江苏省启东市1972-2016年白血病生存率长期趋势分析

Trend Analysis of Leukemia Survival Rate in Qidong City from 1972 to 2016

[目的]对启东市1972-2016年全人群白血病发病病例进行生存率分析,为预后评价及防治提供依据。[方法]采用被动随访和主动随访相结合的方法对启东市1972-2016年2 408例白血病登记病例进行生存结局随访,随访截止日期为2021年12月31日。采用SURV3.01软件中Hakulinen方法 1计算观察生存率(observed survival,OS)和相对生存率(relative survival,RS),应用Hakulinen氏似然比检验法进行统计学检验。用Joinpoint 4.7.0.0软件进行Joinpoint回归分析,计算白血病生存率年度变化百分比(annual percentage change,APC),对白血病总体生存率、分性别生存率作时间趋势分析,判断率的长期趋势变化是否存在统计学差异,并用SAS 9.2软件时间序列分析中的ARIMA模型进行白血病生存率趋势预测。[结果]白血病1、3、5年OS分别为28.16%、15.06%、11.54%,1、3、5年RS分别为28.73%、16.02%、12.83%。1972-2016年各时期生存率分析,1年RS从1972-1981年的11.11%升至2012-2016年的46.44%,5年RS从1972-1981年的2.86%升至2012-2016年的28.73%,5个时期的RS上升趋势有统计学意义(χ^(2)=245.80,P<0.001)。其中男性5年RS为12.17%,女性5年RS为13.57%,男女性RS比较差异无统计学意义(χ^(2)=12.61,P=0.478)。白血病5年RS的长期趋势分析,男性APC为5.37%(t=6.758,P<0.05),女性APC为3.88%(t=6.429,P<0.05),上升趋势均有统计学意义。0~14岁、15~24岁、25~34岁、35~44岁、45~54岁、55~64岁、65~74岁及75+岁各年龄组的5年RS分别为10.95%、9.48%、13.14%、18.10%、16.60%、12.33%、9.08%及13.19%,各年龄组之间RS差异无统计学意义(χ^(2)=51.48,P=0.150)。白血病生存率结果预测,至2026年5年OS升至34.76%,5年RS升至40.07%。[结论]启东市全人群白血病登记病例总体生存率有所提高,但尚有较大的上升空间,应当继续重视白血病的防治研究。

[Purpose] To analyze the trend of survival rate of leukemia in Qidong City of Jiangsu Province from 1972 to 2016. [Methods] Survival outcomes of 2 408 registered cases of leukemia from 1972 to 2016 were followed up until Dec. 31, 2021. The observed survival(OS) and relative survival(RS) were calculated using Hakulinen method 1 in SURV3.01 software. The statistical calculation was performed by Hakulinen’s likelihood ratio test. Joinpoint regression analysis was performed with Joinpoint 4.7.0.0 software to calculate the annual percentage change(APC) of leukemia survival rate. Time trend analysis was performed on the overall survival rate and genderspecific survival rate was determined. ARIMA model in time series analysis in SAS 9.2 software was used to predict the trend of leukemia survival rate. [Results] The 1-, 3-, and 5-year OS of leukemia were 28.16%, 15.06%, and 11.54%, the 1-, 3-, and 5-year RS were 28.73%, 16.02%, and12.83%, respectively. Analysis of the survival rate in each period from 1972 to 2016 showed that1-year RS increased from 11.11% in 1972~1981 to 46.44% in 2012-2016, and 5-year RS increased from 2.86% in 1972-1981 to 28.73% in 2012-2016, the upward trend of RS in the five periods was statistically significant(χ^(2)=245.80, P<0.001). There was no significant difference in RS between males and females(12.17% vs 13.57%,χ^(2)=12.61, P=0.478). The APC for males was 5.37%(t=6.758, P<0.05), and for females was 3.88%(t=6.429, P<0.05). The 5-year RS rates of 0~14, 15~24, 25~34, 35~44, 45~54, 55~64,65~74 and 75+years groups, were 10.95%,9.48%, 13.14%, 18.10%, 16.60%, 12.33%, 9.08%, and 13.19%, respectively(χ^(2)=51.48, P=0.150).It was predicted that the 5-year OS of leukemia would increase to 34.76%, and the 5-year RS would increase to 40.07% by 2026. [Conclusion] The overall survival rate of registered cases of leukemia in the whole population of Qidong City has been improved, but the prevention and treatment of leukemia should be further enhanced.