Hashim Dana, Carioli Greta, Malvezzi Matteo, Bertuccio Paola, Waxman Samuel, Negri Eva, La Vecchia Carlo, Boffetta Paolo
Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Department of Clinical Sciences and Community Health, Universitá degli Studi di Milano, Milan, Italy.
Aging (Albany NY). 2020 Sep 3;12(17):16744-16758. doi: 10.18632/aging.103503.
As a higher proportion of adults live beyond 85 years, their cancer burden is expected to increase. While trends among the oldest old are established for major epithelial cancers (breast, prostate, lung, and colorectal cancers), they are less studied for minor cancers. This study describes age trends of cancer mortality, with emphasis on individuals aged 85+ years.
Overall cancer mortality peaked at 85 years old and decreased or stabilized for all countries except the USA, France, and Japan, in which mortality continued to increase after age 85 years. For most countries, cancers of the oesophagus, stomach, liver, and larynx have a similar flat trend patterns across all ages. Bladder and kidney cancers as well as non-Hodgkin lymphoma, multiple myeloma, and leukemia showed a decreasing pattern after 85 years for UK, Germany, Italy and Poland. Lung cancer peaked at 80 years, although the age-specific peak among women did not follow the same pattern among all countries. Breast and prostate cancers increased after 85 years.
Mortality stabilized or decreased after age 85, particularly for non-hormonal cancers. Whether this reflects a true biological levelling of mortality rates, or lower validity of cancer registration among the oldest old, remains open to discussion.
Completed death data were obtained from the World Health Organization (WHO) for eight countries (2000 to 2014). Age-specific mortality rates were calculated for each 5-year age group above age 64. Joinpoint regression models were used to identify significant changes in mortality trends by age.
随着越来越多的成年人活到85岁以上，预计他们的癌症负担将会增加。虽然对于主要上皮性癌症（乳腺癌、前列腺癌、肺癌和结直肠癌）在最年长者中的发病趋势已有定论，但对于罕见癌症的研究较少。本研究描述了癌症死亡率的年龄趋势，重点关注85岁及以上的人群。
总体癌症死亡率在85岁时达到峰值，除美国、法国和日本外，所有国家的死亡率在85岁后均下降或趋于稳定，而在美国、法国和日本，85岁后死亡率仍继续上升。对于大多数国家来说，食管癌、胃癌、肝癌和喉癌在各年龄段的趋势相似，呈平稳态势。在英国、德国、意大利和波兰，膀胱癌、肾癌以及非霍奇金淋巴瘤、多发性骨髓瘤和白血病在85岁后呈下降趋势。肺癌在80岁时达到峰值，不过各国女性的年龄别峰值模式并不相同。乳腺癌和前列腺癌在85岁后呈上升趋势。
85岁后死亡率趋于稳定或下降，尤其是非激素依赖性癌症。这是反映了死亡率的真正生物学平稳，还是最年长者癌症登记的有效性较低，仍有待讨论。
从世界卫生组织（WHO）获取了八个国家（2000年至2014年）完整的死亡数据。计算了64岁以上每个5岁年龄组的年龄别死亡率。采用Joinpoint回归模型确定死亡率随年龄变化的显著趋势。
