队列法、完全法和现时生存分析方法在乳腺癌随访研究中的应用

Use of cohort analysis, complete analysis and period analysis in estimating long-term survival of breast cancer: a hospital-based report among 7 275 female patients

目的 :应用队列法、完全法和现时生存分析法,估计复旦大学附属肿瘤医院女性乳腺癌的当前生存率及变化趋势。方法 :收集复旦大学附属肿瘤医院1997年1月1日—2011年12月31日确诊的所有7 275例上海户籍女性原发乳腺癌的临床信息资料,以2011年12月31日为随访截止日期,采用主动随访以及与上海全死因登记系统记录联动的方式获得结局信息。分别以2002—2006年和2007—2011年为感兴趣时段,采用队列法、完全法和现时生存分析法估计这2个时段的5年生存率。结果 :统计结果显示,该院2002—2006年乳腺癌的真实5年相对生存率为92.3%,高于队列法估计的84.7%和完全法估计的88.6%,与现时生存分析法估计的90.9%最为接近。在不同临床分期乳腺癌患者中均观察到同样的结果,且在分期较晚的患者中更为明显。进一步采用现时生存分析法估计得到该院2007—2011年乳腺癌的5年相对生存率为93.6%,高于队列法估计的92.3%和完全法估计的92.9%,也高于2002—2006年采用病理分期调整后现时生存分析法估计的5年相对生存率(91.4%)。结论 :该医院女性乳腺癌患者的生存状况近年来有明显提高,并主要来自对分期较晚患者治疗手段的进步。

Objective： To estimate 5-year survival rate of female breast cancer in Fudan University Shanghai Cancer Center using cohort analysis, complete analysis and period analysis methods. Methods： Clinical information was collected for all 7 275 newly-diagnosed local female breast cancer cases in Fudan University Shanghai Cancer Center, during the period from January 1, 1997 to December 31,2011. Follow- up survey and record linkage with the Shanghai Vital Registw were conducted to obtain information on vital status and date of death for all patients up to December 31, 2011. Cohort analysis, complete analysis and period analysis were applied respectively to estimate 5-year survival rate of breast cancer for the interested periods of 2002-2006 and 2007-2011. Results： The observed 5-year relative survival rate was 92.3% for the patients diagnosed during the period of 2002-2006, higher than 84.7% and 88.6% estimated in cohort analysis and complete analysis, respectively, but close to 90.9% calculatedin period analysis. Similar pattern was observed in cancer patients at different pathological stages, but more evident in the advanced stage groups. The 5-year relative survival rate in 2007-2011 was estimated as 93.6% in period analysis, higher than 92.3% and 92.9% estimated in cohort and complete analysis, and higher than 91.4% of the stage- adjusted 5-year relative survival in 2002-2006. Conclusion： The survival status of female breast cancer in the studied hospital has been significantly improved in recent years, which may mainly result from progress in cancer treatment for the patients with advanced stages.