马拉维的癌症生存率：一项回顾性队列研究。
Cancer survival in Malawi: a retrospective cohort study.
作者信息
Msyamboza Kelias Phiri, Manda Geoffrey, Tembo Bvumi, Thambo Chimwemwe, Chitete Linly, Mindiera Christopher, Finch Lucy Kishindo, Hamling Kathryn
机构信息
World Health Organisation, Malawi Country Office, Lilongwe, Malawi ; University of Malawi, College of Medicine, Community Health Department, Lilongwe, Malawi.
University of Malawi, College of Medicine, Community Health Department, Lilongwe, Malawi.
出版信息
Pan Afr Med J. 2014 Oct 31;19:234. doi: 10.11604/pamj.2014.19.234.4675. eCollection 2014.
INTRODUCTION
Cancer is a leading cause of morbidity and mortality worldwide with the burden in sub-Saharan Africa projected to double by year 2030 from 715,000 new cases and 542,000 deaths in 2008. However, cancer survival data to inform interventions for early detection, diagnosis and treatment are lacking.
METHODS
Cancer survival analysis was conducted on 842 cancer patients registered and followed-up from 2006 to 2013 at NdiMoyo Palliative Care Centre in Salima District, central Malawi. Cancer survival was measured from the time of diagnosis.
RESULTS
In both sexes, the common types of cancer were; Kaposi's sarcoma (KS) (48.0%), cervical cancer (21.1%), cancer of oesophagus (14.8%), liver cancer (3.1%) and breast cancer (2.5%). In Males; KS, cancer of the oesophagus, cancer of the liver, bone cancer and non-Hodgkin's lymphoma were the commonest accounting for 67.4%, 19.4%, 3.9%, 1.0% and 1.0% respectively. In females; cancer of the cervix, KS, cancer of the oesophagus, cancer of the breast and cancer of the liver were the top five cancers accounting for 41.6%, 29.2%, 10.3%, 4.9% and 2.3% respectively. Of the 830 cancer patients with complete 5-year follow-up data, the overall median survival time was 9 months. Absolute survival rates at 1, 2, 3, 4 and 5 years or more were 31.8%, 18.0%, 12.5%, 7.8% and 6.0% respectively. The survival rates for top five cancers at 1, 2, 3, and 4 years or more were; KS (n= 397): 47.1%, 30.2%, 21.4% and 13.1%; cancer of the cervix (n = 174): 31.0%, 10.3%, 5.2% and 2.9%; cancer of the oesophagus (n = 124): 4.0%, 2.4%, 1.6% and 1.6%; liver cancer (n = 26): 19.2%, 3.8%, 3.8% and 3.8% and breast cancer (n = 21): 9.5%, 0%, 0%, 0% respectively. The risk of death was high in females than males, in those aged 50 years or more than in those aged less than 50 (p < 0.05).
CONCLUSION
This study demonstrated that cancer survival from the time of diagnosis in Malawi was poor with median survival time of about 9 months and only 6% of patients survived for 5 years or more. Improvement of early detection, diagnostic capability, access to treatment and palliative care services could improve cancer survival.
引言
癌症是全球发病和死亡的主要原因，预计到2030年，撒哈拉以南非洲地区的癌症负担将比2008年的71.5万新发病例和54.2万死亡人数增加一倍。然而，目前缺乏用于指导早期检测、诊断和治疗干预措施的癌症生存数据。
方法
对2006年至2013年在马拉维中部萨利马区恩迪莫约姑息治疗中心登记并随访的842例癌症患者进行了癌症生存分析。癌症生存时间从诊断时开始计算。
结果
在男女两性中，常见的癌症类型为：卡波西肉瘤（KS）（48.0%）、宫颈癌（21.1%）、食管癌（14.8%）、肝癌（3.1%）和乳腺癌（2.5%）。在男性中，KS、食管癌、肝癌、骨癌和非霍奇金淋巴瘤最为常见，分别占67.4%、19.4%、3.9%、1.0%和1.0%。在女性中，宫颈癌、KS、食管癌、乳腺癌和肝癌是前五大癌症，分别占41.6%、29.2%、10.3%、4.9%和2.3%。在830例有完整5年随访数据的癌症患者中，总体中位生存时间为9个月。1年、2年、3年、4年和5年及以上的绝对生存率分别为31.8%、18.0%、12.5%、7.8%和6.0%。前五大癌症在1年、2年、3年和4年及以上的生存率分别为：KS（n = 397）：47.1%、30.2%、21.4%和13.1%；宫颈癌（n = 174）：31.0%、10.3%、5.2%和2.9%；食管癌（n = 124）：4.0%、2.4%、1.6%和1.6%；肝癌（n = 26）：19.2%、3.8%、3.8%和3.8%；乳腺癌（n = 21）：9.5%、0%、0%、0%。女性的死亡风险高于男性，50岁及以上人群的死亡风险高于50岁以下人群（p < 0.05）。
结论
本研究表明，马拉维癌症患者从诊断时起的生存率较低，中位生存时间约为9个月，只有6%的患者存活5年及以上。改善早期检测、诊断能力、获得治疗和姑息治疗服务的机会可能会提高癌症生存率。
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