Sathishkumar Krishnan, Sankarapillai Jayasankar, Santhappan Stephen, Mathew Aleyamma, Nair Rekha A, Gangane Nitin, Khuraijam Sushma, Barman Debanjana, Pandya Shashank, Majumdar Gautam, Deshmane Vinay, Zomawia Eric, Sherpa Ashok T, George Preethi, Maliye Swapna, Rahman Tashnin, Shah Anand, Koyande Shravani, Pachuau Lalawmpuii, Pradhan Priya D, Giboy Shalin Lily, Mathur Prashant
National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, India.
Regional Cancer Centre, Thiruvananthapuram, India.
JAMA Netw Open. 2025 Apr 1;8(4):e253910. doi: 10.1001/jamanetworkopen.2025.3910.
India accounts for more than one-third of oral cancer (OC) cases globally. Cancer survival measures the effectiveness of the health care system's cancer control efforts and the proportion of people who survive during a specified time.
To estimate the 5-year survival rates among patients with OC diagnosed in India and assess the association of survival with age, place of residence, histologic type, and clinical extent of OC.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study evaluated survival of patients diagnosed with primary OC (International Classification of Diseases for Oncology, Third Revision, codes C01-C06) between January 1, 2012, and December 31, 2015, and followed up until June 30, 2021. Patients were included from 10 population-based cancer registries (PBCRs). Data were analyzed between March 15 and August 20, 2024.
Demographic factors (patient age, sex, and place of residence) and disease factors (clinical extent of disease and histologic type).
The main outcome was 5-year age-standardized relative survival (ASRS) for OC among male and female patients. A multivariable Cox proportional hazards model estimated hazard ratio (HR) and 95% CI, adjusting for covariates.
Data from the 10 PBCRs encompassed 14 059 patients of all ages (median age, 55 [IQR, 45-65] years; 10 380 male [73.8%]) diagnosed with OC. The overall 5-year ASRS rate for OC was 37.2% (range, 20.9%-58.4%). The estimated ASRS rates at 5 years were 36.0% (range, 20.7%-59.3%) for male and 39.6% (range, 21.4%-54.8%) for female patients. Ahmedabad urban had the highest 5-year ASRS at 58.4% (95% CI, 56.3%-60.4%) for both sexes, while Manipur had the lowest rates at 20.9% (95% CI, 14.9%-27.6%). Survival rates differed significantly between rural areas (34.1%; 95% CI, 31.4%-36.9%) and urban areas (48.5%; 95% CI, 47.4%-49.7%). Pooled data from Kollam and Thiruvananthapuram revealed that individuals 65 years or older (HR, 1.76; 95% CI, 1.44-2.14) and those with distant metastasis (HR, 3.95; 95% CI, 2.78-5.60) had a significantly higher risk of death.
In this cohort study from India, significant survival disparities were observed among patients with OC based on demographic factors and clinical characteristics. Survival rates were lower in rural areas compared with urban regions, underscoring the inequalities in quality of care and services and emphasizing the need to improve OC survival rates in India.
在全球范围内，印度的口腔癌（OC）病例占比超过三分之一。癌症生存率衡量了医疗保健系统癌症控制工作的成效以及在特定时间段内存活的人群比例。
估计在印度被诊断为OC的患者的5年生存率，并评估生存率与年龄、居住地点、组织学类型和OC临床分期之间的关联。
设计、设置和参与者：这项回顾性队列研究评估了2012年1月1日至2015年12月31日期间被诊断为原发性OC（国际肿瘤疾病分类第三版，代码C01 - C06）的患者的生存率，并随访至2021年6月30日。患者来自10个基于人群的癌症登记处（PBCRs）。在2024年3月15日至8月20日期间对数据进行了分析。
人口统计学因素（患者年龄、性别和居住地点）和疾病因素（疾病的临床分期和组织学类型）。
主要结局是男性和女性患者中OC的5年年龄标准化相对生存率（ASRS）。一个多变量Cox比例风险模型估计了风险比（HR）和95%置信区间，并对协变量进行了调整。
来自10个PBCRs的数据涵盖了14059名各年龄段的患者（中位年龄55岁[四分位间距，45 - 65岁]；10380名男性[73.8%]），他们被诊断为OC。OC的总体5年ASRS率为37.2%（范围，20.9% - 58.4%）。男性患者5年的估计ASRS率为36.0%（范围，20.7% - 59.3%），女性患者为39.6%（范围，21.4% - 54.8%）。艾哈迈达巴德市城区男女的5年ASRS最高，为58.4%（95%置信区间，56.3% - 60.4%），而曼尼普尔邦最低，为20.9%（95%置信区间，14.9% - 27.6%）。农村地区（34.1%；95%置信区间，31.4% - 36.9%）和城市地区（48.5%；95%置信区间，47.4% - 49.7%）的生存率存在显著差异。来自科拉姆和特里凡得琅的汇总数据显示，65岁及以上的个体（HR，1.76；95%置信区间，1.44 - 2.14）和有远处转移的个体（HR，3.95；95%置信区间，2.78 - 5.60）死亡风险显著更高。
在这项来自印度的队列研究中，基于人口统计学因素和临床特征，观察到OC患者之间存在显著的生存差异。农村地区的生存率低于城市地区，这凸显了医疗保健质量和服务方面的不平等，并强调了提高印度OC生存率的必要性。
