老年人恶性肿瘤生存率长期趋势分析

Long-term trend of survival rate of malignant tumors in the elderly over sixty years old

目的对启东市1972~2016年老年人恶性肿瘤发病病例作生存率分析,为预后评价及防治提供依据。方法基于启东市癌症登记报告系统中老年人恶性肿瘤发病66386例登记资料,以主动随访与被动随访相结合的方法追踪生存结局,按性别、年龄别、肿瘤部位别和诊治医院级别进行分析。结果启东市1972~2016年60岁以上老年人发生恶性肿瘤共计66386例,占同期全人群恶性肿瘤病例的56.66%。老年人恶性肿瘤5、10年观察生存率(OSR)分别为14.52%及9.53%,相对生存率(RSR)分别为19.76及18.92,其中男性5年RSR为16.98%、女性为23.91%,差异有统计学意义(χ^(2)=339.83,P<0.001)。男性和女性的5年RSR,分别从1972~1976年的7.53%和15.83%,提高到2012-2016年的28.06%和39.01%。60~64岁、65~69岁、70~74岁、75~79岁、80~84岁及85岁及以上各年龄组5年RSR分别为22.84%、20.53%、17.74%、18.30%、18.02%及14.06%,差异有统计学意义(χ^(2)=694.27,P<0.001)。前10位主要恶性肿瘤中,5年相对生存率(RSR)较好的为女性乳腺癌、前列腺癌、膀胱癌、结直肠癌、恶性淋巴瘤及胃癌,较差的为肝癌、食管癌、肺癌及胰腺癌。2002~2016年与1972~1986年比较,5年RSR绝对值提高较多的为前列腺癌、结直肠癌、女性乳腺癌、膀胱癌,其次为胃癌、恶性淋巴瘤、肝癌、食管癌、肺癌,未见提高的为胰腺癌。区乡级、县级市、地市级(三甲)及省部级(三甲)医院诊治患者的5年RSR分别为13.97%、23.71%、26.12%和28.55%,差异有统计学意义(χ^(2)=841.93,P<0.001)。此45年间,5年观察生存率(OSR)的恶性肿瘤生存率平均年度变化百分比(AAPC)为3.88%(t=6.75,P<0.001),5年RSR的AAPC为3.69%(t=7.44,P=0.001);其中男性5年RSR的AAPC为3.91%(t=9.66,P<0.001),女性AAPC为3.42%(t=6.08,P=0.001)。各年龄组5年RSR的AAPC值:60~64岁为4.08%,65~69岁为4.18%,70~74岁为3.91%,75~79岁为3.12%,80~84岁为3.81%,85岁及以上为0.51%;除85岁及以上外(P=0.615),其余各年龄组的上升趋势均有统计学意义(P<0.01)。结论老年人恶性肿瘤已成为启东当地的主要恶性肿瘤负担,且有显著的性别差异与年龄差异。45年来老年人恶性肿瘤的总体生存率有了显著的提高;老年人恶性肿瘤生存率的提高可能与诊治水平及诊疗机构服务能力的提升有关。

Objective To analyze the survival rate of malignant tumor in the elderly over 60 years old in Qidong city from 1972 to 2016,and to provide basis for prognosis evaluation and prevention.Methods Based on the data of 66386 patients with malignant tumor in the elderly over 60 years old in the Qidong cancer registration and reporting system,the survival outcome was tracked by the method of active follow-up and passive follow-up.All of these data were then analyzed by stratification of sex,age,tumor site and hospital level.Results During the period of 1972 to 2016,the total number of patients with malignant tumors in the elderly were 66386 cases,accounting for 56.66%of patients in all age groups.The observed survival rate(OSR)of 5 and 10 years were 14.52%and 9.53%and relative survival rate(RSR)of 5 and 10 years were 19.76%and 18.92%,respectively,in the elderly in Qidong.The 5-year RSR was 16.98%for males and 23.91%for females,being a statistically significant(χ^(2)=339.83,P<0.001).The 5-year RSRs of elderly patients in males and females increased from 7.53%and 15.83%in 1972-1976 to 28.06%and 39.01%in 2012-2016,respectively.The 5-year RSR of 60-64,65-69,70-74,75-79,80-84 and 85 years old and over were 22.84%,20.53%,17.74%,18.30%,18.02%and 14.06%,respectively,with a statistically significant difference(χ^(2)=694.27,P<0.001).Among the top 10 major malignancies,the ranks of 5-year RSR from high to low were breast cancer,prostate cancer,bladder cancer,colorectal cancer,malignant lymphoma,gastric cancer,liver cancer,esophageal cancer,lung cancer,and pancreatic cancer,respectively.A comparison between 2002--2016 and 1972--1986 showed that the increased rank of absolute values of RSR from highest to lowest were prostate cancer,colorectal cancer,female breast cancer,bladder cancer,gastric cancer,malignant lymphoma,liver cancer,esophageal cancer,lung cancer,and pancreatic cancer,respectively.The 5-year RSR of patients diagnosed in the district/township hospitals,county hospitals,city-level 3A hospitals and provincial-level 3A hospitals were 13.97%,23.71%,26.12%and 28.55%,respectively,with a statistically significant difference(χ^(2)=841.93,P<0.001).In the 45 years,the average annual percentage change(AAPC)ratio of 5-year OSR was 3.88%(t=6.75,P<0.001),and the 5-year RSR was 3.69%(t=7.44,P=0.001);the AAPC of the 5-year RSR was 3.91%(t=9.66,P<0.001)in males and 3.42%(t=6.08,P=0.001)in females.The AAPC ratio of 5-year RSR in each age group were 4.08%for 60-64 years,4.18%for 65-69 years,3.91%for 70-74 years,3.12%for 75-79 years,3.81%for 80-84 years,0.51%for 85 years old and over,respectively.Except for age group of 85 years old and over(P=0.615),significant rising trends were observed in all age groups(P<0.01).Conclusions Malignant tumors in the elderly have become the major cancer burden in Qidong,and there are significant gender and age differences.The overall survival rate in elderly patients with malignant tumors has been significantly improved in the past 45 years,which may be related to the improvement in the level of diagnosis and treatment and the service capacity of hospitals.