de Rijke J M, van der Putten H W H M, Lutgens L C H W, Voogd A C, Kruitwagen R F P M, van Dijck J A A M, Schouten L J
Maastricht Cancer Registry, Comprehensive Cancer Centre Limburg, (IKL), PO Box 2208, The Netherlands.
Eur J Cancer. 2002 Oct;38(15):2041-7. doi: 10.1016/s0959-8049(02)00315-5.
Age at diagnosis has been proven to be an important determinant of the choice of initial treatment for several sites of cancer. Elderly patients are more likely to receive no treatment or less intensive treatment modalities. This study analysed the influence of age on treatment choice and survival in patients diagnosed with cervical cancer. This population-based study used data on 1176 new cases of invasive cervical cancer diagnosed in the period of 1986-1996 from three regional cancer registries in the Netherlands. All available information on treatment and survival (on 1 January 1998) was recorded. Relative survival rates were calculated according to the Hakulinen method. Relative risks (RR) for excess mortality due to the diagnosis of cervical cancer were calculated with a regression model for relative survival rates. Only 5% of the patients aged 70 years and older (n=224) were diagnosed with stage IA disease, compared with 11 and 30% of the patients aged 50-69 years and 49 years and younger, respectively. Almost 50% of the 70+ patients with stage IB-IIA were treated with radiotherapy as a single treatment modality, whereas 64% of the patients aged < or =49 years were treated with surgery alone. In all age groups, treatment for advanced stage disease (stage > or =IIB) was radiotherapy alone. No treatment was given to 10% of the patients aged 70 years and older, 5% of those aged 50-69 years and 1% of those aged 49 years and younger. Five-year relative survival was 69% (95% Confidence Interval (CI): 66-72%) and differed significantly (P=0.001) with age (70+ years: 49%; 50-69 years 58%; < or =49 years: 81%). Multivariate analyses on a subset of patients showed that age was not an independent prognostic factor, whereas stage and treatment modality were very important prognostic factors. Although elderly cancer patients were sometimes treated differently from younger patients, this was in accordance with the guidelines. Relative survival rates differed significantly by age. The multivariate analyses on the subset of patients also revealed that excess mortality increased with age. However, when adjustment was made for stage and treatment, this difference disappeared. The influence of treatment on survival is likely to be due to the selection of patients based on other characteristics, such as tumour volume, comorbidity and performance status.
诊断时的年龄已被证明是决定多种癌症初始治疗方案选择的一个重要因素。老年患者更有可能不接受治疗或接受强度较低的治疗方式。本研究分析了年龄对宫颈癌患者治疗选择和生存情况的影响。这项基于人群的研究使用了荷兰三个地区癌症登记处1986年至1996年期间诊断出的1176例浸润性宫颈癌新病例的数据。记录了所有关于治疗和生存情况（截至1998年1月1日）的可用信息。根据哈库利宁方法计算相对生存率。使用相对生存率回归模型计算因宫颈癌诊断导致的超额死亡率的相对风险（RR）。70岁及以上的患者中只有5%（n = 224）被诊断为IA期疾病，而50 - 69岁和49岁及以下患者的这一比例分别为11%和30%。70岁及以上IB - IIA期患者中近50%仅接受放射治疗作为单一治疗方式，而49岁及以下患者中有64%仅接受手术治疗。在所有年龄组中，晚期疾病（IIB期及以上）的治疗均为单纯放射治疗。70岁及以上患者中有10%未接受治疗，50 - 69岁患者中有5%未接受治疗，49岁及以下患者中有1%未接受治疗。五年相对生存率为69%（95%置信区间（CI）：66 - 72%），且因年龄不同而有显著差异（P = 0.001）（70岁及以上：49%；50 - 69岁：58%；49岁及以下：81%）。对一部分患者进行的多因素分析表明，年龄不是一个独立的预后因素，而分期和治疗方式是非常重要的预后因素。尽管老年癌症患者有时与年轻患者的治疗方式不同，但这符合指南。相对生存率因年龄不同而有显著差异。对这部分患者进行的多因素分析还显示，超额死亡率随年龄增加而升高。然而，在对分期和治疗进行调整后，这种差异消失了。治疗对生存的影响可能是由于根据其他特征（如肿瘤体积、合并症和体能状态）对患者进行了选择。
