Deriving Valid Population-Based Cancer Survival Estimates in the Presence of Nonnegligible Proportions of Cancers Notified by Death Certificates Only
Deriving Valid Population-Based Cancer Survival Estimates in the Presence of Nonnegligible Proportions of Cancers Notified by Death Certificates Only
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DOI：
10.1158/1055-9965.epi-11-0697
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发表时间：
2011-12-01
影响因子：
3.8
通讯作者：
Holleczek, Bernd
中科院分区：
文献类型：
--
作者：
Brenner, Hermann;Holleczek, Bernd
背景：基于人群的癌症登记对癌症存活率的研究是监测抗癌进展的关键组成部分。仅由死亡证明(DCO)通知的患者通常被排除在此类研究之外。“排除DCO”方法的有效性受到了质疑，并提出了另一种“对DCO正确”的方法。方法：通过模型计算评估“排除DCO”方法和“DCO正确”方法的有效性。结果：在合理的假设下，“排除DCO”方法提供了(过于)乐观的生存估计，而“正确考虑DCO”方法提供了(也)悲观的生存估计。例如，在真实存活率为50%的情况下，低于5%的存活患者和15%的垂死患者(DCO病例的比例为7.7%)，这两种方法将分别提供52.8%和48.8%的生存率估计。随着登记的不完整和DCO病例的比例增加，两种方法获得的生存估计值的差异也增大。DCO病例的回溯使生存估计从前者转向后者。结论：在DCO比例不可忽略的情况下，癌症生存研究不应完全基于“排除DCO”或“正确的DCO”方法。这两种方法的联合估计可能有助于描绘真实生存的可信范围。影响：我们的结果可能有助于提高基于人群的癌症生存估计的有效性和可比性。癌症流行病学生物标记物；20(12)；2480-6。(C)2011年AACR。
Background: Studies of cancer survival by population-based cancer registries are a key component in monitoring progress against cancer. Patients notified by death certificates only (DCO) are commonly excluded from such studies. The validity of this "exclude DCO" approach has been questioned and an alternative "correct for DCO" approach has been proposed.Methods: We assess the validity of both the "exclude DCO" approach and the "correct for DCO" approach using model calculations. We illustrate implications for population-based cancer survival analyses by analyses of 5-year relative survival of cancer patients in Saarland, Germany.Results: The "exclude DCO" approach provides (too) optimistic survival estimates and the "correct for DCO" approach provides (too) pessimistic survival estimates under plausible assumptions. For example, in case of true survival of 50%, underascertainment of 5% of surviving patients and of 15% of dying patients (yielding a proportion of DCO cases of 7.7%), the two approaches would provide survival rate estimates of 52.8% and 48.8%, respectively. The difference of survival estimates obtained with both approaches increases with incompleteness of registration and the proportion of DCO cases. Trace back of DCO cases shifts survival estimates from the former toward the latter estimate.Conclusions: In case of nonnegligible DCO proportions, cancer survival studies should not be exclusively based on either the "exclude DCO" or the "correct for DCO" approach. A combination of estimates from both approaches may be useful to delineate a plausibility range for true survival.Impact: Our results may help to enhance validity and comparability of population-based cancer survival estimates. Cancer Epidemiol Biomarkers Prev; 20(12); 2480-6. (C) 2011 AACR.