Stage at diagnosis is a key explanation of differences in breast cancer survival across Europe
Stage at diagnosis is a key explanation of differences in breast cancer survival across Europe
复制标题
DOI：
10.1002/ijc.11226
复制
发表时间：
2003-09-01
影响因子：
6.4
通讯作者：
Berrino, F
中科院分区：
文献类型：
--
作者：
Sant, M;Allemani, C;Berrino, F
我们使用多元回归模型评估了诊断时的疾病分期对1990-1992年4，478名诊断为乳腺癌的患者的5年相对生存率的影响。这些病例是来自6个欧洲国家（爱沙尼亚、法国、意大利、荷兰、西班牙和英国）17个基于人群的癌症登记处的代表性样本，根据相似的生存率将其合并为9个地区组。总体5年相对生存率为79%，从早期淋巴结阴性（T1 N 0 M0）肿瘤的98%;大型淋巴结阴性（T2- 3 N 0 M0）肿瘤的87%;淋巴结阳性（T1- 3 N +M0）肿瘤的76%和局部晚期（T4 NxM 0）肿瘤的55%到转移性（M1）肿瘤的18%和未指明分期的肿瘤的69%。在欧洲，每个疾病阶段的相对生存率有相当大的差异，但这在早期淋巴结阴性肿瘤中最不明显。法国Bas-Rhin、Cote d 'Or、Herault和Isere组的总体5年相对生存率最高（86%），爱沙尼亚组最低（66%）。这些地理群体的特点是早期疾病妇女的百分比最高和最低（T1 N 0 M0：分别为39%和9%）。法国、荷兰和意大利组的手术病例比例最高。腋窝淋巴结检查的数量，一个影响淋巴结状态的因素，是最高的意大利和西班牙。在调整TNM分期和检查的淋巴结数量后，生存差异大大减少，表明对于1990-1992年在欧洲诊断为乳腺癌的这些妇女，生存差异主要是由于诊断时的分期差异。然而，在3个区域组中，即使在这些调整后，死亡的相对风险仍然很高，这表明治疗不是最佳的。一旦考虑到分期，乳腺癌筛查似乎并不影响生存模式。(C)2003 Wiley-Liss，Inc.
We used multiple regression models to assess the influence of disease stage at diagnosis on the 5-year relative survival of 4,478 patients diagnosed with breast cancer in 1990-1992. The cases were representative samples from 17 population-based cancer registries in 6 European countries (Estonia, France, Italy, Netherlands, Spain and UK) that were combined into 9 regional groups based on similar survival. Five-year relative survival was 79% overall, varying from 98% for early, node-negative (T1N0M0) tumours; 87% for large, node-negative (T2-3N0M0) tumours; 76% for node-positive (T1-3N+M0) tumours and 55% for locally advanced (T4NxM0) tumours to 18% for metastatic (M 1) tumours and 69% for tumours of unspecified stage. There was considerable variation across Europe in relative survival within each disease stage, but this was least marked for early node-negative tumours. Overall 5-year relative survival was highest in the French group of Bas-Rhin, Cote d'Or, Herault and Isere (86%), and lowest in Estonia (66%). These geographic groups were characterised by the highest and lowest percentages of women with early stage disease (T1N0M0: 39% and 9%, respectively). The French, Dutch and Italian groups had the highest percentage of operated cases. The number of axillary nodes examined, a factor influencing nodal status, was highest in Italy and Spain. After adjusting for TNM stage and the number of nodes examined, survival differences were greatly reduced, indicating that for these women, diagnosed with breast cancer in Europe during 1990-1992, the survival differences were mainly due to differences in stage at diagnosis. However, in 3 regional groups, the relative risks of death remained high even after these adjustments, suggesting less than optimal treatment. Screening for breast cancer did not seem to affect the survival patterns once stage had been taken into account. (C) 2003 Wiley-Liss, Inc.