Progress in cancer survival, mortality, and incidence in seven high-income countries 1995-2014 (ICBP SURVMARK-2): a population-based study
Progress in cancer survival, mortality, and incidence in seven high-income countries 1995-2014 (ICBP SURVMARK-2): a population-based study
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DOI：
10.1016/s1470-2045(19)30456-5
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发表时间：
2019-11-01
期刊：
影响因子：
51.1
通讯作者：
Bray, Freddie
中科院分区：
文献类型：
--
作者：
Arnold, Melina;Rutherford, Mark J.;Bray, Freddie
背景基于人群的癌症生存估计为癌症服务的有效性提供了有价值的见解，并可以反映治愈的前景。作为国际癌症基准伙伴关系(ICBP)第二阶段的一部分，高收入国家的癌症生存(SURVMARK-2)项目旨在全面概述七个高收入国家的癌症生存情况，并对相应的发病率和死亡率趋势进行比较评估。方法在这项基于人群的纵向研究中，我们收集了七个国家(澳大利亚、加拿大、丹麦、爱尔兰、新西兰、挪威和英国)21个司法管辖区的390万癌症患者的患者水平数据，涉及七个癌症部位(食道、胃、结肠、直肠、胰腺、肺、和卵巢)在1995年至2014年诊断，并随访到2015年12月31日。我们根据诊断部位、年龄组和诊断时期计算诊断后1年和5年的年龄标准化净存活率。我们将发病率和死亡率的变化与存活率的变化相对应，以评估癌症控制方面的进展。在19个符合条件的司法管辖区发现，3764543例癌症病例符合纳入研究的条件。在纳入的19个司法管辖区，1995-2014年间，每个国家几乎所有癌症类型的1年和5年净生存率都有所增加，例如，丹麦、爱尔兰和英国的5年直肠癌生存率增加了13个百分点以上。2010-14年度，澳大利亚、加拿大和挪威的存活率普遍高于新西兰、丹麦、爱尔兰和英国。在研究期间，观察到确诊时年龄在75岁以下的患者比年龄在75岁及以上的患者有更大的生存改善，特别是预后较差的癌症(即食道、胃、胰腺和肺癌)。在研究期间，胃癌、结肠癌、肺癌(男性)和卵巢癌在癌症控制方面的进展(即增加存活率、降低死亡率和发病率)是显而易见的。对发病率、死亡率和存活率趋势的联合评估表明，在研究的七种癌症中，有四种取得了进展。高收入国家的癌症存活率继续增加；然而，国际差距依然存在。虽然真正有效的比较需要注册实践、分类和编码方面的差异最小，但诊断时的疾病阶段、及时获得有效治疗以及合并疾病的程度可能是患者预后的主要决定因素。未来的研究需要评估这些因素的影响，以进一步了解癌症存活率的国际差异。
Background Population-based cancer survival estimates provide valuable insights into the effectiveness of cancer services and can reflect the prospects of cure. As part of the second phase of the International Cancer Benchmarking Partnership (ICBP), the Cancer Survival in High-Income Countries (SURVMARK-2) project aims to provide a comprehensive overview of cancer survival across seven high-income countries and a comparative assessment of corresponding incidence and mortality trends.Methods In this longitudinal, population-based study, we collected patient-level data on 3.9 million patients with cancer from population-based cancer registries in 21 jurisdictions in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway, and the UK) for seven sites of cancer (oesophagus, stomach, colon, rectum, pancreas, lung, and ovary) diagnosed between 1995 and 2014, and followed up until Dec 31, 2015. We calculated age-standardised net survival at 1 year and 5 years after diagnosis by site, age group, and period of diagnosis. We mapped changes in incidence and mortality to changes in survival to assess progress in cancer control.Findings In 19 eligible jurisdictions, 3 764 543 cases of cancer were eligible for inclusion in the study. In the 19 included jurisdictions, over 1995-2014, 1-year and 5-year net survival increased in each country across almost all cancer types, with, for example, 5-year rectal cancer survival increasing more than 13 percentage points in Denmark, Ireland, and the UK. For 2010-14, survival was generally higher in Australia, Canada, and Norway than in New Zealand, Denmark, Ireland, and the UK. Over the study period, larger survival improvements were observed for patients younger than 75 years at diagnosis than those aged 75 years and older, and notably for cancers with a poor prognosis (ie, oesophagus, stomach, pancreas, and lung). Progress in cancer control (ie, increased survival, decreased mortality and incidence) over the study period was evident for stomach, colon, lung (in males), and ovarian cancer.Interpretation The joint evaluation of trends in incidence, mortality, and survival indicated progress in four of the seven studied cancers. Cancer survival continues to increase across high-income countries; however, international disparities persist. While truly valid comparisons require differences in registration practice, classification, and coding to be minimal, stage of disease at diagnosis, timely access to effective treatment, and the extent of comorbidity are likely the main determinants of patient outcomes. Future studies are needed to assess the impact of these factors to further our understanding of international disparities in cancer survival.