英联邦 11 种癌症的发病率和存活率:模拟建模研究。

IF 41.6 1区 医学 Q1 ONCOLOGY
Lancet Oncology Pub Date : 2024-09-01 Epub Date: 2024-08-07 DOI:10.1016/S1470-2045(24)00336-X
Zachary J Ward, Qassi Gaba, Rifat Atun
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引用次数: 0

摘要

背景:2008 年至 2018 年间,英联邦国家新发癌症病例增加了 35%,但许多低收入和中低收入成员国在癌症控制方面进展缓慢。我们旨在研究英联邦国家的癌症结果和优先领域,以便为改善癌症生存率和充分利用稀缺资源的优先工作提供见解和指导:我们对之前开发的全球癌症存活率微观模拟模型进行了调整,该模型适用于 11 种癌症(食道癌、胃癌、结肠癌、直肠癌、肛门癌、肝癌、胰腺癌、肺癌、乳腺癌、子宫颈癌和前列腺癌)。我们纳入了所有 56 个英联邦国家,并根据 2020 年世界银行收入分组(低收入国家、中低收入国家、中高收入国家和高收入国家)和英联邦地理区域进行了分类。我们根据 GLOBOCAN 2020 估算的特定年龄组发病率,模拟了 2020 年每个英联邦国家的癌症发病人数。我们模拟了每位患者的 5 年净存活率,其中考虑了诊断时的分期(I-IV 期)、特定治疗和成像方式的可用性以及护理质量(基于考虑治疗和成像方式的可用性和有效性后预期存活率与观察存活率之间的剩余差异)。我们还模拟了反事实政策情景,将癌症治疗的各个方面提高到高收入国家的平均水平,以估算不同政策的比较效果:在模拟的 11 种癌症中,英联邦的癌症发病率估计占 2020 年全球确诊癌症病例的 14-3%(英联邦病例 1 610 000 例 [95% UI 1 556 000-1 674 000] ,全球病例 11 227 000 例 [11 069 000-11 406 000]),由于人口增长,估计 2050 年将增至 17-3%(3 330 000 [3 154 000-3 539 000] ,全球病例 19 308 000 例 [18 706 000-19 911 000])。2020 年,英联邦国家 11 种癌症的 5 年净存活率合计为 30-7%(95% UI 22-4-38-6),其中低收入国家为 4-1%(0-04-15-2),中低收入国家为 17-8%(3-7-30-9),中上收入国家为 33-1%(23-7-46-0),高收入国家为 59-0%(57-8-60-2)。在单一治疗政策中,扩大放射治疗的可及性对低收入国家的生存率影响最大,手术治疗对中低收入和中高收入国家的影响最大,靶向治疗对高收入国家的影响最大。按地理区域划分,据估计,改善放射治疗的可用性对非洲的影响最大,手术对亚洲的影响最大,靶向治疗对加勒比地区、美洲和欧洲的影响最大,而医疗质量对太平洋英联邦国家的影响最大。比较扩大所有治疗方式与成像方式的一揽子方案,在高收入国家、加勒比地区、美洲、欧洲和太平洋地区,扩大成像的可获得性产生的效益最大,而在所有其他收入群体和地理区域,扩大治疗的可获得性产生的效益更大:我们发现 5 年净生存率存在很大差异,在英联邦国家中,不同收入群体的癌症生存率相差近 15 倍。努力改善治疗和成像模式的可用性以及护理质量对于缩小这些差距至关重要,不同环境下扩大政策的具体优先事项也各不相同。英联邦可以利用广泛的知识和资源,在支持成员国根据具体情况确定优先事项以改善癌症治疗效果方面发挥重要作用:哈佛大学陈博士公共卫生学院。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cancer incidence and survival for 11 cancers in the Commonwealth: a simulation-based modelling study.

Background: The number of new cancer cases in Commonwealth countries rose by 35% between 2008 and 2018, but progress in cancer control has been slow in many low-income and lower-middle-income member states. We aimed to examine cancer outcomes and priority areas in the Commonwealth to provide insight and guidance on prioritisation of efforts to improve cancer survival and make the best use of scarce resources.

