Storm Hans Henrik, Gislum Mette, Kejs Anne Mette Tranbjerg, Engholm Gerda
Afdeling for Forebyggelse og Dokumentation, Kraeftens Bekaempelse, Strandboulevarden 49, 2100 København Ø, Denmark.
Ugeskr Laeger. 2010 Aug 16;172(33):2213-7.
Improved one- and three-year survival was seen after the initiation of the National Cancer Control Plan in year 2000. Short follow-up and lack of five-year survival called for an update with more data.
All cancers from the period 1995-2006 were studied in four cohorts of three-year incident cases from 1995 to 2006 followed to death or to the end of 2008. Age-standardised one-, three- and five-year relative survival and excess mortality were computed.
The improved one- and three-year survival was confirmed. The five-year survival increased from 38% in 1995-1997 to 48% in 2004-2006 for men, but a five percentage point increase is owed to the incidence increase of prostate cancer without changed mortality. In women the increase in survival was from 50% to 55%, i.e. a five percentage point increase. Improved five-year survival was seen for cancers of the oesophagus, colon and rectum, lung, and for haematological cancers; for women, also pancreas, ovary, brain and melanoma, and for men prostate cancer survival improved.
The improved cancer survival was confirmed and it was also observed at the five-year follow-up. The excess mortality is largely present during the first year of follow-up and is a useful indicator of whether changes in diagnosis and care lead to the desired outcome. Overall survival should be interpreted in the context of major changes in recorded incidence due to the introduction of new diagnostic tools and biomarkers such as prostate-specific antigen, as such measures do not necessarily change mortality. Whether cancer care in Denmark has reached the highest international standard remains to be proven by survival comparison to countries with adequate data for a comparative analysis.
2000年启动国家癌症控制计划后,观察到一年和三年生存率有所提高。随访时间短且缺乏五年生存率数据,因此需要更新更多数据。
对1995 - 2006年期间的所有癌症病例进行研究,选取1995年至2006年三年间发病的四个队列,随访至死亡或2008年底。计算年龄标准化的一年、三年和五年相对生存率以及超额死亡率。
一年和三年生存率提高得到证实。男性五年生存率从1995 - 1997年的38%升至2004 - 2006年的48%,但五个百分点的增长归因于前列腺癌发病率上升而死亡率未变。女性生存率从50%升至55%,即提高了五个百分点。食管癌、结肠癌、直肠癌、肺癌以及血液系统癌症的五年生存率有所提高;对女性而言,胰腺癌、卵巢癌、脑癌和黑色素瘤的五年生存率也有所提高,男性前列腺癌生存率有所改善。
癌症生存率提高得到证实,且在五年随访中也观察到这一情况。超额死亡率主要出现在随访的第一年,是诊断和治疗变化是否带来预期结果的有用指标。由于引入了新的诊断工具和生物标志物(如前列腺特异性抗原),记录的发病率发生了重大变化,总体生存率应在此背景下进行解读,因为此类措施不一定会改变死亡率。丹麦的癌症治疗是否已达到最高国际标准,仍有待通过与有足够数据进行比较分析的国家的生存率比较来证明。