Biomedical Center, Faculty of Medicine, Charles University Pilsen, Pilsen, Czech Republic.
Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Cancer Med. 2024 Apr;13(7):e7126. doi: 10.1002/cam4.7126.
We wanted to characterize conditional survival in prostate cancer (PC) in Sweden around and after 2005 when the vast increase in incidence due to the opportunistic testing for prostate specific antigen (PSA) culminated. We hypothesize that analyzing survival data during that time period may help interpret survival trends. We focus on stage-specific analysis using conditional survival in order to define the periods when deaths most commonly occurred.
Data on PC patients were obtained from the Swedish cancer registry for analysis of 1-, 2.5- and 5-year relative survival and conditional relative survival between years 2004 and 2018. Tumor-node-metastatic stage classification at diagnosis was used to specify survival.
Small improvements were observed in stage- and age-related relative survival duriring the study period. Applying conditional relative survival showed that survival in stage T3 up to 2.5 years was better than survival between years 2.5 and 5. Survival in stage T4 was approximately equal in the first and the subsequent 2.5-year period. For M1, the first 2.5 year survival period was worse than the subsequent one. The proportion of high risk and M1 disease in old patients (80+ years) remained very high and their survival improved only modestly.
The data indicate that M1 metastases kill more patients in the first 2.5 years than between years 2.5 and 5 after diagnosis; T4 deaths are equal in the two periods, and in T3 mortality in the first 2.5-year period is lower than between years 2.5 and 5 after diagnosis. Conditional survival could be applied to explore critical survival periods even past 5 years after diagnoses and to monitor success in novel diagnostic and treatment practices. Improvement of survival in elderly patients may require clinical input.
我们希望描述 2005 年前后瑞典前列腺癌（PC）的条件生存情况，当时由于前列腺特异性抗原（PSA）的机会性检测导致发病率大幅上升。我们假设分析这段时间的生存数据可能有助于解释生存趋势。我们专注于使用条件生存进行的特定于阶段的分析，以确定死亡最常见发生的时期。
从瑞典癌症登记处获得 PC 患者的数据，以分析 2004 年至 2018 年期间的 1 年、2.5 年和 5 年相对生存率和条件相对生存率。使用诊断时的肿瘤-淋巴结-转移分期分类来指定生存情况。
在研究期间，观察到与年龄相关的相对生存率和分期相关的生存率略有提高。应用条件相对生存率表明，T3 期至 2.5 年的生存率优于 2.5 年至 5 年之间的生存率。T4 期的生存率在第一个和随后的 2.5 年期间大致相等。对于 M1，第一个 2.5 年的生存期间比随后的生存期间更差。高龄患者（80 岁以上）的高危和 M1 疾病比例仍然非常高，他们的生存状况仅略有改善。
数据表明，M1 转移在诊断后 2.5 年内导致更多患者死亡，而不是在 2.5 年至 5 年之间；T4 期的死亡在两个时期相等，T3 期在第一个 2.5 年期间的死亡率低于诊断后 2.5 年至 5 年之间的死亡率。条件生存可以应用于探索甚至在诊断后 5 年以上的关键生存时期，并监测新的诊断和治疗实践的成功。改善老年患者的生存状况可能需要临床投入。
