Ioka Akiko, Ito Yuri, Tsukuma Hideaki
Department of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Asian Pac J Cancer Prev. 2009 Jul-Sep;10(3):457-62.
Poor survival of older cervical cancer patients has been reported; however, related factors, such as the extent of disease and the competitive risk by aging have not been well evaluated. We applied the relative survival model developed by Dickman et al to resolve this issue. Study subjects were cervical cancer patients retrieved from the Osaka Cancer Registry. They were limited to the 10,048 reported cases diagnosed from 1975 to 1999, based on the quality of data collection on vital status. Age at diagnosis was categorized into <30, 30-54, 55-64, and > or = 65 years. The impact of prognostic factors on 5-year survival was evaluated with the relative survival model, incorporating patients' expected survival in multivariate analysis. The age-specific relative excess risk (RER) of death was significantly higher for older groups as compared with women aged 30-54 years (RER, 1.58 at 55-64 and 2.51 at > or = 65 years). The RER was decreased by 64.8% among the 55-64 year olds as an effect of cancer stage at diagnosis, and by 43.4% among those 65 years old and over. After adding adjustment for treatment modalities, the RER was no longer significantly higher among 55-64 year olds; however, it was still higher among 65 year olds and over. Advanced stage at diagnosis was the main determinant of poor survival among the aged cervical cancer patients, although other factors such as limitations on the combination of treatment were also suggested to have an influence in those aged 65 years and over.
据报道，老年宫颈癌患者的生存率较低；然而，疾病程度和衰老带来的竞争风险等相关因素尚未得到充分评估。我们应用Dickman等人开发的相对生存模型来解决这一问题。研究对象是从大阪癌症登记处检索到的宫颈癌患者。基于生命状态数据收集的质量，他们仅限于1975年至1999年报告的10048例病例。诊断时的年龄分为<30岁、30 - 54岁、55 - 64岁和≥65岁。使用相对生存模型评估预后因素对5年生存率的影响，在多变量分析中纳入患者的预期生存情况。与30 - 54岁的女性相比，老年组特定年龄的死亡相对超额风险（RER）显著更高（55 - 64岁时RER为1.58，≥65岁时为2.51）。55 - 64岁人群中，由于诊断时的癌症分期，RER降低了64.8%，65岁及以上人群中降低了43.4%。在对治疗方式进行调整后，55 - 64岁人群中的RER不再显著更高；然而，65岁及以上人群中的RER仍然较高。诊断时的晚期是老年宫颈癌患者生存率低的主要决定因素，尽管其他因素如治疗组合的限制也被认为对65岁及以上人群有影响。
