Thomson C S, Brewster D H, Dewar J A, Twelves C J
Trent Cancer Registry, 5 Old Fulwood Road, Sheffield S10 3TG, UK.
Eur J Cancer. 2004 Mar;40(5):743-53. doi: 10.1016/j.ejca.2003.08.029.
We investigated changes in survival, and their causes, in women with early breast cancer diagnosed in Scotland. The Scottish Cancer Registry identified 1617 and 2077 such women, without metastases at diagnosis who underwent surgery as part of their primary treatment, diagnosed in 1987 and 1993, respectively. There was a statistically significant 11% improvement in 8-year survival between 1987 and 1993. Survival improved across almost all clinical/pathological, treatment and health care delivery/deprivation categories; improvement was not limited to those women diagnosed through the screening programme. In a multivariate model, improved survival appeared to be explained largely by screening and clinical/pathological prognostic factors. Deprivation also had an adverse effect on survival; however, the geographical variation in survival observed for women diagnosed in 1987 was not apparent by 1993. We did not demonstrate a significant independent effect of surgical caseload on survival. We conclude that survival has increased partly as a consequence of screening and earlier diagnosis, but also due to improvements in the organisation and delivery of care.
我们调查了苏格兰确诊的早期乳腺癌女性患者的生存率变化及其原因。苏格兰癌症登记处分别确定了1987年和1993年诊断出的1617名和2077名此类女性患者，她们在诊断时无转移，且作为主要治疗的一部分接受了手术。1987年至1993年间，8年生存率有统计学意义的11%的提高。几乎所有临床/病理、治疗以及医疗服务提供/贫困类别中的生存率都有所提高；改善并不局限于通过筛查计划确诊的女性。在多变量模型中，生存率的提高似乎主要由筛查以及临床/病理预后因素所解释。贫困也对生存率有不利影响；然而，1987年诊断出的女性患者中观察到的生存率地理差异到1993年已不明显。我们没有证明手术病例数量对生存率有显著的独立影响。我们得出结论认为生存率的提高部分是筛查和早期诊断的结果，也是护理组织和提供方面改善的结果。
