Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy.
Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy.
Lancet Oncol. 2014 Jan;15(1):23-34. doi: 10.1016/S1470-2045(13)70546-1. Epub 2013 Dec 5.
Cancer survival is a key measure of the effectiveness of health-care systems. EUROCARE-the largest cooperative study of population-based cancer survival in Europe-has shown persistent differences between countries for cancer survival, although in general, cancer survival is improving. Major changes in cancer diagnosis, treatment, and rehabilitation occurred in the early 2000s. EUROCARE-5 assesses their effect on cancer survival in 29 European countries.
In this retrospective observational study, we analysed data from 107 cancer registries for more than 10 million patients with cancer diagnosed up to 2007 and followed up to 2008. Uniform quality control procedures were applied to all datasets. For patients diagnosed 2000-07, we calculated 5-year relative survival for 46 cancers weighted by age and country. We also calculated country-specific and age-specific survival for ten common cancers, together with survival differences between time periods (for 1999-2001, 2002-04, and 2005-07).
5-year relative survival generally increased steadily over time for all European regions. The largest increases from 1999-2001 to 2005-07 were for prostate cancer (73.4% [95% CI 72.9-73.9] vs 81.7% [81.3-82.1]), non-Hodgkin lymphoma (53.8% [53.3-54.4] vs 60.4% [60.0-60.9]), and rectal cancer (52.1% [51.6-52.6] vs 57.6% [57.1-58.1]). Survival in eastern Europe was generally low and below the European mean, particularly for cancers with good or intermediate prognosis. Survival was highest for northern, central, and southern Europe. Survival in the UK and Ireland was intermediate for rectal cancer, breast cancer, prostate cancer, skin melanoma, and non-Hodgkin lymphoma, but low for kidney, stomach, ovarian, colon, and lung cancers. Survival for lung cancer in the UK and Ireland was much lower than for other regions for all periods, although results for lung cancer in some regions (central and eastern Europe) might be affected by overestimation. Survival usually decreased with age, although to different degrees depending on region and cancer type.
The major advances in cancer management that occurred up to 2007 seem to have resulted in improved survival in Europe. Likely explanations of differences in survival between countries include: differences in stage at diagnosis and accessibility to good care, different diagnostic intensity and screening approaches, and differences in cancer biology. Variations in socioeconomic, lifestyle, and general health between populations might also have a role. Further studies are needed to fully interpret these findings and how to remedy disparities.
Italian Ministry of Health, European Commission, Compagnia di San Paolo Foundation, Cariplo Foundation.
癌症存活率是衡量医疗体系有效性的关键指标。欧洲癌症与生存研究组织（EUROCARE）是欧洲最大的基于人群的癌症生存情况合作研究组织，该组织的研究表明，各国之间的癌症存活率存在持续差异，尽管总体而言，癌症存活率正在提高。21 世纪初，癌症的诊断、治疗和康复方式发生了重大变化。EUROCARE-5 评估了这些变化对 29 个欧洲国家癌症存活率的影响。
在这项回顾性观察研究中，我们对来自 107 个癌症登记处的数据进行了分析，这些数据涵盖了截至 2007 年被诊断出的 1000 多万名癌症患者，并随访至 2008 年。所有数据集都采用了统一的质量控制程序。对于 2000-07 年被诊断出的患者，我们根据年龄和国家对 46 种癌症进行了 5 年相对生存率加权计算。我们还计算了 10 种常见癌症的国家特异性和年龄特异性生存率，以及不同时期（1999-2001 年、2002-04 年和 2005-07 年）之间的生存率差异。
所有欧洲地区的 5 年相对生存率普遍呈稳步上升趋势。从 1999-2001 年到 2005-07 年，最大的增长出现在前列腺癌（73.4%[95%CI 72.9-73.9] vs 81.7%[81.3-82.1]）、非霍奇金淋巴瘤（53.8%[53.3-54.4] vs 60.4%[60.0-60.9]）和直肠癌（52.1%[51.6-52.6] vs 57.6%[57.1-58.1]）。东欧的存活率普遍较低，低于欧洲平均水平，尤其是预后较好或中等的癌症。北欧、中欧和南欧的存活率最高。英国和爱尔兰的直肠癌、乳腺癌、前列腺癌、皮肤黑色素瘤和非霍奇金淋巴瘤的存活率居中，但肾癌、胃癌、卵巢癌、结肠癌和肺癌的存活率较低。英国和爱尔兰的肺癌存活率在所有时期都远低于其他地区，尽管一些地区（中欧和东欧）的肺癌存活率可能因高估而受到影响。存活率通常随年龄增长而下降，但在不同地区和癌症类型之间下降程度不同。
截至 2007 年，癌症管理方面的重大进展似乎使欧洲的癌症存活率有所提高。国家间存活率差异的可能解释包括：诊断时的分期和获得良好治疗的机会不同，诊断强度和筛查方法不同，以及癌症生物学的不同。人群之间的社会经济、生活方式和一般健康状况的差异也可能起作用。需要进一步研究以充分解释这些发现以及如何弥补差异。
意大利卫生部、欧盟委员会、都灵圣保禄慈善会、米兰的皮尔·卡丹基金会。
