Survival from cancer of the pancreas in England and Wales up to 2001
Survival from cancer of the pancreas in England and Wales up to 2001
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DOI：
10.1038/sj.bjc.6604576
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发表时间：
2008-09-23
影响因子：
8.8
通讯作者：
Coleman, M. P.
中科院分区：
文献类型：
--
作者：
Mitry, E.;Rachet, B.;Coleman, M. P.
胰腺癌占男女癌症总数的3%，每年约有6000例新发病例（库珀等人，2005）。胰腺癌的唯一已知风险因素是吸烟（Lowenfels，1984）。自20世纪70年代中期以来，男性的发病率下降了约10-15%，但女性的发病率略有上升，目前男性和女性的年发病率相似，约为10/100000（Quinn等人，2001）。然而，由于事件病例登记不足和死亡证明过多，发病率和死亡率可能存在偏倚（Remontet et et al，2003）。在这种情况下，在生活中登记诊断为胰腺癌的患者的生存率作为结果的衡量标准特别重要。胰腺癌是最严重的疾病之一：1990-1994年诊断的患者的欧洲平均相对5年生存率低于4%（Sant et al，2003）。我们分析了1986-1999年期间在英格兰和威尔士登记的62815例胰腺癌患者的数据，其中只有74%明显符合条件。超过五分之一（22%）的病例必须从生存分析中排除，因为他们记录的生存率为零（诊断日期与死亡日期相同）：有些人实际上在诊断当天死亡，但大多数人仅从死亡证明（DCO）登记，他们的生存时间未知。在国家数据中，已知约3%的病例是DCO，但这一比例因登记而异，并且无法可靠地将其与国家数据中的真零生存病例区分开来。记录的存活率为零的病例比例从20世纪70年代的12 - 14%上升到20世纪90年代的19-22%（科尔曼等人，1999）。由于他们代表了如此大比例的符合生存分析条件的患者，并且他们的生存期可能短于平均生存期（Berrino et al，1995），因此需要考虑排除他们对观察到的生存期趋势和不平等的影响。在全国范围内，这类案件的比例在19- 25%之间略有波动。然而，这类病例比例的趋势在各地区之间差异很大：北方和约克郡、东安格利亚和牛津郡稳定且相对较低（6-11%）;最初较高但迅速下降（泰晤士河、威尔士）;或最初较低但迅速上升（南部和西部、西米德兰）。
Cancer of the pancreas accounts for some 3% of cancer in both sexes combined, with about 6000 new cases a year (Cooper et al, 2005). The only established risk factor for pancreatic cancer is tobacco smoking (Lowenfels, 1984). Incidence has fallen some 10–15% since the mid-1970s in men but has risen slightly in women, and annual incidence in both sexes is now similar at about 10 per 100000 (Quinn et al, 2001). Both incidence and mortality rates may be biased, however, by under-registration of incident cases and an over-certification of deaths (Remontet et al, 2003). In this context, the survival of patients who were registered with a diagnosis of pancreatic cancer in life assumes particular importance as a measure of outcome. Pancreatic cancer has one of the worst prognoses: the European mean relative 5-year survival rate for patients diagnosed during 1990–1994 was less than 4%(Sant et al, 2003).We analysed the data for 62815 patients registered with pancreatic cancer in England and Wales during the period 1986–1999, only 74% of those were apparently eligible. More than a fifth (22%) of all cases had to be excluded from survival analysis because their recorded survival was zero (date of diagnosis same as date of death): some will in fact have died on the day of diagnosis, but most were registered from a death certificate only (DCO), and their survival time was unknown. Some 3% of cases in the national data were known to have been DCOs, but the proportion varied by registry, and they could not be reliably distinguished from cases with true zero survival in the national data. The proportion of cases whose recorded survival was zero rose from 12 to 14% in the 1970s to 19–22% in the 1990s (Coleman et al, 1999). As they represent such a large proportion of patients who were otherwise eligible for survival analysis, and who may have shorter than average survival (Berrino et al, 1995), the impact of their exclusion on observed trends and inequalities in survival needs to be considered. Nationally, the proportion of such cases fluctuated slightly within the range 19–25%. Trends in the proportion of such cases, however, varied very widely among regions: stable and relatively low (6–11%) in Northern and Yorkshire, East Anglia and Oxfordshire; initially high but falling rapidly (Thames, Wales); or initially low but rising rapidly (South and West, West Midlands).