Li Si Qi, Pan Xiong Fei, Kashaf Michael Saheb, Xue Qing Ping, Luo Hui Jing, Wang Yan Yan, Wen Ying, Yang Chun Xia
Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, RenminNanlu 3-17, Chengdu 610041, China|Center for Disease Control and Prevention of Chenghua District, NO.6 Xinhong Road, Chengdu 610051, China. Email:
Asian Pac J Cancer Prev. 2017 Feb 1;18(2):571-576. doi: 10.22034/APJCP.2017.18.2.571.
Background: Five-year survival is an important metric for progress in cancer control broadly used both in the cancer literature and by the public. In order to assess its validity and relation to other common metrics, we analyzed the relationship between 5-year survival, incidence and mortality using publicly available cancer registry data from England and Wales. Methods: Five-year survival, incidence and mortality data were obtained from the online database of a registered charity, Cancer Research UK. We extracted sex-specific age-standardized mortality, incidence, and 5-year survivalfor16 types of cancer over the period from 1976 to 1995. The relationships between 5-year survival, incidence and mortality were estimated using both Pearson and Spearman correlation coefficients. Results: All 16cancer types showed an increase in 5-year survival for both genders from 1976 to 1995, ranging from 0.2% (pancreas and lung cancer) to 16.6% (prostate cancer) for males and 0.2% (pancreas cancer) to 16.6% (leukemia) for females. From 1976 to 1995, there was no significant correlation between changes in 5-year survival and cancer mortality for either sex (males, Pearson r=0.16, Spearman r=-0.06; females, Pearson r=-0.33, Spearman r=-0.43). A positive relationship between 5-year survival and incidence was noted among males, but not among females (males, Pearson r=0.61, Spearman r=0.53; females, Pearson r=0.03, Spearman r=0.11). However, after excluding breast and prostate cancer, the positive association became weaker and became statistically non-significant for males (Pearson r=0.47; Spearman r=0.41). Conclusions: Our findings suggest that there are no reliable relationships between changes in 5-year survival and cancer incidence or mortality. Increases in 5-year survival might therefore represent poor indicators of progress in cancer control at the population level. In the absence of over-diagnosis, 5-year survival might only indicate improved diagnosis and treatment in clinical practice.
五年生存率是癌症控制进展的一项重要指标，在癌症文献和公众中广泛使用。为了评估其有效性以及与其他常用指标的关系，我们利用英格兰和威尔士公开的癌症登记数据，分析了五年生存率、发病率和死亡率之间的关系。
五年生存率、发病率和死亡率数据取自一家注册慈善机构英国癌症研究中心的在线数据库。我们提取了1976年至1995年期间16种癌症按性别和年龄标准化的死亡率、发病率和五年生存率。使用Pearson和Spearman相关系数估计五年生存率、发病率和死亡率之间的关系。
1976年至1995年期间，所有16种癌症类型的男女五年生存率均有所提高，男性从0.2%（胰腺癌和肺癌）到16.6%（前列腺癌），女性从0.2%（胰腺癌）到16.6%（白血病）。1976年至1995年期间，男女的五年生存率变化与癌症死亡率之间均无显著相关性（男性，Pearson相关系数r = 0.16，Spearman相关系数r = -0.06；女性，Pearson相关系数r = -0.33，Spearman相关系数r = -0.43）。男性的五年生存率与发病率呈正相关，而女性则不然（男性，Pearson相关系数r = 0.61，Spearman相关系数r = 0.53；女性，Pearson相关系数r = 0.03，Spearman相关系数r = 0.11）。然而，排除乳腺癌和前列腺癌后，男性的这种正相关关系变弱且在统计学上无显著性（Pearson相关系数r = 0.47；Spearman相关系数r = 0.41）。
我们的研究结果表明，五年生存率的变化与癌症发病率或死亡率之间不存在可靠的关系。因此，五年生存率的提高可能并非群体层面癌症控制进展的良好指标。在不存在过度诊断的情况下，五年生存率可能仅表明临床实践中诊断和治疗有所改善。
