Tichanek Filip, Försti Asta, Hemminki Otto, Hemminki Akseli, Hemminki Kari
Biomedical Center, Faculty of Medicine, Charles University Pilsen, Pilsen, 30605, Czech Republic.
Institute of Pathological Physiology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
Clin Epidemiol. 2023 May 1;15:503-510. doi: 10.2147/CLEP.S406606. eCollection 2023.
Lung cancer is often diagnosed at an advanced stage and survival has been poor, although long-term studies have been rare. We analyzed data on survival in lung cancer from Denmark, Finland, Norway, and Sweden over a 50-year period (1971-2020).
Relative 1- and 5-year survival data were obtained from the NORDCAN database for 1971-2020. We used generalized additive models to estimate survival trends over time and uncertainty of these estimates. We additionally calculated conditional survival from the 1st to 5th year (5/1-year), estimated annual changes in survival rates, and determined significant breaking points.
In 2016-2020, 5-year survival rate for lung cancer was best for Norwegian men (26.6%) and women (33.2%). The sex difference was significant and it was found for each country. Survival improved modestly until the year 2000, after which time survival curves increased steeply and kept the linear shape to the end of follow-up, indicating consistent improvement in survival. Survival curves for 1- and 5/1-year survival were almost superimposable, indicating that deaths in the first year were approximately as many as in the subsequent 4 years, thus marking sustained long-term survival.
We could document a positive development in lung cancer survival with steep upward trends after the year 2000. Intensions for curative treatment have been increasing and the outcomes have been improving with the help of novel imaging methods. Pathways for facile patient access to treatment have been instituted. Close to 90% of the patients are ever smokers. National anti-smoking acts and alerting people who smoke about early symptoms may be beneficial, as metastatic lung cancer remains difficult to cure.
肺癌通常在晚期才被诊断出来，生存率一直很低，尽管长期研究很少。我们分析了丹麦、芬兰、挪威和瑞典50年期间（1971 - 2020年）肺癌的生存数据。
从NORDCAN数据库获取1971 - 2020年的1年和5年相对生存数据。我们使用广义相加模型来估计随时间变化的生存趋势以及这些估计的不确定性。我们还计算了第1年到第5年的条件生存率（5/1年），估计生存率的年度变化，并确定显著的转折点。
在2016 - 2020年，挪威男性（26.6%）和女性（33.2%）的肺癌5年生存率最高。性别差异显著，且在每个国家都存在。直到2000年生存率有适度改善，此后生存曲线急剧上升，并在随访结束时保持线性，表明生存率持续改善。1年和5/1年生存的生存曲线几乎重叠，表明第一年的死亡人数与随后4年的死亡人数大致相同，从而标志着长期生存的持续性。
我们可以证明2000年后肺癌生存率呈积极发展趋势，上升趋势明显。根治性治疗的意愿不断增加，借助新型成像方法，治疗效果也在改善。已经建立了方便患者获得治疗的途径。近90%的患者曾经吸烟。国家反吸烟法案以及提醒吸烟者注意早期症状可能有益，因为转移性肺癌仍然难以治愈。
