Cancer Research UK Cancer Survival Group, Department of Non Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, and St. Bartholomew's Hospital, London, UK.
Gynecol Oncol. 2012 Oct;127(1):75-82. doi: 10.1016/j.ygyno.2012.06.033. Epub 2012 Jun 27.
We investigate what role stage at diagnosis bears in international differences in ovarian cancer survival.
Data from population-based cancer registries in Australia, Canada, Denmark, Norway, and the UK were analysed for 20,073 women diagnosed with ovarian cancer during 2004-07. We compare the stage distribution between countries and estimate stage-specific one-year net survival and the excess hazard up to 18 months after diagnosis, using flexible parametric models on the log cumulative excess hazard scale.
One-year survival was 69% in the UK, 72% in Denmark and 74-75% elsewhere. In Denmark, 74% of patients were diagnosed with FIGO stages III-IV disease, compared to 60-70% elsewhere. International differences in survival were evident at each stage of disease; women in the UK had lower survival than in the other four countries for patients with FIGO stages III-IV disease (61.4% vs. 65.8-74.4%). International differences were widest for older women and for those with advanced stage or with no stage data.
Differences in stage at diagnosis partly explain international variation in ovarian cancer survival, and a more adverse stage distribution contributes to comparatively low survival in Denmark. This could arise because of differences in tumour biology, staging procedures or diagnostic delay. Differences in survival also exist within each stage, as illustrated by lower survival for advanced disease in the UK, suggesting unequal access to optimal treatment. Population-based data on cancer survival by stage are vital for cancer surveillance, and global consensus is needed to make stage data in cancer registries more consistent.
我们研究诊断时的分期在卵巢癌生存的国际差异中扮演的角色。
分析了澳大利亚、加拿大、丹麦、挪威和英国的基于人群的癌症登记处 2004-07 年间诊断为卵巢癌的 20073 名女性的数据。我们比较了各国之间的分期分布，并使用灵活的参数模型在对数累积超额风险尺度上估计了特定分期的一年净生存率和诊断后 18 个月的超额风险。
英国的一年生存率为 69%，丹麦为 72%，其他地方为 74-75%。在丹麦，74%的患者被诊断为 FIGO 分期 III-IV 期疾病，而其他地方为 60-70%。在疾病的每个分期都存在生存的国际差异；在 FIGO 分期 III-IV 期疾病的患者中，英国的女性比其他四个国家的女性生存率更低（61.4%比 65.8-74.4%）。国际差异在老年女性和晚期或无分期数据的患者中最为明显。
分期的差异部分解释了卵巢癌生存的国际差异，更不利的分期分布导致丹麦的生存率相对较低。这可能是由于肿瘤生物学、分期程序或诊断延迟的差异所致。在每个分期内也存在生存差异，如英国晚期疾病的生存率较低，表明获得最佳治疗的机会不平等。按分期划分的癌症生存的基于人群的数据对于癌症监测至关重要，需要全球共识来使癌症登记处的分期数据更加一致。
