Wéber András, Vokó Zoltán, Kiss Zoltán, Szatmári István, Dobozi Mária, Parrag Petra, Fábián Ibolya, Rokszin György, Nagy Péter, Polgár Csaba, Kenessey István
National Institute of Oncology and National Tumor Biology Laboratory, Budapest, Hungary.
Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary.
BMC Med Res Methodol. 2025 May 26;25(1):145. doi: 10.1186/s12874-025-02600-7.
Population-based, age-standardized net survival estimates provide valuable insights for comparing the effectiveness of cancer treatment and the prospects of cure in an international context. Although numerous studies have previously assessed survival, the choice of life tables may crucially impact the feasibility of such analyses. Therefore, based on available studies, our aim was to understand the critical influence of life tables on net survival estimates.
Record-level data of approximately 50,000 breast, cervical, and ovarian cancer patients were extracted from the Hungarian National Cancer Registry. These patients were diagnosed between 2010 and 2014 and were followed up until December 31, 2019. Life tables for the Hungarian female population were taken from the Human Mortality Database, the Human Life-Table Database and were compiled according to the EUROCARE, CONCORD both multivariable flexible and Ewbank methodology. Regarding the last due to the lack of specific parameters, simulations were performed to assess the missing values. The calculation of 5-year age-standardized net survival using different life tables revealed limitations in the methodology, highlighting the impact of life table selection on survival estimates.
Minor biases were observed in age-standardized net survival when using life tables from different international databases. However, the net survival of breast cancer, which had the most favorable prognosis of the studied malignancies, showed significant discrepancies. Moreover, this research highlights the extreme sensitivity of the applied κ parameter in the CONCORD Ewbank method, underscoring the need for careful consideration when applying this approach.
Present study shed light on how the choice of life tables can lead to differences in survival estimates for the same cancer population. It also emphasizes the importance of open methodological discussions to improve validity and accuracy of international comparability.
基于人群的年龄标准化净生存估计为在国际背景下比较癌症治疗效果和治愈前景提供了有价值的见解。尽管此前已有大量研究评估了生存率，但生命表的选择可能对这类分析的可行性产生至关重要的影响。因此，基于现有研究，我们的目的是了解生命表对净生存估计的关键影响。
从匈牙利国家癌症登记处提取了约50000例乳腺癌、宫颈癌和卵巢癌患者的记录级数据。这些患者于2010年至2014年期间被诊断，并随访至2019年12月31日。匈牙利女性人群的生命表取自人类死亡率数据库、人类生命表数据库，并根据EUROCARE、CONCORD的多变量灵活方法和Ewbank方法进行编制。对于最后一种由于缺乏特定参数的情况，进行了模拟以评估缺失值。使用不同生命表计算5年年龄标准化净生存揭示了该方法的局限性，突出了生命表选择对生存估计的影响。
使用来自不同国际数据库的生命表时，在年龄标准化净生存中观察到轻微偏差。然而，在所研究的恶性肿瘤中预后最有利的乳腺癌的净生存显示出显著差异。此外，本研究强调了CONCORD Ewbank方法中应用的κ参数的极端敏感性，强调在应用该方法时需要仔细考虑。
本研究揭示了生命表的选择如何导致同一癌症人群生存估计的差异。它还强调了开放的方法学讨论对于提高国际可比性的有效性和准确性的重要性。
