Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study
Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study
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DOI：
10.1016/s1470-2045(07)70245-0
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发表时间：
2007-09-01
期刊：
影响因子：
51.1
通讯作者：
Santaquilani, Mariano
中科院分区：
文献类型：
--
作者：
Berrino, Franco;De Angelis, Roberta;Santaquilani, Mariano
背景EUROCARE是最大的基于人群的癌症患者生存合作研究。EUROCARE项目旨在定期监测、分析和解释生存趋势和国家间生存差异。这份报告（EUROCARE-4）提出了8个选定的癌症部位和所有癌症的组合，在1995年至1999年诊断的成年人（年龄2：15岁）欧洲人，并随访至2003年底的生存数据。方法我们分析了来自83个癌症登记处在23个欧洲国家的2699086例成人癌症病例，诊断于1995年至1999年，并随访至2003年12月。我们计算了八种主要癌症的国家特异性和平均加权年龄调整的5年相对生存率。此外，按国家卫生总支出（TNEH）排名的国家计算了所有癌症合并的病例组合调整的5年生存率。对1990- 94年确诊病例的生存率变化进行分析。（53.8% [95% CI 53.3-54.1]）、肺（12.3% [12.1-12.5]）、乳腺（78.9% [78.6-79.2]）、前列腺（75.7% [75.2-76.2]）和卵巢（36.3% [35.7-37. 0])北欧国家（除丹麦外）和中欧的癌症发病率最高，南欧居中，英国和爱尔兰较低，东欧最差。黑色素瘤（81.6% [81.0-82.3]）、睾丸癌（94.2% [93.4-95.0]）和霍奇金病（80.0% [79.0-81.0]）的生存率随地理位置变化不大。在大多数国家，全癌生存率与TNEH相关。与TNEH相似的国家相比，丹麦和英国的全癌生存率较低;芬兰的全癌生存率较高，但TNEH适中。在1990-94年和1995-99年的数据之间，特别是霍奇金病的存活率增加，国家间存活率差异缩小（范围66.1-82.9 [IQR 72.2-78.6] vs 74.0-83.9 [78.6-81.9]），结直肠（29.4-56.7 [45.8-54.1] vs 38.8-59.7 [50.7-57-5]）和乳腺癌（61.7-82.7 [72.3-78.3] vs 69.3-87.6 [76 - 6-82.7]）部位。解释随着时间的推移，这主要是由于生存率低的国家的卫生保健服务有所改善，这可能表明癌症护理有所改善。TNEH高的富裕国家通常有良好的癌症结局，但那些结局明显比TNEH相似的国家差的国家可能没有有效地分配卫生资源。
Background EUROCARE is the largest population-based cooperative study on survival of patients with cancer. The EUROCARE project aims to regularly monitor, analyse, and explain survival trends and between-country differences in survival. This report (EUROCARE-4) presents survival data for eight selected cancer sites and for all cancers combined, diagnosed in adult (aged 2:15 years) Europeans in 1995-99 and followed up until the end of 2003.Methods We analysed data from 83 cancer registries in 23 European countries on 2699086 adult cancer cases that were diagnosed in 1995-99 and followed up to December, 2003. We calculated country-specific and mean-weighted age-adjusted 5-year relative survival for eight major cancers. Additionally, case-mix-adjusted 5-year survival for all cancers combined was calculated by countries ranked by total national expenditure on health (TNEH). Changes to survival were analysed relative to cases diagnosed in 1990-94.Findings Mean age-adjusted 5-year relative survival for colorectal (53.8% [95% Cl 53.3-54.1]), lung (12.3% [12.1-12.5]), breast (78.9% [78.6-79.2]), prostate (75.7% [75.2-76.2]), and ovarian (36.3% [35.7-37. 0]) cancer was highest in Nordic countries (except Denmark) and central Europe, intermediate in southern Europe, lower in the UK and Ireland, and worst in eastern Europe. Survival for melanoma (81.6% [81.0-82.3]), cancer of the testis (94.2% [93.4-95.0]), and Hodgkin's disease (80.0% [79.0-81.0]) varied little with geography. All-cancer survival correlated with TNEH for most countries. Denmark and UK had lower all-cancer survival than countries with similar TNEH; Finland had high all-cancer survival, but moderate TNEH. Survival increased and intercountry survival differences narrowed between the data for 1990-94 and 1995-99 for, notably, Hodgkin's disease (range 66.1-82.9 [IQR 72.2-78.6] vs 74.0-83.9 [78.6-81.9]), colorectal (29.4-56.7 [45.8-54.1] vs 38.8-59.7 [50.7-57-5]), and breast (61.7-82.7 [72.3-78.3] vs 69.3-87.6 [76 - 6-82.7]) sites.Interpretation Increases in survival and decreases in geographic differences over time, which are mainly due to improvements in health-care services in countries with poor survival, might indicate better cancer care. Wealthy countries with high TNEH generally had good cancer outcomes, but those with conspicuously worse outcomes than those with similar TNEH might not be allocating health resources efficiently.