Cancer Research Division, Cancer Council NSW, Sydney, Australia.
Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Cancer Med. 2021 Jun;10(11):3524-3532. doi: 10.1002/cam4.3844. Epub 2021 May 6.
To estimate trends in the crude probability of death for cancer patients by sex, age and spread of disease over the past 30 years in New South Wales, Australia.
Population-based cohort of 716,501 people aged 15-89 years diagnosed with a first primary cancer during 1985-2014 were followed up to 31 December 2015. Flexible parametric relative survival models were used to estimate the age-specific crude probability of dying from cancer and other causes by calendar year, sex and spread of disease for all solid tumours combined and cancers of the colorectum, lung, female breast, prostate and melanoma.
Estimated 10-year sex, age and spread-specific crude probabilities of cancer death generally decreased over time for most cancer types, although the magnitude of the decrease varied. For example, out of 100 fifty-year old men with localized prostate cancer, 12 would have died from their cancer if diagnosed in 1985 and 3 in 2014. Greater degree of spread was consistently associated with higher probability of dying from cancer, although outcomes for lung cancer were consistently poor. For both males and females, the probability of non-cancer deaths was higher among older patients, those diagnosed with localized cancers and where cancer survival was higher.
Crude probabilities presented here may be useful in helping clinicians and their patients better understand prognoses and make informed decisions about treatment. They also provide novel insights into the relative contributions that early detection and improved treatments have on the observed temporal patterns in cancer survival.
本研究旨在评估过去 30 年来澳大利亚新南威尔士州癌症患者的粗死亡率趋势,包括按性别、年龄和疾病扩散程度的变化。
本研究基于人群的队列包括 716501 名年龄在 15 至 89 岁之间、在 1985 年至 2014 年期间被诊断为第一原发性癌症的人群,随访至 2015 年 12 月 31 日。采用灵活参数相对生存模型,按年龄、性别和疾病扩散程度,对所有实体瘤和结直肠癌、肺癌、女性乳腺癌、前列腺癌和黑色素瘤的癌症患者的死亡粗概率进行估计。
估计的 10 年癌症死亡粗概率在大多数癌症类型中随时间推移呈下降趋势,尽管下降幅度有所不同。例如,在 1985 年诊断为局限性前列腺癌的 100 名 50 岁男性中,有 12 人将死于癌症,而在 2014 年诊断的则有 3 人。疾病扩散程度越高,死于癌症的概率就越高,尽管肺癌的预后一直较差。对于男性和女性来说,年龄较大、诊断为局限性癌症且癌症生存率较高的患者死于非癌症的概率更高。
本文提供的粗死亡率可能有助于临床医生及其患者更好地了解预后,并在治疗方面做出明智的决策。它们还为早期检测和改善治疗对观察到的癌症生存时间模式的相对贡献提供了新的见解。