Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study.
Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study.
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DOI：
10.1136/bmjopen-2013-003055
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发表时间：
2013-09-10
期刊：
影响因子：
2.9
通讯作者：
Coleman MP
中科院分区：
文献类型：
--
作者：
Allemani C;Rachet B;Weir HK;Richardson LC;Lepage C;Faivre J;Gatta G;Capocaccia R;Sant M;Baili P;Lombardo C;Aareleid T;Ardanaz E;Bielska-Lasota M;Bolick S;Cress R;Elferink M;Fulton JP;Galceran J;Gózdz S;Hakulinen T;Primic-Zakelj M;Rachtan J;Diba CS;Sánchez MJ;Schymura MJ;Shen T;Tagliabue G;Tumino R;Vercelli M;Wolf HJ;Wu XC;Coleman MP
评估诊断阶段和对治疗指南的遵守程度可以在多大程度上解释美国和欧洲结直肠癌生存率的持续差异。这是一项高分辨率研究，使用有关杜克斯分期、诊断程序、治疗和随访的详细临床数据，由训练有素的提取者根据单一方案直接从病历中收集，并进行标准化质量控制和中央统计分析。美国七个州和欧洲九个国家的 21 个人口登记处提供了 1996 年至 1998 年间诊断患有结直肠癌的 12523 名成年人（15-99 岁）的随机样本数据。使用逻辑回归模型来比较美国和欧洲对“标准护理”的遵守情况。使用灵活的参数模型估计净生存率和超额死亡风险。 Dukes A 和 B 肿瘤的比例在美国和欧洲相似，而 Dukes C 肿瘤在美国更为常见（38% 对 21%），Dukes D 肿瘤在欧洲更为常见（22% 对 10%）。在美国，以治疗为目的的切除术更为常见（85% vs 75%）。老年患者（75-99岁）接受放疗和化疗的可能性降低70-90%。美国 (58%) 以及北欧和西欧 (54-56%) 的年龄标准化 5 年净生存率相似，东欧最低 (42%)。诊断后 5 年内的平均超额风险在东欧最高，尤其是老年患者和患有 Dukes’D 肿瘤的患者。 20世纪90年代末欧洲和美国结直肠癌生存率的巨大差异可能归因于美国的早期阶段和更广泛地使用手术和辅助治疗。老年结直肠癌患者接受手术、化疗或放疗的频率低于年轻患者，尽管有证据表明他们也可能受益。
To assess the extent to which stage at diagnosis and adherence to treatment guidelines may explain the persistent differences in colorectal cancer survival between the USA and Europe. A high-resolution study using detailed clinical data on Dukes’ stage, diagnostic procedures, treatment and follow-up, collected directly from medical records by trained abstractors under a single protocol, with standardised quality control and central statistical analysis. 21 population-based registries in seven US states and nine European countries provided data for random samples comprising 12 523 adults (15–99 years) diagnosed with colorectal cancer during 1996–1998. Logistic regression models were used to compare adherence to ‘standard care’ in the USA and Europe. Net survival and excess risk of death were estimated with flexible parametric models. The proportion of Dukes’ A and B tumours was similar in the USA and Europe, while that of Dukes’ C was more frequent in the USA (38% vs 21%) and of Dukes’ D more frequent in Europe (22% vs 10%). Resection with curative intent was more frequent in the USA (85% vs 75%). Elderly patients (75–99 years) were 70–90% less likely to receive radiotherapy and chemotherapy. Age-standardised 5-year net survival was similar in the USA (58%) and Northern and Western Europe (54–56%) and lowest in Eastern Europe (42%). The mean excess hazard up to 5 years after diagnosis was highest in Eastern Europe, especially among elderly patients and those with Dukes’ D tumours. The wide differences in colorectal cancer survival between Europe and the USA in the late 1990s are probably attributable to earlier stage and more extensive use of surgery and adjuvant treatment in the USA. Elderly patients with colorectal cancer received surgery, chemotherapy or radiotherapy less often than younger patients, despite evidence that they could also have benefited.
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影响因子：
2
作者：
Danieli, Coraline;Remontet, Laurent;Belot, Aurelien
通讯作者：
Belot, Aurelien
影响因子：
158.5
作者：
Kapiteijn, E;Marijnen, CAM;van de Velde, CJH
通讯作者：
van de Velde, CJH
影响因子：
3.1
作者：
Gatta, Gemma;Zigon, Giulia;Faivre, Jean
通讯作者：
Faivre, Jean
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Innos, Kaire;Soplepmann, Jaan;Aareleid, Tiiu
通讯作者：
Aareleid, Tiiu
影响因子：
6.8
作者：
AKAIKE, H
通讯作者：
AKAIKE, H