Yu Xue Q, O'Connell Dianne L, Gibberd Robert W, Smith David P, Dickman Paul W, Armstrong Bruce K
Cancer Epidemiology Research Unit, The Cancer Council New South Wales, P. O. Box 572, Kings Cross, NSW, 1340, Australia.
Cancer Causes Control. 2004 Aug;15(6):611-8. doi: 10.1023/B:CACO.0000036165.13089.e8.
To improve estimation of regional variation in cancer survival and identify cancers to which priority might be given to increase survival.
Survival measures were calculated for 25 major cancer types diagnosed in each of 17 health service regions in New South Wales, Australia, from 1991 to 1998. Region-specific risks of excess death due to cancer were estimated adjusting for age, sex, and extent of disease at, and years since, diagnosis. Empirical Bayes (EB) methods were used to shrink the estimates. The additional numbers of patients who would survive beyond five years were estimated by shifting the State average risk to the 20th centile.
Statistically significant regional variation in the shrunken estimates of risk of excess death was found for nine of the 25 cancer types. The lives of 2903 people (6.4%) out of the 45,047 whose deaths within 5 years were attributable to cancer could be extended with the highest number being for lung cancer (791).
The EB approach gives more precise estimates of region-specific risk of excess death and is preferable to standard methods for identifying cancer sites where gains in survival might be made. The estimated number of lives that could be extended can assist health authorities in prioritising investigation of and attention to causes of regional variation in survival.
改进对癌症生存率区域差异的估计，并确定可能优先考虑提高生存率的癌症类型。
计算了1991年至1998年在澳大利亚新南威尔士州17个卫生服务区域中每个区域诊断出的25种主要癌症类型的生存指标。针对年龄、性别以及诊断时疾病的范围和诊断后的年份，对因癌症导致的额外死亡的区域特定风险进行了估计。采用经验贝叶斯（EB）方法对估计值进行收缩。通过将州平均风险转移到第20百分位数来估计五年后存活的额外患者数量。
在25种癌症类型中的9种中，发现收缩后的额外死亡风险估计值存在统计学上显著的区域差异。在5年内死亡归因于癌症的45047人中，有2903人（6.4%）的生命可以延长，其中肺癌人数最多（791人）。
经验贝叶斯方法能更精确地估计区域特定的额外死亡风险，并且比标准方法更适合识别可能提高生存率的癌症部位。估计的可延长生命数量可帮助卫生当局确定对生存区域差异原因进行调查和关注的优先次序。
