Survival of Australian women with invasive epithelial ovarian cancer: a population-based study
Survival of Australian women with invasive epithelial ovarian cancer: a population-based study
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DOI：
10.5694/mja14.00132
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发表时间：
2014-09-01
影响因子：
11.4
通讯作者：
Jordan, Susan J.
中科院分区：
文献类型：
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作者：
Anuradha, Satyamurthy;Webb, Penelope M.;Jordan, Susan J.
目的：通过社会人口学和临床因素描述澳大利亚上皮性卵巢癌妇女的全国完整队列的生存模式。设计、环境和参与者：2005年所有1192名被诊断为侵袭性上皮性卵巢癌的妇女都是通过基于州的癌症登记处确定的。我们在2009年从他们的医疗记录中获得了详细的信息，并在2012年更新了生存数据。主要观察指标：3年、5年和7年粗生存率；3年和5年条件生存期；以及多变量Cox比例风险模型中参与者和癌症特征与生存之间关联的风险比（hr）。结果：总体粗5年生存率为35% （95% CI, 33%-38%）。对于诊断后1年以上的女性，有条件生存率适度增加，尽管对于诊断后2年的女性，再存活5年的概率仍然只有53% （95% CI, 49%-57%）。年龄增长和疾病分期与生存率差的关系最为密切。在对这些因素进行调整后，患有癌肉瘤（HRadj, 2.1 [95% CI, 1.3-3.2]）、透明细胞癌（HRadj,1.7 [95% CI, 1.2-2.3]）和粘液癌（HRadj, 2.6 [95% CI, 1.6-4.0]）的女性的生存率明显低于患有浆液性癌症的女性。诊断时腹水的存在（HRadj,1.5 [95% CI, 1.3-1.8]）、Charlson合并症评分3 （HRadj,1.5 [95% CI, 1.1-2.1]）、相对社会经济劣势（HRadj,1.2 [95% CI, 1.1-1.4]）和区域偏远居住（HRadj,1.2 [95% CI, 1.0-1.4]）也与较差的生存率相关。结论：除了预期的年龄和分期的不良反应外，我们还发现了组织学亚型、腹水存在和合并症的生存差异。地理和社会经济差异是否与获得治疗或其他因素有关，值得进一步调查。有条件生存估计证实，卵巢癌妇女的长期预后仍然很差，这加强了预防和更好治疗的必要性。
Objective: To describe survival patterns in a nationally complete cohort of Australian women with epithelial ovarian cancer, by sociodemographic and clinical factors.Design, setting and participants: All 1192 women diagnosed with invasive epithelial ovarian cancer in 2005 were identified through state-based cancer registries. We obtained detailed information from their medical records in 2009 and updated survival data in 2012.Main outcome measures: Crude 3-year, 5-year and 7-year survival rates; 3-year and 5-year conditional survival; and hazard ratios (HRs) for the association of participant and cancer characteristics with survival, from multivariable Cox proportional hazards models.Results: Overall crude 5-year survival was 35% (95% CI, 33%-38%). Conditional survival increased moderately for women who lived beyond a year from diagnosis, although for women alive 2 years after diagnosis, the probability of surviving a further 5 years was still only 53% (95% CI, 49%-57%). Increasing age and disease stage were most strongly associated with poor survival. After adjusting for these, survival was significantly worse for women with carcinosarcomas (HRadj, 2.1 [95% CI, 1.3-3.2]), clear cell (HRadj,1.7 [95% CI, 1.2-2.3]) and mucinous (HRadj, 2.6 [95% CI, 1.6-4.0]) cancers than for women with serous cancers. Presence of ascites at diagnosis (HRadj,1.5 [95% CI, 1.3-1.8]), Charlson comorbidity score 3 (HRadj, 1.5 [95% CI, 1.1-2.1]), relative socioeconomic disadvantage (HRadj,1.2 [95% CI, 1.1-1.4]) and regional remote residence (HRadj, 1.2 [95% CI, 1.0-1.4]) were also associated with poorer survival.Conclusions: Along with expected adverse effects of age and stage, we found survival differences by histological subtype, presence of ascites and comorbidities. Whether geographic and socioeconomic differences relate to treatment access or other factors warrants further investigation. Conditional survival estimates confirm the ongoing poor long-term prognosis for women with ovarian cancer, reinforcing the need for prevention and better treatments.