Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Cancer. 2020 Oct 1;126(19):4379-4389. doi: 10.1002/cncr.33080. Epub 2020 Jul 29.
Although pediatric cancer mortality and survival have improved in the United States over the past 40 years, differences exist by age, race/ethnicity, cancer site, and economic status. To assess progress, this study examined recent mortality and survival data for individuals younger than 20 years.
Age-adjusted death rates were calculated with the National Vital Statistics System for 2002-2016. Annual percent changes (APCs) and average annual percent changes (AAPCs) were calculated with joinpoint regression. Five-year relative survival was calculated on the basis of National Program of Cancer Registries data for 2001-2015. Death rates and survival were estimated overall and by sex, 5-year age group, race/ethnicity, cancer type, and county-based economic markers.
Death rates decreased during 2002-2016 (AAPC, -1.5), with steeper declines during 2002-2009 (APC, -2.6), and then plateaued (APC, -0.4). Leukemia and brain cancer were the most common causes of death from pediatric cancer, and brain cancer surpassed leukemia in 2011. Death rates decreased for leukemia and lymphoma but were unchanged for brain, bone, and soft-tissue cancers. From 2001-2007 to 2008-2015, survival improved from 82.0% to 85.1%. Survival was highest in both periods among females, those aged 15 to 19 years, non-Hispanic Whites, and those in counties in the top 25% by economic status. Survival improved for leukemias, lymphomas, and brain cancers but plateaued for bone and soft-tissue cancers.
Although overall death rates have decreased and survival has increased, differences persist by sex, age, race/ethnicity, cancer type, and economic status. Improvements in pediatric cancer outcomes may depend on improving therapies, access to care, and supportive and long-term care.
尽管美国在过去 40 年中已经改善了儿科癌症的死亡率和存活率，但在年龄、种族/族裔、癌症部位和经济状况方面仍存在差异。为了评估进展情况，本研究对 20 岁以下人群的最新死亡率和存活率数据进行了审查。
2002-2016 年，使用国家生命统计系统计算年龄调整死亡率。使用连接点回归计算年度百分比变化（APC）和平均年度百分比变化（AAPC）。2001-2015 年，根据国家癌症登记计划的数据计算了 5 年相对存活率。总体以及按性别、5 岁年龄组、种族/族裔、癌症类型和以县为基础的经济指标估计死亡率和存活率。
2002-2016 年期间死亡率下降（AAPC，-1.5），2002-2009 年期间下降更为陡峭（APC，-2.6），然后趋于平稳（APC，-0.4）。白血病和脑瘤是儿童癌症死亡的最常见原因，脑瘤在 2011 年超过白血病。白血病和淋巴瘤的死亡率下降，但脑瘤、骨癌和软组织癌的死亡率不变。2001-2007 年至 2008-2015 年，存活率从 82.0%提高到 85.1%。在两个时期，女性、15 至 19 岁年龄组、非西班牙裔白人和经济状况排名前 25%的县的存活率均最高。白血病、淋巴瘤和脑瘤的存活率提高，但骨癌和软组织癌的存活率趋于平稳。
尽管总体死亡率下降，存活率提高，但在性别、年龄、种族/族裔、癌症类型和经济状况方面仍存在差异。改善儿科癌症的结果可能取决于改善治疗方法、获得治疗的机会以及支持和长期护理。
