40-year trends in an index of survival for all cancers combined and survival adjusted for age and sex for each cancer in England and Wales, 1971-2011: a population-based study
40-year trends in an index of survival for all cancers combined and survival adjusted for age and sex for each cancer in England and Wales, 1971-2011: a population-based study
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DOI：
10.1016/s0140-6736(14)61396-9
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发表时间：
2015-03-28
期刊：
影响因子：
168.9
通讯作者：
Rachet, Bernard
中科院分区：
文献类型：
--
作者：
Quaresma, Manuela;Coleman, Michel P.;Rachet, Bernard
在人群水平上评估癌症控制的进展越来越重要。基于人口的生存趋势以及发病率和死亡率趋势为了解卫生系统的总体有效性提供了关键的见解。为了这个目的，我们的目的是提供一个独特的措施癌症survival.Methods在这项观察性研究中，我们分析了生存的趋势与人口为基础的数据为720万成年人诊断为第一，原发性，侵袭性恶性肿瘤在英格兰和威尔士在1971年至2011年，并随访至2012年底。我们使用国家癌症登记处和威尔士癌症情报和监测单位的数据构建了所有癌症的生存指数。该指数旨在独立于癌症患者年龄分布的变化以及每个性别中致命癌症比例的变化。我们分析了1971-72年、1980-81年、1990-91年、2000-01年、2005-06年和2010-11年选定时期诊断后1年、5年和10年癌症生存指数的趋势。我们还估计了每种癌症的年龄-性别调整生存率的趋势。我们将年龄最大（75-99岁）和最小（15-44岁）患者之间的净生存率差异定义为生存率的年龄差距。我们评估了自1971.Findings的年龄差距的绝对变化（%）净生存的整体指数大幅增加，在40年期间1971-2011年，在英格兰和威尔士。对于1971-72年诊断的患者，诊断后1年的净生存指数为50%。40年后，诊断后10年预测值相同，为50%。在此期间，女性平均10%的生存优势持续存在。2010年至2011年诊断的患者经年龄和性别调整后的预测10年净生存率范围从胰腺癌的1.1%到睾丸癌的98.2%。净生存的最老的患者（75-99岁）是持续低于最年轻的（15-44岁），即使调整后的死亡率高得多的原因，而不是癌症在老年people.Interpretation这些研究结果支持大幅增加短期和长期的净生存从所有癌症合并在英格兰和威尔士。净生存指数提供了一个方便的单一数字，总结了任何一个人群中癌症生存的总体模式，在每个日历期间，对于年轻和老年男性和女性以及各种癌症，生存率非常不同。持续存在的性别差异部分是由于癌症在女性中的分布比男性更有利。不同癌症的存活率差异很大，存活率持续存在年龄差距，这表明需要重新努力改善癌症预后。除非目前公众对公共卫生研究共享个人数据的担忧得到解决，否则未来将不可能对癌症生存指数进行监测。版权所有（C）Alfresma等人。根据CC BY的条款分发的开放获取文章。
Background Assessment of progress in cancer control at the population level is increasingly important. Population-based survival trends provide a key insight into the overall effectiveness of the health system, alongside trends in incidence and mortality. For this purpose, we aimed to provide a unique measure of cancer survival.Methods In this observational study, we analysed trends in survival with population-based data for 7.2 million adults diagnosed with a first, primary, invasive malignancy in England and Wales during 1971-2011 and followed up to the end of 2012. We constructed a survival index for all cancers combined using data from the National Cancer Registry and the Welsh Cancer Intelligence and Surveillance Unit. The index is designed to be independent of changes in the age distribution of patients with cancer and of changes in the proportion of lethal cancers in each sex. We analysed trends in the cancer survival index at 1, 5, and 10 years after diagnosis for the selected periods 1971-72, 1980-81, 1990-91, 2000-01, 2005-06, and 2010-11. We also estimated trends in age-sex-adjusted survival for each cancer. We define the difference in net survival between the oldest (75-99 years) and youngest (15-44 years) patients as the age gap in survival. We evaluated the absolute change (%) in the age gap since 1971.Findings The overall index of net survival increased substantially during the 40-year period 1971-2011, both in England and in Wales. For patients diagnosed in 1971-72, the index of net survival was 50% at 1 year after diagnosis. 40 years later, the same value of 50% was predicted at 10 years after diagnosis. The average 10% survival advantage for women persisted throughout this period. Predicted 10-year net survival adjusted for age and sex for patients diagnosed between 2010 and 2011 ranged from 1.1% for pancreatic cancer to 98.2% for testicular cancer. Net survival for the oldest patients (75-99 years) was persistently lower than for the youngest (15-44 years), even after adjustment for the much higher mortality from causes other than cancer in elderly people.Interpretation These findings support substantial increases in both short-term and long-term net survival from all cancers combined in both England and Wales. The net survival index provides a convenient, single number that summarises the overall patterns of cancer survival in any one population, in each calendar period, for young and old men and women and for a wide range of cancers with very disparate survival. The persistent sex difference is partly due to a more favourable cancer distribution in women than men. The very wide differences in survival for different cancers, and the persistent age gap in survival, suggest the need for renewed efforts to improve cancer outcomes. Future monitoring of the cancer survival index will not be possible unless the current crisis of public concern about sharing of individual data for public health research can be resolved. Copyright (C) Quaresma et al. Open Access article distributed under the terms of CC BY.