Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
Transplantation. 2011 Oct 27;92(8):913-7. doi: 10.1097/TP.0b013e31822e0c08.
Relative survival estimates, used in population-based monitoring of survival of patients with cancer, accounts for differences in the background mortality (obtained from general population life tables) of patient populations to improve the comparability of survival estimates. We apply and demonstrate the benefits of this measure in solid organ transplantation for the first time.
Data of deceased and living donor kidney transplant recipients aged 0 to 17, 18 to 39, 40 to 49, 50 to 59, and 60+ registered in the United Network for Organ Sharing/Organ Procurement and Transplantation Network data set and age, sex, calendar period, and race-specific US life table for 2006 were used. We calculated absolute 5- and 10-year patient survival by period analysis to obtain up-to-date estimates, whereas the expected survival of the exactly matched group of the general population was derived from life table data. Relative survival was calculated as the ratio of observed and expected survival.
For 5-year absolute survival, an age gradient of 23.7% and 14.0% units between the youngest and the oldest age group was found for recipients of kidneys from deceased and living donors, respectively. For relative survival, the age gradient was decreased substantially, to 15.0% and 5.0% units, respectively. For 10-year survival, the nominal effect of accounting for background mortality was even larger.
Absolute survival estimates fail to account for potential differences in background mortality of various patient groups in general and may substantially overestimate the survival gap of older patients. Relative survival may be a useful additional measure in registry-based transplant patient outcome monitoring.
相对生存率估计数用于基于人群的癌症患者生存率监测，可考虑患者人群的背景死亡率（从一般人群生命表中获得）的差异，以提高生存率估计数的可比性。我们首次将这种方法应用于并展示了在实体器官移植中的益处。
使用 2006 年美国联合器官共享网络/器官获取和移植网络数据集以及年龄、性别、日历期和特定种族的美国生命表中登记的 0 至 17、18 至 39、40 至 49、50 至 59 和 60 岁以上的已故和活体供肾移植受者的数据。我们通过时期分析计算绝对 5 年和 10 年患者生存率，以获得最新的估计值，而与一般人群完全匹配的组的预期生存率则源自生命表数据。相对生存率为观察生存率与预期生存率的比值。
对于 5 年的绝对生存率，从已故供体和活体供体获得肾脏的受者的年龄梯度分别为 23.7%和 14.0%。对于相对生存率，年龄梯度大大降低，分别为 15.0%和 5.0%。对于 10 年生存率，考虑背景死亡率的名义效应甚至更大。
绝对生存率估计数未能考虑到一般情况下不同患者群体的潜在背景死亡率差异，并且可能大大高估了老年患者的生存率差距。相对生存率可能是基于登记的移植患者预后监测的一种有用的附加措施。
