Howlader Nadia, Mariotto Angela B, Woloshin Steven, Schwartz Lisa M
Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (NH, AM); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Department of Veterans Affairs Medical Center, Veterans Affairs Outcomes Group, White River Junction, VT (SW, LMS).
J Natl Cancer Inst Monogr. 2014 Nov;2014(49):255-64. doi: 10.1093/jncimonographs/lgu022.
To isolate progress against cancer from changes in competing causes of death, population cancer registries have traditionally reported cancer prognosis (net measures). But clinicians and cancer patients generally want to understand actual prognosis (crude measures): the chance of surviving, dying from the specific cancer and from competing causes of death in a given time period.
To compare cancer and actual prognosis in the United States for four leading cancers-lung, breast, prostate, and colon-by age, comorbidity, and cancer stage and to provide templates to help patients, clinicians, and researchers understand actual prognosis.
Using population-based registry data from the Surveillance, Epidemiology, and End Results (SEER) Program, we calculated cancer prognosis (relative survival) and actual prognosis (five-year overall survival and the "crude" probability of dying from cancer and competing causes) for three important prognostic determinants (age, comorbidity [Charlson-score from 2012 SEER-Medicare linkage dataset] and cancer stage at diagnosis).
For younger, healthier, and earlier stage cancer patients, cancer and actual prognosis estimates were quite similar. For older and sicker patients, these prognosis estimates differed substantially. For example, the five-year overall survival for an 85-year-old patient with colorectal cancer is 54% (cancer prognosis) versus 22% (actual prognosis)-the difference reflecting the patient's substantial chance of dying from competing causes. The corresponding five-year chances of dying from the patient's cancer are 46% versus 37%. Although age and comorbidity lowered actual prognosis, stage at diagnosis was the most powerful factor: The five-year chance of colon cancer death was 10% for localized stage and 83% for distant stage.
Both cancer and actual prognosis measures are important. Cancer registries should routinely report both cancer and actual prognosis to help clinicians and researchers understand the difference between these measures and what question they can and cannot answer. We encourage them to use formats like the ones presented in this paper to communicate them clearly.
为了将癌症进展与其他竞争性死亡原因的变化区分开来，人口癌症登记处传统上报告癌症预后（净指标）。但临床医生和癌症患者通常想了解实际预后（粗略指标）：在特定时间段内存活、死于特定癌症以及死于其他竞争性死亡原因的几率。
按年龄、合并症和癌症分期比较美国四种主要癌症（肺癌、乳腺癌、前列腺癌和结肠癌）的癌症预后和实际预后，并提供模板以帮助患者、临床医生和研究人员了解实际预后。
利用监测、流行病学和最终结果（SEER）计划基于人群的登记数据，我们计算了三种重要预后决定因素（年龄、合并症[来自2012年SEER - 医疗保险关联数据集的查尔森评分]和诊断时的癌症分期）的癌症预后（相对生存率）和实际预后（五年总生存率以及死于癌症和其他竞争性原因的“粗略”概率）。
对于年轻、健康且处于早期阶段的癌症患者，癌症预后和实际预后估计相当相似。对于年老和病情较重的患者，这些预后估计差异很大。例如，一名85岁的结肠癌患者的五年总生存率为54%（癌症预后），而实际预后为22%——差异反映了患者死于其他竞争性原因的很大几率。患者死于癌症的相应五年几率分别为46%和37%。尽管年龄和合并症降低了实际预后，但诊断时的分期是最有力的因素：局部阶段结肠癌的五年死亡几率为10%，远处阶段为83%。
癌症预后和实际预后指标都很重要。癌症登记处应常规报告癌症预后和实际预后，以帮助临床医生和研究人员了解这些指标之间的差异以及它们能回答和不能回答的问题。我们鼓励他们使用本文中呈现的格式来清晰地传达这些信息。
