Disparities by Race, Age, and Sex in the Improvement of Survival for Major Cancers: Results From the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program in the United States, 1990 to 2010.
Disparities by Race, Age, and Sex in the Improvement of Survival for Major Cancers: Results From the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program in the United States, 1990 to 2010.
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DOI：
10.1001/jamaoncol.2014.161
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发表时间：
2015-04
期刊：
影响因子：
28.4
通讯作者：
Zheng W
中科院分区：
文献类型：
--
作者：
Zeng C;Wen W;Morgans AK;Pao W;Shu XO;Zheng W
癌症诊疗取得实质性进展，癌症存活率稳步提高。年龄、种族和性别的改善程度尚不清楚。根据年龄、种族和性别来量化美国随着时间的推移存活率改善的程度。癌症随访数据的纵向分析。1990-2009年的癌症诊断数据和2010年的跟踪数据来自九个基于人口的登记，这是NCI监测、流行病学和最终结果(SEER)计划的一部分。从1990年到2009年，SEER登记的大约102万名患者被诊断患有结肠癌/直肠癌、乳腺癌、前列腺癌、肺癌、肝癌、胰腺癌或卵巢癌。对1995-1999年、2000-2004年和2005-2009年期间被诊断为癌症患者的癌症特异性死亡的危险比(HR)和95%可信区间(CI)进行了估计，并与1990-1994年的诊断进行了比较。结肠癌/直肠癌、乳腺癌、前列腺癌、肺癌和肝癌的存活率显著提高。年轻患者的改善更为明显。例如，就2005年至2009年确诊的50岁患者而言，与1990年至1994年确诊的同一年龄组患者相比，结直肠癌、乳腺癌、肝癌和前列腺癌的调整后RR(95%CI)分别为0.57(0.55-0.60)、0.48(0.45-0.51)、0.61(0.57-0.68)和0.32(0.30-0.36)。而老年患者(75~85岁)的相对危险度(95%Cis)分别为0.88(0.84~0.82)、0.88(0.84~0.92)、0.76(0.69~0.84)和0.65(0.61~0.70)。在肺癌和胰腺癌中也观察到了类似的、尽管较弱的年龄相关时期效应。2005年至2009年确诊的50~年龄组和75~85岁确诊的肺癌患者调整后的肺癌相对危险度(95%CI)分别为0.75(95%CI，0.73~0.77)和0.84(95%CI，0.81~0.86)，而1990~1994年确诊的同一年龄组肺癌患者的校正RR(95%CI)分别为0.73[95%CI，0.69~0.77]和0.90[95%CI，0.85~0.95]。与白人或亚洲人相比，非裔美国人在前列腺癌存活率方面有更大的改善。从1990年到2009年，非裔美国人的卵巢癌存活率下降，但白人的存活率有所提高。在改善程度上没有明显的性别差异。与老年患者相比，年轻患者从最近的肿瘤学进步中受益更大。在所有癌症中，非裔美国人的存活率都比白人差，前列腺癌的存活率下降了，但卵巢癌的存活率增加了。确定与癌症存活率的不同改善相关的因素可以为未来所有人的癌症护理的改善提供信息。
Substantial progress has been made in cancer diagnosis and treatment, resulting in a steady improvement in cancer survival. The degree of improvement by age, race and sex remains unclear. to quantify the degree of survival improvement over time by age, race and sex in the United States. Longitudinal analyses of cancer follow-up data. Cancer diagnosis data for 1990–2009 and follow-up data to 2010 from nine population-based registries, part of the NCI Surveillance, Epidemiology, and End Results (SEER) program. Approximately 1.02 million patients from SEER registries diagnosed with cancer of the colon/rectum, breast, prostate, lung, liver, pancreas, or ovary from 1990–2009. Hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer-specific death were estimated for patients diagnosed with any of these cancers during, 1995–1999, 2000–2004, and 2005–2009, compared diagnoses in 1990–1994. Significant improvements in survival were found for cancers of the colon/rectum, breast, prostate, lung, and liver. Improvements were more pronounced for younger patients. For example, for patients aged 50–64 and diagnosed between 2005–2009, adjusted HRs (95%CI) were 0.57 (0.55–0.60), 0.48 (0.45–0.51), 0.61 (0.57–0.68), and 0.32 (0.30–0.36), for cancer of the colon/rectum, breast, liver and prostate, respectively, compared with the same age group of patients diagnosed during 1990–94. However, the corresponding HRs (95% CIs) for elderly patients (aged 75–85) were only 0.88 (0.84–0.82), 0.88 (0.84–0.92), 0.76 (0.69–0.84), and 0.65 (0.61–0.70), for the same four cancer sites, respectively. A similar, although weaker, age-related period effect was observed for lung and pancreatic cancers. The adjusted HRs (95%CIs) for lung cancer were 0.75 (95%CI, 0.73–0.77) and 0.84 (95%CI, 0.81–0.86), respectively, for patients aged 50 to 64 years and 75 to 85 years diagnosed between 2005 and 2009, compared with the same age groups of patients diagnosed between 1990 and 1994 (0.73 [95%CI, 0.69–0.77] and 0.90 [95%CI, 0.85–0.95], respectively. Compared with whites or Asians, African Americans experienced greater improvement in prostate cancer survival. From 1990 to 2009, ovarian cancer survival declined among African Americans, but improved among whites. No apparent sex difference in the degree of improvement was noted. Younger patients experienced greater benefit from recent oncology advances than elderly patients. African Americans experienced poorer survival than whites for all cancers, and the racial difference in cancer survival decreased for prostate cancer but increased for ovarian cancer. Identifying factors associated with varied improvement in cancer survival can inform future improvements in cancer care for all.