Georgakis Marios K, Papathoma Paraskevi, Ryzhov Anton, Zivkovic-Perisic Snezana, Eser Sultan, Taraszkiewicz Łukasz, Sekerija Mario, Žagar Tina, Antunes Luis, Zborovskaya Anna, Bastos Joana, Florea Margareta, Coza Daniela, Demetriou Anna, Agius Domenic, Strahinja Rajko M, Themistocleous Marios, Tolia Maria, Tzanis Spyridon, Alexiou George A, Papanikolaou Panagiotis G, Nomikos Panagiotis, Kantzanou Maria, Dessypris Nick, Pourtsidis Apostolos, Petridou Eleni T
Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Department of Neurology, University Hospital, Linköping, Sweden.
Cancer. 2017 Nov 15;123(22):4458-4471. doi: 10.1002/cncr.30884. Epub 2017 Jul 14.
Unique features and worse outcomes have been reported for cancers among adolescents and young adults (AYAs; 15-39 years old). The aim of this study was to explore the mortality and survival patterns of malignant central nervous system (CNS) tumors among AYAs in Southern-Eastern Europe (SEE) in comparison with the US Surveillance, Epidemiology, and End Results (SEER) program.
Malignant CNS tumors diagnosed in AYAs during the period spanning 1990-2014 were retrieved from 14 population-based cancer registries in the SEE region (n = 11,438). Age-adjusted mortality rates were calculated and survival patterns were evaluated via Kaplan-Meier curves and Cox regression analyses, and they were compared with respective 1990-2012 figures from SEER (n = 13,573).
Mortality rates in SEE (range, 11.9-18.5 deaths per million) were higher overall than the SEER rate (9.4 deaths per million), with decreasing trends in both regions. Survival rates increased during a comparable period (2001-2009) in SEE and SEER. The 5-year survival rate was considerably lower in the SEE registries (46%) versus SEER (67%), mainly because of the extremely low rates in Ukraine; this finding was consistent across age groups and diagnostic subtypes. The highest 5-year survival rates were recorded for ependymomas (76% in SEE and 92% in SEER), and the worst were recorded for glioblastomas and anaplastic astrocytomas (28% in SEE and 37% in SEER). Advancing age, male sex, and rural residency at diagnosis adversely affected outcomes in both regions.
Despite definite survival gains over the last years, the considerable outcome disparities between the less affluent SEE region and the United States for AYAs with malignant CNS tumors point to health care delivery inequalities. No considerable prognostic deficits for CNS tumors are evident for AYAs versus children. Cancer 2017;123:4458-71. © 2017 American Cancer Society.
青少年和青年（15 - 39岁）癌症患者具有独特特征且预后较差。本研究旨在探讨东南欧（SEE）青少年和青年恶性中枢神经系统（CNS）肿瘤的死亡率和生存模式，并与美国监测、流行病学和最终结果（SEER）项目进行比较。
从SEE地区14个基于人群的癌症登记处检索1990 - 2014年期间诊断为恶性CNS肿瘤的青少年和青年患者（n = 11,438）。计算年龄调整死亡率，并通过Kaplan - Meier曲线和Cox回归分析评估生存模式，并与SEER 1990 - 2012年的相应数据（n = 13,573）进行比较。
SEE的死亡率（范围为每百万11.9 - 18.5例死亡）总体高于SEER的死亡率（每百万9.4例死亡），两个地区的死亡率均呈下降趋势。在SEE和SEER的可比时期（2001 - 2009年）生存率均有所提高。SEE登记处的5年生存率（46%）明显低于SEER（67%），主要是因为乌克兰的生存率极低；这一发现适用于所有年龄组和诊断亚型。室管膜瘤的5年生存率最高（SEE为76%，SEER为92%），胶质母细胞瘤和间变性星形细胞瘤的5年生存率最差（SEE为28%，SEER为37%）。年龄增长、男性以及诊断时居住在农村对两个地区的预后均产生不利影响。
尽管过去几年生存率有明显提高，但在恶性CNS肿瘤的青少年和青年患者中，较贫困的SEE地区与美国之间存在显著的预后差异，这表明医疗保健服务存在不平等。与儿童相比，青少年和青年CNS肿瘤患者没有明显的预后缺陷。《癌症》2017年；123：4458 - 71。© 2017美国癌症协会。
