Lang Kathleen, Korn Jonathan R, Lee David W, Lines Lisa M, Earle Craig C, Menzin Joseph
Boston Health Economics, Inc, Waltham, USA.
BMC Cancer. 2009 Jul 13;9:227. doi: 10.1186/1471-2407-9-227.
BACKGROUND: The purpose of this study was to estimate the relative impact of changes in demographics, stage at detection, treatment mix, and medical technology on 5-year survival among older colorectal cancer (CRC) patients. METHODS: We selected older patients diagnosed with CRC between 1992 and 2000 from the SEER-Medicare database and followed them through 2005. Trends in demographic characteristics, stage at detection and initial treatment mix were evaluated descriptively. Separate multivariate logistic regression models for colon (CC) and rectal cancer (RC) patients were estimated to isolate the independent effects of these factors along with technological change (proxied by cohort year) on 5-year survival. RESULTS: Our sample included 37,808 CC and 13,619 RC patients (combined mean +/- SD age: 77.2 +/- 7.0 years; 55% female; 87% white). In recent years, more CC patients were diagnosed at Stage I and fewer at Stages II and IV, and more RC patients were diagnosed at Stage I and fewer at Stages II and III. CC and RC patients diagnosed in later years were slightly older with somewhat better Charlson scores and were more likely to be female, from the Northeast, and from areas with higher average education levels. Surgery alone was more common in later years for CC patients while combined surgery, chemotherapy, and radiotherapy was more common for RC patients. Between 1992 and 2000, 5-year observed survival improved from 43.0% to 46.3% for CC patients and from 39.4% to 42.2% for RC patients. Multivariate logistic regressions indicate that patients diagnosed in 2000 had significantly greater odds of 5-year survival than those diagnosed in 1992 (OR: 1.35 for CC, 1.38 for RC). Our decomposition suggests that early detection had little impact on survival; rather, technological improvements (e.g., new medical technologies or more effective use of existing technologies) and changing demographics were responsible for the largest share of the change in 5-year survival in CC and RC between 1992 and 2000. CONCLUSION: Technological advances and changes in patient demographics had the largest impact on improved colorectal cancer survival during the study period.
背景：本研究旨在评估人口统计学变化、确诊分期、治疗组合及医疗技术对老年结直肠癌（CRC）患者5年生存率的相对影响。 方法：我们从监测、流行病学和最终结果（SEER）-医疗保险数据库中选取了1992年至2000年期间确诊为CRC的老年患者，并对他们进行随访直至2005年。对人口统计学特征、确诊分期和初始治疗组合的趋势进行了描述性评估。针对结肠癌（CC）和直肠癌（RC）患者分别建立多元逻辑回归模型，以分离这些因素以及技术变革（以队列年份为代理变量）对5年生存率的独立影响。 结果：我们的样本包括37808例CC患者和13619例RC患者（合并平均年龄±标准差：77.2±7.0岁；55%为女性；87%为白人）。近年来，更多的CC患者在I期被诊断出来，而在II期和IV期被诊断出来的患者减少；更多的RC患者在I期被诊断出来，而在II期和III期被诊断出来的患者减少。在后期被诊断出的CC和RC患者年龄稍大，查尔森评分略高，且更有可能是女性，来自东北部地区，以及平均教育水平较高的地区。近年来，单纯手术在CC患者中更为常见，而联合手术、化疗和放疗在RC患者中更为常见。1992年至2000年期间，CC患者的5年观察生存率从43.0%提高到46.3%，RC患者从39.4%提高到42.2%。多元逻辑回归表明，2000年确诊的患者5年生存几率显著高于1992年确诊的患者（OR：CC为1.35，RC为1.38）。我们的分解分析表明，早期检测对生存率影响不大；相反，技术进步（如新的医疗技术或对现有技术的更有效利用）和人口统计学变化是1992年至2000年期间CC和RC患者5年生存率变化的最大原因。 结论：在研究期间，技术进步和患者人口统计学变化对结直肠癌生存率的提高影响最大。
Dan Med J. 2012-4
Oncol Rep. 2011-6-8
Clin Gastroenterol Hepatol. 2009-2
Crit Rev Oncol Hematol. 2009-9
Asian Pac J Cancer Prev. 2018-11-28
Frontline Gastroenterol. 2018-4
Saudi J Gastroenterol. 2016
Clin Gastroenterol Hepatol. 2009-2
J Natl Cancer Inst. 2008-5-7
CA Cancer J Clin. 2007
Surg Endosc. 2006-4
CA Cancer J Clin. 2004
Zotero 插件
