肺癌生存趋势和预后因素：西班牙赫罗纳省 26 年的基于人群研究。

Lung cancer survival trends and prognostic factors: A 26-year population-based study in Girona Province, Spain.

机构信息

Department of Medical Oncology, Catalan Institute of Oncology, Doctor Josep Trueta University Hospital, Av. França s/n, 17007 Girona, Spain; Precision Oncology Group (OncoGIR-Pro), Girona BiomedicaI Research Institute (IDIBGI-CERCA), Parc Hospitalari Martí i Julià, Edifici M2, 17190 Salt, Spain.

Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology, Directorate Plan of Oncology, Girona Biomedical Research Institute Dr. Josep Trueta (IDIBGI-CERCA), 17004 Girona, Spain; Josep Carreras Leukaemia Research Institute, c/ del sol 15, 17004 Girona, Spain.

出版信息

Lung Cancer. 2024 Nov;197:107995. doi: 10.1016/j.lungcan.2024.107995. Epub 2024 Oct 20.

DOI:10.1016/j.lungcan.2024.107995

PMID:39447337

Abstract

BACKGROUND

Lung cancer (LC) is Europe's primary cause of cancer-related mortality largely due to its historically low survival rates. The aim of this study was to analyze 26-year survival trends in the province of Girona, Spain, and to identify key prognostic factors.

METHODS

Population-based study of LC cases collected between 1994 and 2019, with follow-up until December 31, 2021. Variables included date of diagnosis, sex, age, histology, and tumor stage (the latter since 2010). Diagnosis dates were categorized into three periods (1994-2002, 2003-2011, and 2012-2019). Multivariate flexible parametric models, incorporating age as a non-linear, time-varying covariate, were used to analyze net survival (NS) and trends. Annual absolute change in survival (AAC_S) was calculated using 3-year NS.

RESULTS

The analysis of 9,113 LC cases showed a NS improvement between the first and last period (7.1 months (95 %CI: 6.5;7.6) to 8.5 months (95 %CI: 7.9;9.1)). Squamous cell carcinoma (NSC-SCC) showed the greatest improvement with an AAC_S of 0.32 % (95 % CI: 0.21; 0.43), while survival for non-small cell lung cancer not otherwise specified declined (AAC_S of -0.19 % (95 %CI: -0.26; -0.12)). Prognostic analysis of the 3,642 cases (2010-2019) indicated a lower LC death risk for adenocarcinoma and NSC-SCC compared to LC not otherwise specified (HR 0.52 and 0.62, respectively). Increasing tumor stage correlated with higher LC mortality risk (1.8-, 4.0-, and 10.1-fold increase for stage II, III, and IV, respectively, compared to stage I).

CONCLUSIONS

LC survival has notably improved, particularly for NSC-SCC. Survival is influenced by sex, age, date of diagnosis, tumor histology and especially by stage, underscoring comprehensive data collection's importance.

摘要

背景

肺癌（LC）是欧洲癌症相关死亡的主要原因，主要是因为其历史上生存率较低。本研究的目的是分析西班牙赫罗纳省 26 年的生存趋势，并确定关键的预后因素。

方法

这是一项基于人群的 LC 病例研究，收集了 1994 年至 2019 年期间的数据，并随访至 2021 年 12 月 31 日。纳入的变量包括诊断日期、性别、年龄、组织学和肿瘤分期（自 2010 年起）。诊断日期分为三个时期（1994-2002 年、2003-2011 年和 2012-2019 年）。采用包含年龄为非线性、时变协变量的多变量灵活参数模型，分析净生存（NS）和趋势。使用 3 年 NS 计算生存的年绝对变化（AAC_S）。

结果

对 9113 例 LC 病例的分析显示，第一期和最后一期之间 NS 有所改善（7.1 个月（95%CI：6.5；7.6）至 8.5 个月（95%CI：7.9；9.1））。鳞状细胞癌（NSC-SCC）的改善最大，AAC_S 为 0.32%（95%CI：0.21；0.43），而非小细胞肺癌（NSCLC）的生存情况则有所下降（AAC_S 为-0.19%（95%CI：-0.26；-0.12））。对 3642 例（2010-2019 年）病例的预后分析表明，与非特指性 LC 相比，腺癌和 NSC-SCC 的 LC 死亡风险较低（HR 分别为 0.52 和 0.62）。肿瘤分期的增加与 LC 死亡率的增加呈正相关（与 I 期相比，II 期、III 期和 IV 期分别增加 1.8 倍、4.0 倍和 10.1 倍）。