Biodemography of Aging Research Unit, Center for Population Health and Aging, Duke University, Durham, North Carolina.
Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
Stat Med. 2019 Jul 30;38(17):3184-3203. doi: 10.1002/sim.8170. Epub 2019 May 13.
Time trends of lung cancer prevalence and mortality are the result of three competing processes: changes in the incidence rate, stage-specific survival, and ascertainment at early stages. Improvements in these measures act concordantly to improve disease-related mortality, but push the prevalence rate in opposite directions making a qualitative interpretation difficult. The goal of this paper is to evaluate the relative contributions of these components to changes in lung cancer prevalence and mortality.
Partitioning of prevalence and mortality trends into their components using SEER data for 1973-2013.
The prevalence of lung cancer increases for females and decreases for males. In 1998, the former was due to increased incidence (45%-50% of total trend), improved survival (40%-45%), and increased ascertainment at early stages (10%-15%). In males, a rapidly declining incidence rate overpowered the effects of survival and ascertainment resulting in an overall decrease in prevalence over time. Trends in lung cancer mortality are determined by incidence during 1993-2002 with noticeable contribution of survival after 2002.
Lung cancer incidence was the main driving force behind trends in prevalence and mortality. Improved survival played essential role from 2000 onwards. Trends in stage ascertainment played a small but adverse role. Our results suggest that further improvement in lung cancer mortality can be achieved through advances in early stage ascertainment, especially for males, and that in spite of success in treatment, adenocarcinoma continues to exhibit adverse trends (especially in female incidence) and its role among other histology-specific lung cancers will increase in the near future.
肺癌患病率和死亡率的时间趋势是三个竞争过程的结果：发病率、特定阶段生存率和早期发现率的变化。这些措施的改善协同作用以改善与疾病相关的死亡率，但使患病率朝着相反的方向发展，使得定性解释变得困难。本文的目的是评估这些因素对肺癌患病率和死亡率变化的相对贡献。
使用 1973 年至 2013 年 SEER 数据将患病率和死亡率趋势分解为其组成部分。
女性肺癌的患病率增加，而男性则减少。1998 年，前者归因于发病率的增加（占总趋势的 45%-50%）、生存率的提高（40%-45%）和早期发现率的增加（10%-15%）。在男性中，发病率的快速下降抵消了生存率和发现率的影响，导致患病率随时间总体下降。肺癌死亡率的趋势由 1993 年至 2002 年的发病率决定，2002 年后生存率的贡献明显。
肺癌发病率是患病率和死亡率趋势的主要驱动力。从 2000 年开始，生存率发挥了至关重要的作用。分期发现率的趋势虽然作用较小，但却是不利的。我们的结果表明，通过早期发现率的提高，特别是在男性中，可以进一步提高肺癌死亡率，尽管在治疗方面取得了成功，但腺癌仍继续表现出不利趋势（尤其是在女性发病率方面），并且在不久的将来，它在其他组织学特异性肺癌中的作用将增加。
