上海人群肺癌生存率分析

Survival analysis of patients with lung cancer in Shanghai

背景与目的:肺癌在我国是第一位新发和死亡恶性肿瘤。该研究旨在掌握以人群为基础的肺癌生存率资料,为评价肺癌防治效果提供参考。方法:该研究根据上海市肿瘤登记处收集的2002—2006年诊断的肺癌病例的登记和生存随访报告资料,采用寿命表法和EdererⅡ法对肺癌患者的观察生存率(observed survival,OS)和相对生存率(relative survival,RS)及其相关人口学和疾病状况特征资料进行分析,以反映上海地区人群肺癌的生存现况。结果:纳入分析的上海市2002—2006年诊断的肺癌病例41 802例,5年OS和RS分别为13.75%和20.23%,中位生存期318 d。女性5年OS(15.49%)高于男性(13.00%)。郊区5年OS(14.25%)高于市区(13.23%)。生存率随着年龄、诊断时期别的升高而降低。0~34岁年龄组5年OS为38.21%,大于等于75岁年龄组仅为5.48%;Ⅰ期病例5年OS为55.47%,Ⅳ期病例为5.27%。不同病理学分型的病例生存情况有差异,鳞癌的5年OS最高(24.40%),其次是腺癌(22.26%),再次为大细胞肺癌(20.27%)和小细胞肺癌(12.22%)。从1972—1976年到2002—2006年,上海市区男性肺癌的5年OS从6.8%提高到12.4%;女性肺癌的5年OS从7.3%提高到14.9%。RS所得结果相似。结论:在过去30年中,上海市肺癌患者的生存情况有所提高,在各国家地区之中处于中上水平,但与其他癌症相比肺癌预后仍然较差。吸烟等危险因素的防控、低剂量螺旋CT作为早期筛查的手段以及靶向治疗是未来提高肺癌生存率的方向。

Background and purpose： The incidence and mortality of lung cancer ranked first in China. This study aimed to describe lung cancer survival in Shanghai, and provide background information for cancer prevention and treatment evaluation. Methods： Data of lung cancer cases diagnosed during 2002-2006, follow-up information and death report were collected from Shanghai Cancer Registry. Life table method and Ederer Ⅱ were used to calculate observed survival （OS） and relative survival （RS） respectively. Related demographic characteristics and status were also analyzed to present the survival situations of the lung cancer survivors in Shanghai. Results： In this study, 41 802 lung cancer cases were included in analysis. The 5-year OS and RS for lung cancer were 13.75% and 20.23% respectively, and median survival time was 318 days. Survival rate was higher among females than males, with the 5-year OS of 15.49% and 13.00% respectively. The 5-year OS was higher among suburban residents （14.25%） than urban residents （13.23%）. Survival rates decreased with increasing age and advanced stage. Patients aged 0-34 had a 5-year OS of 38.21%, while patients aged above 75 had a 5-year OS of 5.48%. Patients diagnosed with stage I had a 5-year OS of 55.47%, while patients diagnosed with stage IV had a 5-year OS of 5.27%. Survival of lung cancer patients differed by tumor histological subtype. The 5-year OS of squamous lung cancer （24.40%） was higher than other histological types, followed by adenocarcinoma （22.26%）, large cell （20.27%） and small cell lung cancer （12.22%）. From 1972-1976 to 2002-2006, the 5-year OS of urban male patients increased from 6.8% to 12.4%, and 5-year OS of urban female patients increased from 7.3% to 14.9%. Analysis of RS gave the similar results. Conclusion： During the past 30 years, survival rate of lung cancer patients in Shanghai improved steadily, and the survival condition is above average among different countries and areas. However, survival rate of lung cancer is still low compared with other types of cancer. Future focus should be placed on the control of tobacco smoking, early detection by low-dose helical computed tomography and targeted theranv to further imorove lun- cancer survival.