Annual Report to the Nation on the Status of Cancer, 1975-2014, Featuring Survival.
Annual Report to the Nation on the Status of Cancer, 1975-2014, Featuring Survival.
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DOI：
10.1093/jnci/djx030
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发表时间：
2017-09-01
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影响因子：
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通讯作者：
Weir HK
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作者：
Jemal A;Ward EM;Johnson CJ;Cronin KA;Ma J;Ryerson B;Mariotto A;Lake AJ;Wilson R;Sherman RL;Anderson RN;Henley SJ;Kohler BA;Penberthy L;Feuer EJ;Weir HK
背景资料：美国癌症协会（ACS），疾病控制和预防中心（CDC），国家癌症研究所（NCI）和北美中央癌症登记协会（NAACCR）合作提供美国癌症发生和趋势的年度更新。这份年度报告强调了存活率。方法：数据来自CDC和NCI资助的基于人群的癌症登记项目，并由NAACCR汇编。通过联合点分析估计了所有癌症合并以及按性别列出的主要癌症类型的年龄标准化发病率和死亡率趋势，并表示为年度百分比变化。我们使用相对生存率和经考克斯回归模型校正的癌症诊断后的相对死亡风险（风险比[HR]）来检查生存率随时间和社会人口因素的变化或差异。 结果如下：从2010年到2014年，男性的总体癌症死亡率每年下降1.8%（95%置信区间[CI] = -1.8至-1.8），女性每年下降1.4%（95% CI = -1.4至-1.3），儿童每年下降1.6%（95% CI = -2.0至-1.3）。男性16种最常见癌症中的11种和女性18种最常见癌症中的13种的死亡率下降，包括肺癌、结直肠癌、女性乳腺癌和前列腺癌，而肝癌（男性和女性）、胰腺癌（男性）、脑癌（男性）和子宫癌的死亡率上升。相比之下，2009年至2013年，男性的总体发病率每年下降2.3%（95% CI = -3.1至-1.4），但女性保持稳定。对于几种但不是所有的癌症类型，早期和晚期疾病的生存率随着时间的推移在统计学上显着改善。例如，在1975年至1977年以及2006年至2012年期间，远距离疾病的五年相对生存率从18.7%显著增加（95% CI = 16.9%至20.6%）至33.6%（95% CI = 32.2%至35.0%），但肝癌未发生（从1.1%，95% CI = 0.3%至2.9%，至2.3%，95% CI = 1.6%至3.2%）。生存率因种族/民族和州而异。例如，与非西班牙裔白人相比，非西班牙裔黑人中所有癌症合并的校正相对死亡风险高33%（HR = 1.33，95%CI = 1.32至1.34），非西班牙裔美国印第安人/阿拉斯加原住民高51%（HR = 1.51，95%CI = 1.46至1.56）。 结论：美国的癌症死亡率继续下降。然而，在降低死亡率和提高存活率方面，若干癌症类型的进展有限，这突出表明需要加紧努力，发现新的预防、早期发现和治疗战略，并广泛和公平地采用经证明有效的预防措施。
Background: The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate to provide annual updates on cancer occurrence and trends in the United States. This Annual Report highlights survival rates. Methods: Data were from the CDC- and NCI-funded population-based cancer registry programs and compiled by NAACCR. Trends in age-standardized incidence and death rates for all cancers combined and for the leading cancer types by sex were estimated by joinpoint analysis and expressed as annual percent change. We used relative survival ratios and adjusted relative risk of death after a diagnosis of cancer (hazard ratios [HRs]) using Cox regression model to examine changes or differences in survival over time and by sociodemographic factors. Results: Overall cancer death rates from 2010 to 2014 decreased by 1.8% (95% confidence interval [CI] = –1.8 to –1.8) per year in men, by 1.4% (95% CI = –1.4 to –1.3) per year in women, and by 1.6% (95% CI = –2.0 to –1.3) per year in children. Death rates decreased for 11 of the 16 most common cancer types in men and for 13 of the 18 most common cancer types in women, including lung, colorectal, female breast, and prostate, whereas death rates increased for liver (men and women), pancreas (men), brain (men), and uterine cancers. In contrast, overall incidence rates from 2009 to 2013 decreased by 2.3% (95% CI = –3.1 to –1.4) per year in men but stabilized in women. For several but not all cancer types, survival statistically significantly improved over time for both early and late-stage diseases. Between 1975 and 1977, and 2006 and 2012, for example, five-year relative survival for distant-stage disease statistically significantly increased from 18.7% (95% CI = 16.9% to 20.6%) to 33.6% (95% CI = 32.2% to 35.0%) for female breast cancer but not for liver cancer (from 1.1%, 95% CI = 0.3% to 2.9%, to 2.3%, 95% CI = 1.6% to 3.2%). Survival varied by race/ethnicity and state. For example, the adjusted relative risk of death for all cancers combined was 33% (HR = 1.33, 95% CI = 1.32 to 1.34) higher in non-Hispanic blacks and 51% (HR = 1.51, 95% CI = 1.46 to 1.56) higher in non-Hispanic American Indian/Alaska Native compared with non-Hispanic whites. Conclusions: Cancer death rates continue to decrease in the United States. However, progress in reducing death rates and improving survival is limited for several cancer types, underscoring the need for intensified efforts to discover new strategies for prevention, early detection, and treatment and to apply proven preventive measures broadly and equitably.