1973 - 1990年瑞典结肠癌患者的生存率。集水区之间的趋同情况。

Survival after colon cancer 1973-1990 in Sweden. Convergence between catchment areas.

作者信息

Blomqvist P, Ekbom A, Nyrén O, Krusemo U, Bergström R, Adami H O

机构信息

Department of Cancer Epidemiology, University Hospital, Uppsala, Sweden.

出版信息

Ann Surg. 1997 Feb;225(2):208-16. doi: 10.1097/00000658-199702000-00009.

DOI:10.1097/00000658-199702000-00009

PMID:9065298

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1190650/

Abstract

OBJECTIVE

The objective of the study is to analyze the temporal trends in relative survival among patients with colon cancer in catchment areas of hospitals of different categories and regions in Sweden.

BACKGROUND

In Sweden, cancer of the colon is the second most common type of cancer in women and the third most common in men, afflicting approximately 3000 individuals annually. During the past decades, survival has improved, but it is not clear what factors have contributed to this development. Changes in the natural history of the disease, altered alimentary habits, advances in diagnosis, and treatment have been suggested. The effects of centralized care still are debated.

METHOD

Longitudinal observational study of relative survival of all patients with colon cancer from 1973 to 1993 in Sweden (n = 41,700) by period of diagnosis and hospital category of primary catchment area was conducted. Multivariate analyses of relative hazards of any interaction between length of follow-up, period of diagnosis, hospital category of the primary catchment area, age at diagnosis, and region were performed.

RESULTS

Relative survival in patients with colon cancer improved substantially from 1973 through 1990. The prognosis in patients from primary catchment areas of regional-university hospitals did not change during this period, and the prognostic improvement was noted only in county and local hospital areas, where survival approached that of regional hospitals. Although new management regimens may have been introduced unevenly, improved perioperative care best explains this convergence. Low-incidence regions showed the lowest survival, but this improved with time, although not significantly.

CONCLUSIONS

Although survival in patients with colon cancer improved and convergence between different catchment area categories was seen, a large initial gap as well as a remaining difference may warrant future monitoring to ensure equal prognosis, irrespective of domicile.

摘要

目的

本研究旨在分析瑞典不同类别和地区医院服务区域内结肠癌患者的相对生存率随时间的变化趋势。

背景

在瑞典，结肠癌是女性中第二常见的癌症类型，男性中第三常见，每年约有3000人患病。在过去几十年中，生存率有所提高，但尚不清楚哪些因素促成了这一发展。有人提出疾病自然史的变化、饮食习惯的改变、诊断和治疗的进步等因素。集中护理的效果仍存在争议。

方法

对1973年至1993年瑞典所有结肠癌患者（n = 41,700）按诊断时期和主要服务区域的医院类别进行相对生存率的纵向观察研究。对随访时间、诊断时期、主要服务区域的医院类别、诊断时年龄和地区之间的任何相互作用的相对风险进行多变量分析。

结果

1973年至1990年期间，结肠癌患者的相对生存率显著提高。在此期间，区域大学医院主要服务区域的患者预后没有变化，仅在县和地方医院区域观察到预后改善，其生存率接近区域医院。尽管新的管理方案引入可能不均衡，但围手术期护理的改善最能解释这种趋同现象。低发病率地区的生存率最低，但随着时间推移有所改善，尽管改善不显著。