Worldwide comparison of survival from childhood leukaemia for 1995-2009, by subtype, age, and sex (CONCORD-2): a population-based study of individual data for 89 828 children from 198 registries in 53 countries.
Worldwide comparison of survival from childhood leukaemia for 1995-2009, by subtype, age, and sex (CONCORD-2): a population-based study of individual data for 89 828 children from 198 registries in 53 countries.
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DOI：
10.1016/s2352-3026(17)30052-2
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发表时间：
2017-05
期刊：
影响因子：
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通讯作者：
CONCORD Working Group
中科院分区：
文献类型：
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作者：
Bonaventure A;Harewood R;Stiller CA;Gatta G;Clavel J;Stefan DC;Carreira H;Spika D;Marcos-Gragera R;Peris-Bonet R;Piñeros M;Sant M;Kuehni CE;Murphy MFG;Coleman MP;Allemani C;CONCORD Working Group
全球在获得医疗保健方面的不平等反映在癌症存活率的差异上。协和计划旨在评估以人群为基础的癌症存活率的全球差异和趋势。在这项以人群为基础的研究中，我们的目标是在全球范围内评估儿童白血病几种亚型的生存不平等。参与协和的癌症登记机构被要求提交所有在1995年1月1日至2009年12月31日期间被诊断患有白血病的0-14岁儿童的肿瘤登记，并跟踪到2009年12月31日。国际肿瘤学疾病分类第三版中的形态编码定义了血液学恶性肿瘤。我们排除了那些数据被判断为不太可靠的登记数据，或者只包括淋巴瘤，以及来自可用于分析的儿童数据少于10人的国家的数据。我们还因为缺少出生日期、诊断或最后已知的生命状态而排除了记录。我们使用适当的寿命表按诊断历期(1995-99、2000-04和2005-09)、性别和确诊年龄(包括1、1-4、5-9和10-14年，包括1、1-4、5-9和10-14年)估计了儿童的5年净生存率(即，在控制了其他原因的死亡后至少5年存活的概率)。我们估计了年龄标准化的净存活率，用于国际比较前体细胞急性淋巴细胞性白血病(ALL)和急性髓系白血病(AML)的生存趋势。我们分析了来自53个国家198个登记处的89名 828名儿童的数据。在1995-99年间，所有淋巴细胞性白血病合并的5年标化净存活率从中国登记的10.6%(95%可信区间3·1-18.2)到奥地利的86.8%(81.6-92.0)不等。直到2005年至2009年，儿童白血病5年生存率的国际差异仍然很大，当时淋巴细胞性白血病的年龄标准化生存率从哥伦比亚卡利的52.4%(95%可信区间42·8-61.9)到德国登记的91.6%(·5-93.6%)，急性髓细胞白血病的年龄标准化生存率从保加利亚的33.3%(18.9-47.7%)到德国登记的78.2%(72.084.3%)不等。前体细胞ALL的存活率与所有淋巴细胞性白血病的存活率总和非常接近，具有相似的变异。在大多数国家，在2000-04至2005-09年间，急性髓系白血病的存活率比所有国家的存活率提高得更多。每种类型白血病的存活率随年龄的变化明显不同：1-4岁和5-9岁儿童的存活率最高，而婴儿(1岁以下)的存活率最低。男孩和女孩之间的存活率没有系统性差异。全球儿童白血病存活率的不平等随着时间的推移而缩小，但对急性淋巴细胞白血病和急性髓细胞白血病来说仍然非常广泛。这些结果为卫生政策制定者提供了关于卫生保健系统有效性的有用信息，并为癌症政策制定者减少儿童癌症生存中的不平等提供了有用的信息。加拿大抗癌伙伴关系、北爱尔兰癌症焦点、新南威尔士州癌症研究所、英国癌症研究中心、美国疾病控制和预防中心、瑞士再保险公司、瑞士癌症研究基金会、瑞士癌症联盟和肯塔基大学。
Global inequalities in access to health care are reflected in differences in cancer survival. The CONCORD programme was designed to assess worldwide differences and trends in population-based cancer survival. In this population-based study, we aimed to estimate survival inequalities globally for several subtypes of childhood leukaemia. Cancer registries participating in CONCORD were asked to submit tumour registrations for all children aged 0–14 years who were diagnosed with leukaemia between Jan 1, 1995, and Dec 31, 2009, and followed up until Dec 31, 2009. Haematological malignancies were defined by morphology codes in the International Classification of Diseases for Oncology, third revision. We excluded data from registries from which the data were judged to be less reliable, or included only lymphomas, and data from countries in which data for fewer than ten children were available for analysis. We also excluded records because of a missing date of birth, diagnosis, or last known vital status. We estimated 5-year net survival (ie, the probability of surviving at least 5 years after diagnosis, after controlling for deaths from other causes [background mortality]) for children by calendar period of diagnosis (1995–99, 2000–04, and 2005–09), sex, and age at diagnosis (<1, 1–4, 5–9, and 10–14 years, inclusive) using appropriate life tables. We estimated age-standardised net survival for international comparison of survival trends for precursor-cell acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML). We analysed data from 89 828 children from 198 registries in 53 countries. During 1995–99, 5-year age-standardised net survival for all lymphoid leukaemias combined ranged from 10·6% (95% CI 3·1–18·2) in the Chinese registries to 86·8% (81·6–92·0) in Austria. International differences in 5-year survival for childhood leukaemia were still large as recently as 2005–09, when age-standardised survival for lymphoid leukaemias ranged from 52·4% (95% CI 42·8–61·9) in Cali, Colombia, to 91·6% (89·5–93·6) in the German registries, and for AML ranged from 33·3% (18·9–47·7) in Bulgaria to 78·2% (72·0–84·3) in German registries. Survival from precursor-cell ALL was very close to that of all lymphoid leukaemias combined, with similar variation. In most countries, survival from AML improved more than survival from ALL between 2000–04 and 2005–09. Survival for each type of leukaemia varied markedly with age: survival was highest for children aged 1–4 and 5–9 years, and lowest for infants (younger than 1 year). There was no systematic difference in survival between boys and girls. Global inequalities in survival from childhood leukaemia have narrowed with time but remain very wide for both ALL and AML. These results provide useful information for health policy makers on the effectiveness of health-care systems and for cancer policy makers to reduce inequalities in childhood cancer survival. Canadian Partnership Against Cancer, Cancer Focus Northern Ireland, Cancer Institute New South Wales, Cancer Research UK, US Centers for Disease Control and Prevention, Swiss Re, Swiss Cancer Research foundation, Swiss Cancer League, and the University of Kentucky.