Gon Yasufumi, Zha Ling, Morishima Toshitaka, Kimura Yasuyoshi, Asai Kanako, Kudo Haruka, Sasaki Tsutomu, Mochizuki Hideki, Miyashiro Isao, Sobue Tomotaka
Department of Neurology, Osaka University Graduate School of Medicine.
Academic Clinical Research Center, Osaka University Hospital.
J Epidemiol. 2025 Mar 5;35(3):147-153. doi: 10.2188/jea.JE20240230. Epub 2025 Jan 31.
Advancements in cancer care have improved survivorship, potentially leading to changes in mortality causes. This study aimed to investigate the causes of death among cancer survivors, specially focusing on non-cancer-related mortality.
This nationwide population-based cohort study analyzed the causes of death based on the time since cancer diagnosis using data from the National Cancer Registry in Japan between January 2016 and December 2019. Non-cancer-related deaths were identified, and mortality risks associated with non-cancer diseases were compared to those of the Japanese general population using standardized mortality ratios (SMRs) with 95% confidence intervals (CIs). The follow-up period was up to 4 years after cancer diagnosis.
A total of 3,990,661 patients (45.8% women) were included in the analysis, yielding 6,237,269 person-years of follow-up. Of these, 1,001,857 (25.1%) patients died during the study period. Cancer-related and non-cancer-related causes accounted for 86.6% and 13.4% of deaths, respectively. The proportion of non-cancer-related deaths increased from 10.2% at 6 months to 31.6% at 4 years after cancer diagnosis. Heart disease (21.8%), cerebrovascular disease (9.8%), and pneumonia (9.1%) were the leading cause of non-cancer-related deaths: the SMRs for these diseases were 2.69 (95% CI, 2.66-2.72), 2.07 (95% CI, 2.03-2.10), and 2.41 (95% CI, 2.36-2.45), respectively. The SMR for suicide was 1.81 (95% CI, 1.74-1.89); however, it lost significance in males and females 2 and 2.5 years after cancer diagnosis, respectively.
The proportion of non-cancer-related deaths among cancer patients has increased over time, emphasizing the need to manage cancer and its comorbidities carefully.
癌症治疗的进展提高了生存率，可能导致死亡原因发生变化。本研究旨在调查癌症幸存者的死亡原因，特别关注非癌症相关死亡率。
这项基于全国人口的队列研究利用日本国家癌症登记处2016年1月至2019年12月的数据，根据癌症诊断后的时间分析死亡原因。确定非癌症相关死亡，并使用标准化死亡率（SMR）及95%置信区间（CI）将与非癌症疾病相关的死亡风险与日本普通人群的风险进行比较。随访期为癌症诊断后长达4年。
共有3990661名患者（45.8%为女性）纳入分析，随访人年数为6237269人年。其中，1001857名（25.1%）患者在研究期间死亡。癌症相关和非癌症相关原因分别占死亡人数的86.6%和13.4%。非癌症相关死亡比例从癌症诊断后6个月时的10.2%增加到4年时的31.6%。心脏病（21.8%）、脑血管疾病（9.8%）和肺炎（9.1%）是非癌症相关死亡的主要原因：这些疾病的标准化死亡率分别为2.69（95%CI，2.66 - 2.72）、2.07（95%CI，2.03 - 2.10）和2.41（95%CI，2.36 - 2.45）。自杀的标准化死亡率为1.81（95%CI，1.74 - 1.89）；然而，分别在癌症诊断后2年和2.5年，男性和女性的该死亡率不再具有统计学意义。
癌症患者中非癌症相关死亡的比例随时间增加，强调了谨慎管理癌症及其合并症的必要性。