Methods: We adapted a previously developed microsimulation model of global cancer survival for 11 cancer sites (oesophagus, stomach, colon, rectum, anus, liver, pancreas, lung, breast, cervix uteri, and prostate). All 56 Commonwealth countries were included and classified based on the 2020 World Bank Income groups (low-income, lower-middle-income, upper-middle-income, and high-income countries) and Commonwealth geographical areas. We modelled the number of incident cancer cases in each Commonwealth country in 2020, based on age group-specific estimates of incidence rates from GLOBOCAN 2020. We simulated 5-year net survival for each patient, accounting for the stage at diagnosis (I-IV), availability of specific treatment and imaging modalities, and quality of care (based on residual differences in expected versus observed survival after accounting for the availability and effectiveness of treatment and imaging modalities). We also simulated counterfactual policy scenarios, in which we scaled up various aspects of cancer care to the mean level of high-income countries to estimate the comparative effectiveness of different policies.

Findings: Incident cancers in the Commonwealth accounted for an estimated 14·3% of global diagnosed cancer cases in 2020 among the 11 cancers modelled (1 610 000 Commonwealth cases [95% UI 1 556 000-1 674 000] of 11 227 000 global cases [11 069 000-11 406 000]) and are estimated to increase to 17·3% in 2050 due to population growth (3 330 000 [3 154 000-3 539 000] of 19 308 000 [18 706 000-19 911 000]). The 5-year net survival across 11 cancers combined in 2020 was 30·7% (95% UI 22·4-38·6) in Commonwealth countries, ranging from 4·1% (0·04-15·2) in low-income countries, 17·8% (3·7-30·9) in lower-middle-income countries, 33·1% (23·7-46·0) in upper-middle-income countries, to 59·0% (57·8-60·2) in high-income countries. Among single treatment policies, scaling up access to radiotherapy had the largest survival impact in low-income countries, surgery had the largest impact in lower-middle-income and upper-middle-income countries, and targeted therapy had the largest impact in high-income countries. By geographical area, improving radiotherapy availability was estimated to have the largest impact in Africa, surgery in Asia, targeted therapy in the Caribbean and the Americas and Europe, and quality of care in the Pacific Commonwealth countries. Comparing packages of scaling up the availability of all treatment modalities versus imaging modalities, expanding availability of imaging yielded the largest benefits in high-income countries, and in the Caribbean and the Americas, Europe, and the Pacific, whereas expanding treatment yielded larger benefits in all other income groups and geographical areas.

Interpretation: We found large variation in 5-year net survival, with a nearly 15-times difference in cancer survival by country income group within the Commonwealth. Efforts to improve the availability of treatment and imaging modalities and quality of care will be crucial to reduce these disparities, with specific priorities of scale-up policies varying by setting. The Commonwealth could leverage a broad range of knowledge and resources and have an important role in supporting member countries with setting-specific priorities to improve cancer outcomes.

Funding: Harvard T H Chan School of Public Health.

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来源期刊
Lancet Oncology
Lancet Oncology 医学-肿瘤学
CiteScore
62.10
自引率
1.00%
发文量
913
审稿时长
3-8 weeks
期刊介绍: The Lancet Oncology is a trusted international journal that addresses various topics in clinical practice, health policy, and global oncology. It covers a wide range of cancer types, including breast, endocrine system, gastrointestinal, genitourinary, gynaecological, haematological, head and neck, neurooncology, paediatric, thoracic, sarcoma, and skin cancers. Additionally, it includes articles on epidemiology, cancer prevention and control, supportive care, imaging, and health-care systems. The journal has an Impact Factor of 51.1, making it the leading clinical oncology research journal worldwide. It publishes different types of articles, such as Articles, Reviews, Policy Reviews, Personal Views, Clinical Pictures, Comments, Correspondence, News, and Perspectives. The Lancet Oncology also collaborates with societies, governments, NGOs, and academic centers to publish Series and Commissions that aim to drive positive changes in clinical practice and health policy in areas of global oncology that require attention.
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