age-standardised incidence rates (ASIR) of infection-attributable cancers at the country level. Estimates were stratified for sex, age group, and country, and were aggregated according to geographical regions and World Bank income groups.Findings We found that, for 2018, an estimated 2.2 million infection-attributable cancer cases were diagnosed worldwide, corresponding to an infection-attributable ASIR of 25.0 cases per 100 000 person-years. Primary causes were Helicobacter pylori (810000 cases, ASIR 8.7 cases per 100 000 person-years), human papillomavirus (690 000, 8.0), hepatitis B virus (360 000, 4.1) and hepatitis C virus (160 000, 1.7). Infection-attributable ASIR was highest in eastern Asia (37.9 cases per 100 000 person-years) and sub-Saharan Africa (33.1), and lowest in northern Europe (13.6) and western Asia (13.8). China accounted for a third of worldwide cancer cases attributable to infection, driven by high ASIR of H pylori (15.6) and hepatitis B virus (11.7) infection. The cancer burden attributed to human papillomavirus showed the clearest relationship with country income level (from ASIR of 6. 9 cases per 100 000 person-years in high-income countries to 16.1 in low-income countries).Interpretation Infection-attributable cancer incidence, in addition to the absolute number of cases, allows for refined geographic analyses and identification of populations with a high infection-associated cancer burden. When cancer prevention is largely considered in a non-communicable disease context, there is a crucial need for resources directed towards cancer prevention programmes that target infection, particularly in high-risk populations. Such interventions can markedly reduce the increasing cancer burden and associated mortality. Copyright (C) 2019 International Agency for Research on Cancer; licensee Elsevier.