2001 - 2009年美国按种族和分期划分的结肠癌生存率：CONCORD - 2研究结果
Colon cancer survival in the United States by race and stage (2001-2009): Findings from the CONCORD-2 study.
作者信息
White Arica, Joseph Djenaba, Rim Sun Hee, Johnson Christopher J, Coleman Michel P, Allemani Claudia
机构信息
Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia.
Cancer Data Registry of Idaho, Boise, Idaho.
出版信息
Cancer. 2017 Dec 15;123 Suppl 24(Suppl 24):5014-5036. doi: 10.1002/cncr.31076.
BACKGROUND
In the first CONCORD study (2008), 5-year survival for patients diagnosed with colon cancer between 1990 and 1994 in the United States was among the highest in the world (60%), but there were large racial disparities in most participating states. The CONCORD-2 study (2015) enabled the examination of survival trends between 1995 and 2009 for US states by race and stage.
METHODS
The authors analyzed data from 37 state population-based cancer registries, covering approximately 80% of the US population, for patients who were diagnosed with colon cancer between 2001 and 2009 and were followed through 2009. Survival up to 5 years was corrected for background mortality (net survival) using state-specific and race-specific life tables and age-standardized using the International Cancer Survival Standard weights. Survival is presented by race (all, black, white), stage, state, and calendar period (2001-2003 and 2004-2009) to account for changes in methods used to collect stage.
RESULTS
Five-year net survival increased by 0.9%, from 63.7% between 2001 and 2003 to 64.6% between 2004 and 2009. More black than white patients were diagnosed with distant-stage disease between 2001 and 2003 (21.5% vs 17.2%) and between 2004 and 2009 (23.3% vs 18.8%). Survival improved for both blacks and whites, but 5-year net survival was 9-10% lower for blacks than for whites both between 2001 and 2003 (54.7% vs 64.5%) and between 2004 and 2009 (56.6% vs 65.4%). The absolute difference between blacks and whites decreased by only 1% during the decade.
CONCLUSIONS
Five-year net survival from colon cancer increased slightly over time. Survival among blacks diagnosed between 2004 and 2009 had still not reached the level of that among whites diagnosed between 1990 and 1994, some 15 to 20 years earlier. These findings suggest a need for more targeted efforts to improve screening and to ensure timely, appropriate treatment, especially for blacks, to reduce this large and persistent disparity in survival. Cancer 2017;123:5014-36. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
背景
在第一项CONCORD研究（2008年）中，1990年至1994年期间在美国被诊断为结肠癌的患者的5年生存率位居世界前列（60%），但在大多数参与研究的州存在很大的种族差异。CONCORD - 2研究（2015年）使得能够按种族和分期对1995年至2009年期间美国各州的生存趋势进行研究。
方法
作者分析了来自37个基于州人口的癌症登记处的数据，这些登记处覆盖了约80%的美国人口，研究对象为2001年至2009年期间被诊断为结肠癌并随访至2009年的患者。使用特定州和特定种族的生命表对5年生存率进行背景死亡率校正（净生存率），并使用国际癌症生存标准权重进行年龄标准化。按种族（所有、黑人、白人）、分期、州和日历期（2001 - 2003年和2004 - 2009年）呈现生存率，以考虑收集分期所用方法的变化。
结果
5年净生存率提高了0.9%，从2001年至2003年期间的63.7%升至2004年至2009年期间的64.6%。2001年至2003年期间（21.5%对17.2%）以及2004年至2009年期间（23.3%对18.8%），被诊断为远处分期疾病的黑人患者多于白人患者。黑人和白人的生存率均有所提高，但2001年至2003年期间（54.7%对64.5%）以及2004年至2009年期间（56.6%对65.4%），黑人的5年净生存率比白人低9% - 10%。在这十年间，黑人和白人之间的绝对差异仅下降了1%。
结论
结肠癌的5年净生存率随时间略有提高。2004年至2009年期间被诊断为结肠癌的黑人患者的生存率仍未达到约15至20年前1990年至1994年期间被诊断为结肠癌的白人患者的水平。这些发现表明需要做出更具针对性的努力来改善筛查并确保及时、适当的治疗，尤其是针对黑人，以减少这种巨大且持续存在的生存差异。《癌症》2017年；123:5014 - 36。2017年发表。本文为美国政府作品，在美国属于公共领域。
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