Raymond L, Obradovic M, Fioretta G
Institut de médecine sociale et préventive, Université de Genève.
Soz Praventivmed. 1988;33(6):269-73. doi: 10.1007/BF02106781.
Quality of care assessment is one of the principal issues considered when studying the survival of cancer patients. Survival rates based on hospital series ("clinical survival") essentially aim at evaluating the impact of therapy, taking into account the stage of the tumor. When, on the other hand, survival rates refer to a demographically defined population ("epidemiologic survival") they depend not only on quality of therapy but also on differentials in access to health services which in turn condition partly the stage at time of diagnosis and therapy selection. Since these patterns of access can vary according to socio-cultural characteristics, the epidemiologist is tempted to focus the prognostic analysis of survival on these characteristics. In a cancer registry setting, clinical indicators (stage of the lesions, type of health care institution and therapy) must not be neglected. Rather, these must be analyzed both as co-factors of survival and as phenomena to be explained in their own right. Issues relating to this topic are discussed using the example of breast cancer in Geneva.
医疗质量评估是研究癌症患者生存率时考虑的主要问题之一。基于医院病例系列得出的生存率（“临床生存率”）主要旨在评估治疗的影响，同时考虑肿瘤分期。另一方面，当生存率涉及到按人口统计学定义的人群时（“流行病学生存率”），它们不仅取决于治疗质量，还取决于获得医疗服务的差异，而这又部分决定了诊断时的分期和治疗选择。由于这些获得医疗服务的模式会因社会文化特征而有所不同，流行病学家倾向于将生存预后分析聚焦于这些特征。在癌症登记处的环境中，临床指标（病变分期、医疗机构类型和治疗方法）不容忽视。相反，这些指标既必须作为生存的共同因素进行分析，也必须作为自身有待解释的现象进行分析。本文以日内瓦的乳腺癌为例讨论了与该主题相关的问题。
