英国癌症登记处中病例确定的完整性和生存时间误差：对 1 年生存率估计的影响。
Completeness of case ascertainment and survival time error in English cancer registries: impact on 1-year survival estimates.
机构信息
King's College London, Thames Cancer Registry, 42 Weston Street, London SE1 3QD, UK.
出版信息
Br J Cancer. 2011 Jun 28;105(1):170-6. doi: 10.1038/bjc.2011.168. Epub 2011 May 10.
BACKGROUND
It has been suggested that cancer registries in England are too dependent on processing of information from death certificates, and consequently that cancer survival statistics reported for England are systematically biased and too low.
METHODS
We have linked routine cancer registration records for colorectal, lung, and breast cancer patients with information from the Hospital Episode Statistics (HES) database for the period 2001-2007. Based on record linkage with the HES database, records missing in the cancer register were identified, and dates of diagnosis were revised. The effects of those revisions on the estimated survival time and proportion of patients surviving for 1 year or more were studied. Cases that were absent in the cancer register and present in the HES data with a relevant diagnosis code and a relevant surgery code were used to estimate (a) the completeness of the cancer register. Differences in survival times calculated from the two data sources were used to estimate (b) the possible extent of error in the recorded survival time in the cancer register. Finally, we combined (a) and (b) to estimate (c) the resulting differences in 1-year cumulative survival estimates.
RESULTS
Completeness of case ascertainment in English cancer registries is high, around 98-99%. Using HES data added 1.9%, 0.4% and 2.0% to the number of colorectal, lung, and breast cancer registrations, respectively. Around 5-6% of rapidly fatal cancer registrations had survival time extended by more than a month, and almost 3% of rapidly fatal breast cancer records were extended by more than a year. The resulting impact on estimates of 1-year survival was small, amounting to 1.0, 0.8, and 0.4 percentage points for colorectal, lung, and breast cancer, respectively.
INTERPRETATION
English cancer registration data cannot be dismissed as unfit for the purpose of cancer survival analysis. However, investigators should retain a critical attitude to data quality and sources of error in international cancer survival studies.
背景
有人认为，英国的癌症登记处过于依赖从死亡证明中处理信息，因此报告的英国癌症生存率统计数据存在系统性偏差且过低。
方法
我们将 2001-2007 年期间结直肠癌、肺癌和乳腺癌患者的常规癌症登记记录与医院病例统计（HES）数据库中的信息进行了链接。基于与 HES 数据库的记录链接，确定了癌症登记处缺失的记录，并修正了诊断日期。研究了这些修正对估计生存时间和 1 年以上存活患者比例的影响。使用在癌症登记处中不存在但在 HES 数据中存在相关诊断代码和相关手术代码的病例来估计：（a）癌症登记处的完整性。从两个数据源计算的生存时间的差异用于估计（b）癌症登记处记录的生存时间中可能存在的误差程度。最后，我们结合（a）和（b）来估计（c）1 年累计生存率估计值的差异。
结果
英国癌症登记处的病例发现完整性很高，约为 98-99%。使用 HES 数据分别为结直肠癌、肺癌和乳腺癌登记增加了 1.9%、0.4%和 2.0%。大约 5-6%的快速致命癌症登记的生存时间延长了一个月以上，几乎 3%的快速致命乳腺癌记录延长了一年以上。这对 1 年生存率估计的影响很小，分别相当于结直肠癌、肺癌和乳腺癌的 1.0%、0.8%和 0.4%。
结论
英国癌症登记数据不能被视为不适合癌症生存分析。然而，在国际癌症生存研究中，调查人员应保持对数据质量和误差来源的批判性态度。
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