Dept of Public Health, School of medicine, University of Otago, Wellington, New Zealand; Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford OX3 7LF, UK.
Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
J Geriatr Oncol. 2021 Sep;12(7):1044-1051. doi: 10.1016/j.jgo.2021.04.003. Epub 2021 Apr 15.
We described the role of patient-related and clinical factors on age disparities in colon cancer survival among patients aged 50-99 using New Zealand population-based cancer registry data linked to hospitalisation data.
We included 21,270 new colon cancer cases diagnosed between 1 January 2006 and 31 July 2017, followed up to end 2019. We modelled the effect of age at diagnosis, sex, ethnicity, deprivation, comorbidity, and emergency presentation on colon cancer survival by stage at diagnosis using flexible excess hazard regression models.
The excess mortality in older patients was minimal for localised cancers, maximal during the first six months for regional cancers, the first eighteen months for distant cancers, and over the three years for missing stages. The age pattern of the excess mortality hazard varied according to sex for distant cancers, emergency presentation for regional and distant cancers, and comorbidity for cancer with missing stages. Ethnicity and deprivation did not influence age disparities in colon cancer survival.
Factors reflecting timeliness of cancer diagnosis most affected age-related disparities in colon cancer survival, probably by impacting treatment strategy. Because of the high risk of poor outcomes related to treatment in older patients, efforts made to improve earlier diagnosis in older patients are likely to help reduce age disparities in colon cancer survival in New Zealand.
我们利用新西兰基于人群的癌症登记数据与住院数据进行关联，描述了与患者相关的因素和临床因素对 50-99 岁结肠癌患者生存的年龄差异的作用。
我们纳入了 2006 年 1 月 1 日至 2017 年 7 月 31 日期间诊断的 21270 例新结肠癌病例，随访至 2019 年底。我们使用灵活的超额风险回归模型，根据诊断时的分期，对年龄、性别、种族、贫困程度、合并症和紧急就诊等因素对结肠癌生存的影响进行了建模。
局部癌症的老年患者的超额死亡率最小，区域癌症的前六个月最大，远处癌症的前十八个月最大，缺失阶段的三年中最大。超额死亡风险的年龄模式因远处癌症的性别、区域和远处癌症的紧急就诊以及缺失阶段癌症的合并症而有所不同。种族和贫困程度并不影响结肠癌生存的年龄差异。
反映癌症诊断及时性的因素对结肠癌生存的年龄相关差异影响最大，这可能是通过影响治疗策略造成的。由于老年患者治疗相关的不良预后风险较高，因此，为改善老年患者的早期诊断所做的努力可能有助于减少新西兰结肠癌生存的年龄差异。
