美国与中国城市人口在所有癌症类型及20种特定癌症方面的生存差异：一项基于人群的研究。
Survival differences between the USA and an urban population from China for all cancer types and 20 individual cancers: a population-based study.
作者信息
Fu Ruiying, Sun Ke, Wang Xiaofeng, Liu Bingsheng, Wang Tao, Morze Jakub, Nawrocki Sergiusz, An Lan, Zhang Siwei, Li Li, Wang Shaoming, Chen Ru, Sun Kexin, Han Bingfeng, Lin Hong, Wang Huinan, Liu Dan, Wang Yang, Li Youwei, Zhang Qian, Mu Huijuan, Geng Qiushuo, Sun Feng, Zhao Haitao, Zhang Xuehong, Lu Lingeng, Mei Dan, Zeng Hongmei, Wei Wenqiang
机构信息
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Dalian Center for Disease Control and Prevention, Liaoning, 116035, China.
出版信息
Lancet Reg Health West Pac. 2023 May 23;37:100799. doi: 10.1016/j.lanwpc.2023.100799. eCollection 2023 Aug.
BACKGROUND
The systematic comparison of cancer survival between China and the USA is rare. Here we aimed to assess the magnitude of survival disparities and disentangle the impact of the stage at diagnosis between a Chinese metropolitan city and the USA on cancer survival.
METHODS
We included 11,046 newly diagnosed cancer patients in Dalian Cancer Registry, China, 2015, with the follow-up data for vital status until December 2020. We estimated age-standardised 5-year relative survival and quantified the excess hazard ratio (EHR) of death using generalised linear models for all cancers and 20 individual cancers. We compared these estimates with 17 cancer registries' data from the USA, using the Surveillance, Epidemiology, and End Results database. We further estimated the stage-specific survival for five major cancers by region.
FINDINGS
Age-standardised 5-year relative survival for all patients in Dalian was lower than that in the USA (49.9% vs 67.9%). By cancer types, twelve cancers with poorer prognosis were observed in Dalian compared to the USA, with the largest gap seen in prostate cancer (Dalian: 55.8% vs USA: 96.0%). However, Dalian had a better survival for lung cancer, cervical cancer, and bladder cancer. Dalian patients had a lower percentage of stage Ⅰ colorectal cancer (Dalian: 17.9% vs USA: 24.2%) and female breast cancer (Dalian: 40.9% vs USA: 48.9%). However, we observed better stage-specific survival among stage Ⅰ-Ⅱ lung cancer patients in Dalian than in the USA.
INTERPRETATION
This study suggests that although the overall prognosis for patients was better in the USA than in Dalian, China, survival deficits existed in both countries. Improvement in cancer early detection and cancer care are needed in both countries.
FUNDING
National Key R&D Program (2021YFC2501900, 2022YFC3600805), Major State Basic Innovation Program of the Chinese Academy of Medical Sciences (2021-I2M-1-010, 2021-I2M-1-046), and Talent Incentive Program of Cancer Hospital of Chinese Academy of Medical Sciences.
背景
中国和美国之间癌症生存率的系统比较很少见。在此，我们旨在评估生存率差异的程度，并厘清中国一个大城市与美国在癌症生存率方面诊断时分期的影响。
方法
我们纳入了中国大连癌症登记处2015年新诊断的11046例癌症患者，并获取了截至2020年12月的生命状态随访数据。我们估计了年龄标准化的5年相对生存率，并使用广义线性模型对所有癌症和20种特定癌症量化死亡的超额风险比（EHR）。我们使用监测、流行病学和最终结果数据库，将这些估计值与美国17个癌症登记处的数据进行比较。我们进一步按地区估计了五种主要癌症的分期特异性生存率。
结果
大连所有患者的年龄标准化5年相对生存率低于美国（49.9%对67.9%）。按癌症类型来看，与美国相比，大连有12种预后较差的癌症，前列腺癌的差距最大（大连：55.8%对美国：96.0%）。然而，大连肺癌、宫颈癌和膀胱癌的生存率较好。大连患者中Ⅰ期结直肠癌（大连：17.9%对美国：24.2%）和女性乳腺癌（大连：40.9%对美国：48.9%）的比例较低。然而，我们观察到大连Ⅰ - Ⅱ期肺癌患者的分期特异性生存率高于美国。
解读
本研究表明，尽管美国患者的总体预后优于中国大连，但两国都存在生存差距。两国都需要改善癌症早期检测和癌症护理。
资助
国家重点研发计划（2021YFC2501900，2022YFC3600805），中国医学科学院重大国家基础创新计划（2021 - I2M - 1 - 010，2021 - I2M - 1 - 046），以及中国医学科学院肿瘤医院人才激励计划。
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