The African Cancer Registry Network, Oxford, UK; Department of Medical Genetics, University of Cambridge, Cambridge, UK; Global Health Working Group, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.
Lancet Glob Health. 2024 Jun;12(6):e947-e959. doi: 10.1016/S2214-109X(24)00130-X.
The Cancer Survival in Africa, Asia, and South America project (SURVCAN-3) of the International Agency for Research on Cancer aims to fill gaps in the availability of population-level cancer survival estimates from countries in these regions. Here, we analysed survival for 18 cancers using data from member registries of the African Cancer Registry Network across 11 countries in sub-Saharan Africa.
We included data on patients diagnosed with 18 cancer types between Jan 1, 2005, and Dec 31, 2014, from 13 population-based cancer registries in Cotonou (Benin), Abidjan (CÔte d'Ivoire), Addis Ababa (Ethiopia), Eldoret and Nairobi (Kenya), Bamako (Mali), Mauritius, Namibia, Seychelles, Eastern Cape (South Africa), Kampala (Uganda), and Bulawayo and Harare (Zimbabwe). Patients were followed up until Dec 31, 2018. Patient-level data including cancer topography and morphology, age and date at diagnosis, vital status, and date of death (if applicable) were collected. The follow-up (survival) time was measured from the date of incidence until the date of last contact, the date of death, or until the end of the study, whichever occurred first. We estimated the 1-year, 3-year, and 5-year survival (observed, net, and age-standardised net survival) by sex, cancer type, registry, country, and human development index (HDI). 1-year and 3-year survival data were available for all registries and all cancer sites, whereas availability of 5-year survival data was slightly more variable; thus to provide medium-term survival prospects, we have focused on 3-year survival in the Results section.
10 500 individuals from 13 population-based cancer registries in 11 countries were included in the survival analyses. 9177 (87·4%) of 10 500 cases were morphologically verified. Survival from cancers with a high burden and amenable to prevention was poor: the 3-year age-standardised net survival was 52·3% (95% CI 49·4-55·0) for cervical cancer, 18·1% (11·5-25·9) for liver cancer, and 32·4% (27·5-37·3) for lung cancer. Less than half of the included patients were alive 3 years after a cancer diagnosis for eight cancer types (oral cavity, oesophagus, stomach, larynx, lung, liver, non-Hodgkin lymphoma, and leukaemia). There were differences in survival for some cancers by sex: survival was longer for females with stomach or lung cancer than males with stomach or lung cancer, and longer for males with non-Hodgkin lymphomas than females with non-Hodgkin lymphomas. Survival did not differ by country-level HDI for cancers of the oral cavity, oesophagus, liver, thyroid, and for Hodgkin lymphoma.
For cancers for which population-level prevention strategies exist, and with relatively poor prognosis, these estimates highlight the urgent need to upscale population-level prevention activities in sub-Saharan Africa. These data are vital for providing the knowledge base for advocacy to improve access to prevention, diagnosis, and care for patients with cancers in sub-Saharan Africa.
Vital Strategies, the Martin-Luther-University Halle-Wittenberg, and the International Agency for Research on Cancer.
For the French and Portuguese translations of the abstract see Supplementary Materials section.
国际癌症研究机构的非洲、亚洲和南美洲癌症生存情况项目（SURVCAN-3）旨在填补这些地区国家缺乏人群水平癌症生存估计数据的空白。在这里，我们分析了撒哈拉以南非洲 11 个国家的非洲癌症登记网络成员登记处的 18 种癌症的生存情况。
我们纳入了 2005 年 1 月 1 日至 2014 年 12 月 31 日期间在贝宁科托努、科特迪瓦阿比让、埃塞俄比亚亚的斯亚贝巴、肯尼亚埃尔多雷特和内罗毕、马里巴马科、毛里求斯、纳米比亚、塞舌尔、南非东开普省、乌干达坎帕拉和津巴布韦布拉瓦约和哈拉雷的 13 个基于人群的癌症登记处诊断为 18 种癌症类型的患者数据。患者随访至 2018 年 12 月 31 日。收集了包括癌症部位和形态、年龄和诊断日期、生存状态以及（如适用）死亡日期在内的患者数据。随访（生存）时间从发病日期计算至最后一次联系日期、死亡日期或研究结束日期（以先发生者为准）。我们按性别、癌症类型、登记处、国家和人类发展指数（HDI）来估计 1 年、3 年和 5 年的生存率（观察生存率、净生存率和年龄标准化净生存率）。所有登记处和所有癌症部位都有 1 年和 3 年的生存率数据，而 5 年生存率数据的可用性略为多样；因此，为了提供中期生存前景，我们在结果部分重点关注 3 年生存率。
在 11 个国家的 13 个基于人群的癌症登记处的 10500 名个体中进行了生存分析。在 10500 例病例中，有 9177 例（87.4%）形态学得到证实。具有高负担且可预防的癌症的生存情况较差：宫颈癌的 3 年年龄标准化净生存率为 52.3%（95%CI 49.4-55.0），肝癌为 18.1%（11.5-25.9），肺癌为 32.4%（27.5-37.3）。在诊断出癌症后的 3 年内，有 8 种癌症（口腔、食管、胃、喉、肺、肝、非霍奇金淋巴瘤和白血病）的患者中，不到一半仍存活。一些癌症的生存情况因性别而异：女性胃癌和肺癌患者的生存率高于男性，而男性非霍奇金淋巴瘤患者的生存率高于女性。癌症的生存情况不因国家层面的人类发展指数而有所不同：口腔癌、食管癌、肝癌、甲状腺癌和霍奇金淋巴瘤的生存情况并无差异。
对于存在人群级预防策略且预后相对较差的癌症，这些估计值突出表明迫切需要在撒哈拉以南非洲地区扩大人群级预防活动。这些数据对于为在撒哈拉以南非洲地区为癌症患者提供预防、诊断和护理的知识基础提供了支持。
Vital Strategies、马丁-路德-哈勒-维滕贝格大学和国际癌症研究机构。
