Division of Cancer Information and Control, Department of Preventive Medicine, Aichi Cancer Center, Nagoya, Japan.
Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceuticals Sciences, Okayama, Japan.
Int J Cancer. 2020 Dec 1;147(11):3102-3109. doi: 10.1002/ijc.33135. Epub 2020 Jul 6.
Previously, the main treatment for multiple myeloma (MM) was cytotoxic chemotherapies, including autologous stem-cell transplantation (ASCT), but survival benefit in the elderly was limited. More recently, clinical trials and practical experience with novel agents with superior efficacy have shown improved survival, including in the elderly. However, this improvement cannot be simply interpreted as a decline in mortality rate that is an important public health measure of progress against cancer. Here, we assessed the trends in mortality rates of MM in parallel with incidence rates in Japan and the U.S. We used national mortality data and population-based cancer registry data in both countries from 1995 to 2015, during which 74 972 patients in Japan and 229 290 patients in the U.S. died of MM. Trends in mortality and incidence rates were characterized using joinpoint regression analysis. Despite upward trends in incidence, mortality rates showed a significant decrement after 2005 in Japan, with an annual percent change [APC (95% confidence interval)] of -2.5% (-2.9% to -2.1%), and after 2002 in the U.S., with an APC of -2.0% (-2.6% to -1.5%). In both countries, the change in mortality trend coincided with the introduction of the novel agents. Moreover, improvements in mortality were particularly large in patients aged 70 to 79 years, who cannot receive ASCT. Our results indicate that the benefits of novel agents for MM are appreciable at the population level and may encourage further development of novel agents for malignancies that can be widely applied to the patients.
先前，多发性骨髓瘤（MM）的主要治疗方法是细胞毒性化疗，包括自体干细胞移植（ASCT），但对老年人的生存获益有限。最近，新型药物的临床试验和实际经验显示出更好的疗效，包括对老年人，生存得到了改善。然而，这种改善不能简单地解释为死亡率的下降，因为死亡率是癌症防治工作的一个重要公共卫生指标。在这里，我们评估了日本和美国 MM 死亡率与发病率的趋势。我们使用了两国 1995 年至 2015 年的国家死亡率数据和基于人群的癌症登记数据，在此期间，日本有 74972 名患者和美国有 229290 名患者死于 MM。使用 joinpoint 回归分析来描述死亡率和发病率趋势。尽管发病率呈上升趋势，但日本的死亡率在 2005 年后出现显著下降，年变化百分比（APC（95%置信区间））为-2.5%（-2.9%至-2.1%），美国在 2002 年后出现下降，APC 为-2.0%（-2.6%至-1.5%）。在这两个国家，死亡率趋势的变化与新型药物的引入相一致。此外，70 至 79 岁的不能接受 ASCT 的老年患者的死亡率改善尤其显著。我们的研究结果表明，新型药物在多发性骨髓瘤患者人群中具有显著获益，可能会鼓励进一步开发可广泛应用于患者的新型恶性肿瘤药物。
