台湾25年来癌症生存率的演变：基于生存期-时期-队列模型的现时预测

文献信息

中文摘要

背景： 自1982年以来，癌症一直是台湾的首要死因，但长期生存趋势仍未得到充分描述。我们评估了25年癌症生存趋势，包括分期特异性结局。
方法： 我们分析了台湾癌症登记数据，纳入1996年至2021年间诊断为癌症的15-99岁患者。我们估算了所有部位合计的癌症生存指数，以及各癌种经年龄和性别调整的5年相对生存比。对于2018年之前的诊断采用Ederer II队列法，对于2018-2020年的诊断采用生存期-时期-队列模型进行现时预测。对2010-2017年诊断的17种癌症评估了TNM分期特异性生存。
结果： 5年癌症生存指数从1996年的46.8%上升至2020年的现时预测估计值56.2%。生存改善最明显的是小肠癌、肺癌和鼻咽癌，其中肺腺癌也向更早期诊断转变。宫颈癌、肾盂癌、膀胱癌、脑及中枢神经系统癌和胆囊癌的生存率下降。大多数癌症的分期特异性生存基本保持稳定，而肺癌显示出明显改善，包括腺癌各分期以及晚期鳞状细胞癌。
结论： 全国癌症生存率显著改善，但持续存在的癌种特异性差距凸显了早期发现、治疗和癌症控制的优先事项。
影响： 这些基于人群的估计为监测癌症预后、评估癌症控制进展以及识别需要更多临床和公共卫生关注的癌症及分期提供了及时证据。

英文摘要

BACKGROUND: Cancer has been the leading cause of death in Taiwan since 1982, but long-term survival trends remain incompletely characterized. We evaluated 25-year cancer survival trends, including stage-specific outcomes.
METHODS: We analyzed Taiwan Cancer Registry data for patients aged 15-99 years diagnosed with cancer between 1996 and 2021. We estimated the cancer survival index for all sites combined and age- and sex-adjusted 5-year relative survival ratios for individual cancers. The Ederer II cohort method was used for diagnoses before 2018, and the survivorship-period-cohort model was used to nowcast survival for diagnoses in 2018-2020. TNM stage-specific survival was evaluated for 17 cancers diagnosed during 2010-2017.
RESULTS: The 5-year cancer survival index increased from 46.8% in 1996 to a nowcast estimate of 56.2% in 2020. Survival improved most for small intestine, lung, and nasopharyngeal cancers, with lung adenocarcinoma also shifting toward earlier-stage diagnosis. Survival declined for cervical, renal pelvis, bladder, brain and CNS, and gallbladder cancers. Stage-specific survival remained largely stable for most cancers, whereas lung cancer showed clear gains, including across all stages of adenocarcinoma and in late-stage squamous cell carcinoma.
CONCLUSIONS: Nationwide cancer survival improved substantially, but persistent cancer-specific gaps highlight priorities for early detection, treatment, and cancer control.
IMPACT: These population-based estimates provide timely evidence for monitoring cancer prognosis, evaluating cancer-control progress, and identifying cancers and stages requiring greater clinical and public health attention.