1990~2021年中国男性睾丸癌疾病负担变化趋势分析

Analysis of the Trends in the Disease Burden of Testicular Cancer in Chinese Men from 1990 to 2021

摘要: 目的：基于2021年全球疾病负担研究(Global Burden of Disease Study 2021, GBD 2021)数据，分析1990~2021年中国男性睾丸癌发病、死亡及伤残调整寿命年(DALYs)的疾病负担变化趋势，探究其年龄分布规律、长期演变趋势与人口学驱动因素，并预测未来疾病负担发展态势。方法：提取GBD 2021数据库中1990~2021年中国男性睾丸癌发病数、死亡数、DALYs，计算ASIR、ASMR和ASDR。比较1990年与2021年疾病负担水平，采用估计年度变化百分比(EAPC)评估ASIR、ASMR和ASDR的长期变化趋势。进一步分析2021年不同年龄组睾丸癌发病、死亡及DALYs的分布特征。采用Das Gupta分解法将1990~2021年发病数、死亡数和DALYs变化分解为人口增长、人口老龄化和流行病学变化三部分，并采用APCM模型预测中国睾丸癌的ASIR和ASMR的未来变化趋势。结果：1990~2021年，中国男性睾丸癌发病负担明显增加，死亡和DALYs的年龄标化负担整体呈下降趋势。新发病例数由1839例增至6696例，ASIR由0.32/10万升至0.79/10万；死亡人数由1048例增至1245例，但ASMR由0.21/10万降至0.14/10万；DALYs由49,459人年降至44,760人年，ASDR由8.06/10万降至5.34/10万。EAPC分析显示，ASIR呈显著上升趋势，EAPC为2.70% (95% CI: 2.37%~3.04%)，而ASMR和ASDR均呈显著下降趋势，EAPC分别为−1.84% (95% CI: −2.17%~−1.51%)和−1.94% (95% CI: −2.27%~−1.61%)。年龄分层分析显示，2021年睾丸癌发病数和DALYs主要集中于青壮年男性，其中30~34岁年龄组负担最重；死亡负担则更多集中于老年人群。分解分析显示，发病数增加主要由流行病学变化驱动，而死亡数和DALYs变化中流行病学变化表现为负向贡献。预测结果显示，未来中国男性睾丸癌的ASIR可能继续上升并逐渐趋于平台，ASMR则保持下降趋势。结论：1990~2021年中国男性睾丸癌发病负担明显上升，而死亡和DALYs的年龄标化负担总体下降。未来应加强青壮年男性早期识别、高危人群管理、规范化诊疗、生育力保护及长期随访，同时重视高龄患者的个体化管理。

Abstract: Objective: Based on data from the Global Burden of Disease Study 2021 (GBD 2021), this study analyzes the changing trends in the disease burden of testicular cancer incidence, mortality, and disability-adjusted life years (DALYs) in Chinese men from 1990 to 2021, exploring its age distribution patterns, long-term evolution trends, and demographic drivers, and predicting future disease burden trends. Methods: The incidence, mortality, and DALYs of testicular cancer in Chinese men from 1990 to 2021 were extracted from the GBD 2021 database. ASIR, ASMR, and ASDR were calculated. The disease burden levels in 1990 and 2021 were compared, and the estimated percentage annual change (EAPC) was used to assess the long-term trends of ASIR, ASMR, and ASDR. Further analysis was conducted on the distribution characteristics of testicular cancer incidence, mortality, and age-standardized mortality events (DALYs) in different age groups in 2021. The Das Gupta decomposition method was used to decompose the changes in incidence, mortality, and DALYs from 1990 to 2021 into three components: population growth, population aging, and epidemiological changes. The APCM model was then used to predict the future trends of ASIR and ASMR for testicular cancer in China. Results: From 1990 to 2021, the incidence burden of testicular cancer in Chinese men increased significantly, while the age-standardized burden of mortality and DALYs generally showed a downward trend. The number of new cases increased from 1839 to 6696, and the ASIR rose from 0.32/100,000 to 0.79/100,000; the number of deaths increased from 1048 to 1245, but the ASMR decreased from 0.21/100,000 to 0.14/100,000; DALYs decreased from 49,459 person-years to 44,760 person-years, and the ASDR decreased from 8.06/100,000 to 5.34/100,000. EAPC analysis showed that the ASIR showed a significant upward trend, with an EAPC of 2.70% (95% CI: 2.37%~3.04%), while the ASMR and ASDR both showed a significant downward trend, with EAPCs of −1.84% (95% CI: −2.17%~−1.51%) and −1.94% (95% CI: −2.27%~−1.61%), respectively. Age-stratified analysis showed that in 2021, the incidence and age-standardized burden (DALYs) of testicular cancer were mainly concentrated in young and middle-aged men, with the 30~34 age group bearing the heaviest burden; the mortality burden, however, was more concentrated in the elderly population. Decomposition analysis showed that the increase in incidence was mainly driven by epidemiological changes, while epidemiological changes had a negative contribution to changes in mortality and DALYs. Predictive results indicate that the ASIR (autoimmune disease incidence rate) of testicular cancer in Chinese men may continue to rise and gradually plateau, while the ASMR (autoimmune disease rate) will continue to decline. Conclusion: From 1990 to 2021, the incidence burden of testicular cancer in Chinese men increased significantly, while the age-standardized burden of mortality and DALYs generally decreased. Future efforts should focus on strengthening early identification, high-risk group management, standardized diagnosis and treatment, fertility protection, and long-term follow-up in young and middle-aged men, while also emphasizing individualized management of elderly patients.