Cancer Epidemiology Group, Centre for Epidemiology & Biostatistics, University of Leeds, NYCRIS, St James's University Hospital, Leeds, UK.
Gut. 2011 Aug;60(8):1087-93. doi: 10.1136/gut.2010.229575. Epub 2011 Feb 8.
To examine differences in the relative survival and excess death rates of patients with colorectal cancer in Norway, Sweden and England.
All individuals diagnosed with colorectal cancer (ICD10 (International Classification of Diseases, 10th revision) C18-C20) between 1996 and 2004 in England, Norway and Sweden were included in this population-based study of patients with colorectal cancer. The main outcome measures were 5-year cumulative relative period of survival and excess death rates stratified by age and period of follow-up.
The survival of English patients with colorectal cancer was significantly lower than was observed in both Norway and Sweden. Five-year age-standardised colon cancer relative survival was 51.1% (95% CI 50.1% to 52.0%) in England compared with 57.9% (95% CI 55.2% to 60.5%) in Norway and 59.9% (95% CI 57.7% to 62.0%) in Sweden. Five-year rectal cancer survival was 52.3% (95% CI 51.1% to 53.5%) in England compared with 60.7% (95% CI 57.0% to 64.2%) and 59.8% (95% CI 56.9% to 62.6%) in Norway and Sweden, respectively. The lower survival for colon cancer in England was primarily due to a high number of excess deaths among older patients in the first 3 months after diagnosis. In patients with rectal cancer, excess deaths remained elevated until 2 years of follow-up. If the lower excess death rate in Norway applied in the English population, then 890 (13.6%) and 654 (16.8%) of the excess deaths in the colon and rectal cancer populations, respectively, could have been prevented at 5 years follow-up. Most of these avoidable deaths occurred shortly after diagnosis.
There was significant variation in survival between the countries, with the English population experiencing a poorer outcome, primarily due to a relatively higher number of excess deaths in older patients in the short term after diagnosis. It seems likely, therefore, that in England a greater proportion of the population present with more rapidly fatal disease (especially in the older age groups) than in Norway or Sweden.
研究挪威、瑞典和英国结直肠癌患者的相对生存率和超额死亡率差异。
本基于人群的结直肠癌患者研究纳入了 1996 年至 2004 年期间在英格兰、挪威和瑞典被诊断患有结直肠癌（ICD10（国际疾病分类，第 10 版）C18-C20）的所有个体。主要观察指标为按年龄和随访时间分层的 5 年累积相对期间生存率和超额死亡率。
英国结直肠癌患者的生存率明显低于挪威和瑞典。5 年年龄标准化结肠癌相对生存率在英格兰为 51.1%（95%CI 50.1%至 52.0%），而在挪威为 57.9%（95%CI 55.2%至 60.5%），在瑞典为 59.9%（95%CI 57.7%至 62.0%）。5 年直肠癌生存率在英格兰为 52.3%（95%CI 51.1%至 53.5%），而在挪威和瑞典分别为 60.7%（95%CI 57.0%至 64.2%）和 59.8%（95%CI 56.9%至 62.6%）。英格兰结肠癌生存率较低主要是由于诊断后 3 个月内老年患者超额死亡人数较多。在直肠癌患者中，超额死亡人数直到 2 年随访时仍居高不下。如果在英格兰人群中应用挪威较低的超额死亡率，那么在 5 年随访时，结肠癌和直肠癌人群的超额死亡人数中分别有 890 人（13.6%）和 654 人（16.8%）可以避免。这些可避免的死亡大多发生在诊断后不久。
各国之间的生存率存在显著差异，英国人群的预后较差，主要是由于诊断后短期内老年患者的超额死亡人数相对较多。因此，与挪威或瑞典相比，英国人群中可能有更多比例的人患有更快致命的疾病（尤其是在年龄较大的人群中）。
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