肺癌是全世界最常见的非皮肤癌症。2012 年全球肺癌死亡数为 180 万例,仍是癌症死亡的最常见原因,占全球癌症死亡总数的 17.6%。[8]GLOBOCAN. Lung cancer: estimated incidence, mortality and prevalence worldwide in 2012. http://globocan.iarc.fr/ (last accessed 14 September 2017).http://globocan.iarc.fr/old/FactSheets/cancers/lung-new.asp[9]Ferlay J, Autier P, Boniol M, et al. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol. 2007;18:581-592.http://annonc.oxfordjournals.org/content/18/3/581.fullhttp://www.ncbi.nlm.nih.gov/pubmed/17287242?tool=bestpractice.com 肺癌在欧洲是第三大常见的肿瘤,非小细胞肺癌占所有肺癌的 80%。[9]Ferlay J, Autier P, Boniol M, et al. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol. 2007;18:581-592.http://annonc.oxfordjournals.org/content/18/3/581.fullhttp://www.ncbi.nlm.nih.gov/pubmed/17287242?tool=bestpractice.com[10]D'Addario G, Felip E, ESMO Guidelines Working Group. Non-small-cell lung cancer: ESMO clinical recommendations for diagnosis, treatment and follow up. Ann Oncology. 2008;19(suppl 2):ii39–ii40.http://annonc.oxfordjournals.org/content/19/suppl_2/ii39.full.pdf+htmlhttp://www.ncbi.nlm.nih.gov/pubmed/18456762?tool=bestpractice.com 肺癌在男性的所有癌症中占 14%,在女性的所有癌症中占 11%。肺癌的年龄标准化率在男、女性中分别为 56/100,000 人和 38/100,000 人。[11]Office for National Statistics. Cancer registrations in England, 2010. http://www.ons.gov.uk/ (last accessed 14 September 2017).http://www.ons.gov.uk/ons/rel/vsob1/cancer-registrations-in-england/2010/2010-cancer-registrations-in-england-statistical-bulletin-2.html
发病率和死亡率数据相差很大,但似乎与烟草使用有关。据估计,在 2000 年,全世界吸烟导致了 85% 的男性和 47% 的女性患肺癌,在欧洲和北美肺癌发生率最高。[12]Cancer Research UK/WHO. World cancer factsheet. January 2014. http://www.cancerresearch.org.uk/ (last accessed 10 September 2016).http://publications.cancerresearchuk.org/downloads/Product/CS_REPORT_WORLD.pdf 在 20 世纪中期,也就是烟草使用快速上升后的几十年,美国肺癌发病率显著增加。最近肺癌的发病率下降可能与最近几十年烟草使用减少有关。[13]Leone FT, Evers-Casey S, Toll BA, et al. Treatment of tobacco use in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(suppl):e61S-e77S.http://journal.chestnet.org/article/S0012-3692(13)60289-5/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/23649454?tool=bestpractice.com 男性肺癌的发病率在 20 世纪 80 年代开始下降。十年后,即 20 世纪 90 年代末,女性肺癌的发病率也开始下降。肺癌年龄标准化发病率的不断下降,使总体死亡率下降。在 2007 到 2011 年间,美国男性和女性年龄校正死亡率每年平均分别下降 2.9% 和 1.9%。[14]Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5-29.http://onlinelibrary.wiley.com/doi/10.3322/caac.21254/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25559415?tool=bestpractice.com 现在几乎一半的病例出现在发展中国家,在这些国家死亡率也较高。[12]Cancer Research UK/WHO. World cancer factsheet. January 2014. http://www.cancerresearch.org.uk/ (last accessed 10 September 2016).http://publications.cancerresearchuk.org/downloads/Product/CS_REPORT_WORLD.pdf 2015 年,美国仍有 15.1% 的人口吸烟,提示肺癌仍是一个重要的公共卫生问题。[15]Centers for Disease Control and Prevention. Burden of tobacco use in the US. May 2016. http://www.cdc.gov/tobacco (last accessed 14 September 2017).http://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html
肺癌也是美国癌症死亡的主要原因。估计美国 2018 年将诊断 234,030 例新发肺癌病例,将有 154,050 人死于肺癌,肺癌占所有癌症死亡的 25.3%。[16]National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Lung and Bronchus Cancer. 2018 [internet publication].https://seer.cancer.gov/statfacts/html/lungb.html 在 2011 年,肺癌死亡数高于前列腺癌、结直肠癌和胰腺癌的总和。[1]Howlader N, Noone AM, Krapcho M, et al (eds); National Cancer Institute. SEER cancer statistics review, 1975-2014. June 2017. http://seer.cancer.gov (last accessed 14 September 2017).https://seer.cancer.gov/csr/1975_2014/sections.html[14]Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5-29.http://onlinelibrary.wiley.com/doi/10.3322/caac.21254/fullhttp://www.ncbi.nlm.nih.gov/pubmed/25559415?tool=bestpractice.com
根据美国国家癌症研究所的监测、流行病学和最终结果 (Surveillance Epidemiology and End Results, SEER) 注册显示:肺癌发病率在黑人和非西班牙裔白人中最高;在美洲原住民、西班牙裔人、亚洲/太平洋岛民中最低。[1]Howlader N, Noone AM, Krapcho M, et al (eds); National Cancer Institute. SEER cancer statistics review, 1975-2014. June 2017. http://seer.cancer.gov (last accessed 14 September 2017).https://seer.cancer.gov/csr/1975_2014/sections.html