Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece.
National Cancer Registry of Ukraine, National Institute of Cancer, Kyiv, Ukraine.
Eur J Cancer. 2015 Nov;51(17):2665-77. doi: 10.1016/j.ejca.2015.08.018. Epub 2015 Sep 3.
Childhood central nervous system (CNS) tumour registration and control programs in Southern and Eastern Europe remain thin, despite the lethal nature of the disease. Mortality/survival data were assembled to estimate the burden of malignant CNS tumours, as well as the potential role of sociodemographic survival determinants across 14 cancer registries of this region.
Average age-adjusted mortality rates were calculated, whereas time trends were quantified through Poisson and Joinpoint regressions. Kaplan-Meier curves were derived for the maximum and the more recent (10 and 5 year) registration periods. Multivariate Cox regression models were used to assess demographic and disease-related determinants.
Variations in mortality (8-16 per million) and survival (5-year: 35-69%) were substantial among the participating registries; in most registries mortality trend was stable, whereas Bulgaria, having the highest starting rate, experienced decreasing annual mortality (-2.4%, p=0.001). A steep decrease in survival rates was evident before the second year of follow-up. After controlling for diagnostic subgroup, age, gender and diagnostic year, Greece seemed to present higher survival compared with the other contributing registries, although the follow-up period was short. Irrespective of country, however, rural residence was found to impose substantial adverse repercussions on survival (hazard ratio (HR): 1.2, 95% confidence interval (CI): 1.1-1.4).
Cross-country mortality and survival variations possibly reflect suboptimal levels of health care delivery and cancer control in some regions of Southern and Eastern Europe, notwithstanding questionable death certification patterns or follow-up procedures. Continuous childhood cancer registration and linkage with clinical data are prerequisite for the reduction of survival inequalities across Europe.
尽管儿童中枢神经系统（CNS）肿瘤具有致命性，但在南欧和东欧，儿童中枢神经系统肿瘤登记和控制项目仍然很少。我们收集了死亡率/生存率数据，以评估恶性 CNS 肿瘤的负担，以及该地区 14 个癌症登记处的社会人口学生存决定因素的潜在作用。
计算了平均年龄调整死亡率，通过泊松和 Joinpoint 回归来量化时间趋势。为最大和最近（10 年和 5 年）登记期绘制了 Kaplan-Meier 曲线。使用多变量 Cox 回归模型评估人口统计学和疾病相关决定因素。
参与登记处的死亡率（8-16/百万）和生存率（5 年：35-69%）差异很大；在大多数登记处，死亡率趋势稳定，而保加利亚的起始率最高，死亡率呈逐年下降趋势（-2.4%，p=0.001）。在随访的第二年之前，生存率明显下降。在控制诊断亚组、年龄、性别和诊断年后，希腊似乎比其他参与登记处的生存率更高，尽管随访期较短。然而，无论国家如何，农村居住都对生存率产生了实质性的不利影响（风险比（HR）：1.2，95%置信区间（CI）：1.1-1.4）。
跨国死亡率和生存率的差异可能反映了南欧和东欧一些地区的医疗保健提供和癌症控制水平不理想，尽管存在可疑的死亡证明模式或随访程序。儿童癌症连续登记和与临床数据的链接是减少欧洲各地生存不平等的前提条件。
Zotero 插件