Recent cancer survival in Europe: a 2000-02 period analysis of EUROCARE-4 data
Recent cancer survival in Europe: a 2000-02 period analysis of EUROCARE-4 data
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DOI：
10.1016/s1470-2045(07)70246-2
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发表时间：
2007-09-01
期刊：
影响因子：
51.1
通讯作者：
Kunkler, Ian
中科院分区：
文献类型：
--
作者：
Verdecchia, Arduino;Francisci, Silvia;Kunkler, Ian
传统的癌症生存分析在研究期开始时提供癌症管理的数据，并且通常与当前的实践无关，因为它们指的是使用可能不再使用的旧方案治疗的患者的生存。因此，缩短提供生存估计的延迟是可取的。周期分析可以通过使用最近的数据来估计癌症的生存。我们的目的是将周期分析方法应用于欧洲癌症登记处收集的数据，以估计各国和癌症部位的近期生存率，并评估欧洲的生存率变化。我们还将我们的发现与美国SEER（监测、流行病学和最终结果）项目中关于美国癌症生存的数据进行了比较。方法：我们分析了2000- 2002年诊断为癌症的患者的生存数据，这些数据来自参与EUROCARE-4研究的47个欧洲癌症登记处。2000- 2002年诊断的患者的5年相对生存期是不同随访时间队列的间隔特异性相对生存值的乘积。对2000-02年诊断的患者的5年生存概况进行了欧洲平均值和欧洲5个地区的估计，并将研究结果与2000-02年诊断的患者的美国SEER注册数据进行了比较。对1991-2002年诊断的患者的5年生存概况和1997-2002年诊断的患者的10年生存概况也按时期法对所有恶性肿瘤、地理区域和癌症部位进行了估计。研究结果：对于所有癌症，2000- 2002年确诊的患者，年龄调整后的5年生存率均有所提高，尤其是结直肠癌、乳腺癌、前列腺癌和甲状腺癌、霍奇金病和非霍奇金淋巴瘤患者。2000- 2002年欧洲平均年龄调整5年生存率较高的是睾丸癌（97.3% [95% CI 96.4-98.2]）和黑色素瘤（86.1%[84.3-88]）。[0])，甲状腺癌（83.2%）[80.9-85]。[6])，何杰金氏病（81.4%[78.9-84]）。1])，女性乳腺癌(79.0%[78.1-80]。[0])、子宫体（78.0%[76.2-79.9]）和前列腺癌（77.5% [76.5-78.6]）；胃癌（24.9%[23.7-26.2]）、慢性髓性白血病（32.2%[29.0-3 5.7]）、急性髓性白血病较低。(14.8%[13.4 - -16.4]),肺癌(10 - 9%[10.5 - -11.4])。2000- 2002年诊断的患者生存率一般在北欧国家最高，在东欧国家最低，尽管1991-2002年期间，东欧患者在主要癌症部位的生存率提高最高（结直肠癌为30.3%[28.3-32]）。[5]至44.7% [42.8- 46.7]；乳腺癌从60%[57.2-63.0]上升至73.9% [71.7-76.2]；前列腺癌从39.5%[35.0-44.6]到68.0%[64 - 2-72.1])。对于所有实体肿瘤，除了胃癌、睾丸癌和软组织癌，美国SEER登记中2000- 2002年诊断的患者生存率高于欧洲平均水平。对于血液系统恶性肿瘤，除了非霍奇金淋巴瘤外，2000- 2002年美国SEER登记数据和欧洲平均值具有可比性。癌症服务基础设施、预防和筛查规划、获得诊断和治疗设施、肿瘤部位特异性方案、多学科管理、循证临床指南的应用以及临床试验的招募可能是我们在结果中注意到的大部分差异的原因。
Background Traditional cancer-survival analyses provide data on cancer management at the beginning of a study period, and are often not relevant to current practice because they refer to survival of patients treated with older regimens that might no longer be used. Therefore, shortening the delay in providing survival estimates is desirable. Period analysis can estimate cancer survival by the use of recent data. We aimed to apply the period-analysis method to data that were collected by European cancer registries to estimate recent survival by country and cancer site, and to assess survival changes in Europe. We also compared our findings with data on cancer survival in the USA from the US SEER (Surveillance, Epidemiology, and End Results) programme.Methods We analysed survival data for patients diagnosed with cancer in 2000-02, collected from 47 of the European cancer registries participating in the EUROCARE-4 study. 5-year period relative survival for patients diagnosed in 2000-02 was estimated as the product of interval-specific relative survival values of cohorts with different lengths of follow-up. 5-year survival profiles for patients diagnosed in 2000-02 were estimated for the European mean and for five European regions, and findings were compared with US SEER registry data for patients diagnosed in 2000-02. A 5-year survival profile for patients diagnosed in 1991-2002 and a 10-year survival profile for patients diagnosed in 1997-2002 were also estimated by the period method for all malignancies, by geographical area, and by cancer site.Findings For all cancers, age-adjusted 5-year period survival improved for patients diagnosed in 2000-02, especially for patients with colorectal, breast, prostate, and thyroid cancer, Hodgkin's s disease, and non-Hodgkin lymphoma. The European mean age-adjusted 5-year survival calculated by the period method for 2000-02 was high for testicular cancer (97.3% [95% CI 96.4-98.2]), melanoma (86.1% [84.3-88 .0]), thyroid cancer (83.2% [80.9-85 . 6]), Hodgkin' s disease (81.4% [78.9-84. 1]), female breast cancer (79.0% [78.1-80 . 0]), corpus uteri (78.0% [76.2-79.9]), and prostate cancer (77.5% [76.5-78.6]); and low for stomach cancer (24.9% [23.7-26.2]), chronic myeloid leukaemia (32.2% [29.0-3 5.7]), acute myeloid leukaemia. (14.8% [13.4-16.4]), and lung cancer (10 - 9% [10.5-11.4]). Survival for patients diagnosed in 2000-02 was generally highest for those in northem European countries and lowest for those in eastem European countries, although, patients in eastern European had the highest improvement in survival for major cancer sites during 1991-2002 (colorectal cancer from 30.3% [28.3-32 .5] to 44.7% [42.8-46 .7]; breast cancer from 60% [57.2-63.0] to 73.9% [71.7-76.2]; for prostate cancer from 39.5% [35.0-44.6] to 68.0% [64 - 2-72.1]). For all solid tumours, with the exception of stomach, testicular, and soft-tissue cancers, survival for patients diagnosed in 2000-02 was higher in the US SEER registries than for the European mean. For haematological malignancies, data from US SEER registries and the European mean were comparable in 2000-02, except for non-Hodgkin lymphoma.Interpretation Cancer-service infrastructure, prevention and screening programmes, access to diagnostic and treatment facilities, tumour-site-specific protocols, multidisciplinary management, application of evidence-based clinical guidelines, and recruitment to clinical trials probably account for most of the differences that we noted in outcomes.