撒哈拉以南非洲地区符合美国国立综合癌症网络（NCCN）指南的癌症护理：一项基于人群的5种癌症多国研究
NCCN guideline-concordant cancer care in sub-Saharan Africa: a population-based multicountry study of 5 cancers.
作者信息
Mezger Nikolaus Christian Simon, Seraphin Tobias Paul, Ballé Robert, Griesel Mirko, Joko-Fru Yvonne Walburga, Hämmerl Lucia, Feuchtner Jana, Liu Biying, Zietsman Annelle, Kamaté Bakarou, Gnangnon Freddy Houéhanou Rodrigue, Gnahatin Franck, Mboungou Dimitry Moudiongui, Assefa Mathewos, Amulen Phoebe Mary, Chesumbai Gladys, Chingonzoh Tatenda, Lorenzoni Cesaltina Feirreira, Korir Anne, Carvalho Santos Pablo S, Mezger Jörg Michael, Al-Ali Haifa Kathrin, Mikolajczyk Rafael, Parkin Donald Max, Jemal Ahmedin, Kantelhardt Eva Johanna
机构信息
Global and Planetary Health Working Group, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Germany.
Global Public Health Department, Karolinska Institutet, Stockholm, Sweden.
出版信息
J Natl Cancer Inst. 2025 Jan 1;117(1):120-133. doi: 10.1093/jnci/djae221.
BACKGROUND
To assess population-based quality of cancer care in sub-Saharan Africa and to identify specific gaps and joint opportunities, we assessed concordance of diagnostics and treatments with National Comprehensive Cancer Network Harmonized Guidelines for leading cancer types in 10 countries.
METHODS
Adult patients with female breast cancer, cervical cancer, colorectal cancer, non-Hodgkin lymphoma, and prostate cancer were randomly drawn from 11 population-based cancer registries. Guideline concordance of diagnostics and treatment was assessed using clinical records. In a subcohort of 906 patients with potentially curable cancer (stage I-III breast cancer, cervical cancer, colorectal cancer, prostate cancer, aggressive non-Hodgkin lymphoma [any stage]) and documentation for more than 1 month after diagnosis, we estimated factors associated with guideline-concordant treatment or minor deviations.
RESULTS
Diagnostic information based on guidelines was complete for 1030 (31.7%) of a total of 3246 patients included. In the subcohort with curable cancer, guideline-concordant treatment was documented in 374 (41.3%, corresponding to 11.7% of 3246 patients included in the population-based cohort): aggressive non-Hodgkin lymphoma (59.8%/9.1% population based), breast cancer (54.5%/19.0%), prostate cancer (39.0%/6.1%), colorectal cancer (33.9%/9.5%), and cervical cancer (27.8%/11.6%). Guideline-concordant treatment was most frequent in Namibia (73.1% of the curable cancer subcohort/32.8% population based) and lowest in Kampala, Uganda (13.5%/3.1%). Guideline-concordant treatment was negatively associated with poor ECOG-ACRIN performance status, locally advanced disease stage, origin from low Human Development Index countries, and a diagnosis of colorectal cancer or cervical cancer.
CONCLUSIONS
The quality of diagnostic workup and treatment showed major deficits, with considerable disparities among countries and cancer types. Improved diagnostic services are necessary to increase the share of curable cancer in sub-Saharan Africa. Treatment components within National Comprehensive Cancer Network Guidelines for several cancers should be prioritized.
背景
为评估撒哈拉以南非洲地区基于人群的癌症治疗质量，并确定具体差距和共同机遇，我们评估了10个国家主要癌症类型的诊断和治疗与美国国立综合癌症网络（National Comprehensive Cancer Network，NCCN）统一指南的一致性。
方法
从11个基于人群的癌症登记处随机抽取成年女性乳腺癌、宫颈癌、结直肠癌、非霍奇金淋巴瘤和前列腺癌患者。使用临床记录评估诊断和治疗的指南一致性。在一个包含906例潜在可治愈癌症患者（I - III期乳腺癌、宫颈癌、结直肠癌、前列腺癌、侵袭性非霍奇金淋巴瘤[任何分期]）且诊断后记录超过1个月的亚队列中，我们估计了与指南一致治疗或轻微偏差相关的因素。
结果
在纳入的3246例患者中，1030例（31.7%）的诊断信息符合指南要求。在可治愈癌症亚队列中，374例（41.3%，相当于基于人群队列中3246例患者的11.7%）记录了符合指南的治疗：侵袭性非霍奇金淋巴瘤（基于人群的59.8%/9.1%）、乳腺癌（54.5%/19.0%）、前列腺癌（39.0%/6.1%）、结直肠癌（33.9%/9.5%）和宫颈癌（27.8%/11.6%）。符合指南的治疗在纳米比亚最为常见（可治愈癌症亚队列的73.1%/基于人群的32.8%），在乌干达坎帕拉最低（13.5%/3.1%）。符合指南的治疗与东部肿瘤协作组（ECOG - ACRIN）表现状态差、局部晚期疾病分期、来自人类发展指数低的国家以及结直肠癌或宫颈癌诊断呈负相关。
结论
诊断检查和治疗质量存在重大缺陷，国家和癌症类型之间存在显著差异。改善诊断服务对于提高撒哈拉以南非洲可治愈癌症的比例至关重要。应优先考虑NCCN指南中针对几种癌症的治疗部分。
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