Hongmei Zeng1, Wanqing Chen2, Rongshou Zheng1, Siwei Zhang1, John S Ji3, Xiaonong Zou1, Changfa Xia1, Kexin Sun1, Zhixun Yang1, He Li1, Ning Wang4, Renqiang Han5, Shuzheng Liu6, Huizhang Li7, Huijuan Mu8, Yutong He9, Yanjun Xu10, Zhentao Fu11, Yan Zhou12, Jie Jiang13, Yanlei Yang14, Jianguo Chen15, Kuangrong Wei16, Dongmei Fan17, Jian Wang18, Fangxian Fu19, Deli Zhao20, Guohui Song21, Jianshun Chen22, Chunxiao Jiang23, Xin Zhou24, Xiaoping Gu25, Feng Jin26, Qilong Li27, Yanhua Li28, Tonghao Wu29, Chunhua Yan30, Jianmei Dong31, Zhaolai Hua32, Peter Baade33, Freddie Bray34, Ahmedin Jemal35, Xue Qin Yu36, Jie He37. 1. National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. 2. National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: chenwq@cicams.ac.cn. 3. Environmental Research Center, Duke Kunshan University, Jiangsu, China; Nicholas School of the Environment, Duke University, Durham, NC, USA. 4. Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, China. 5. Jiangsu Center for Disease Control and Prevention, Jiangsu, China. 6. Henan Cancer Hospital, Henan, China. 7. Zhejiang Provincial Office for Cancer Prevention and Control, Zhejiang Cancer Center/Cancer Hospital, Zhejiang, China. 8. Liaoning Center for Disease Control and Prevention, Shenyang, China. 9. Fourth Hospital of Hebei Medical University, Hebei, China. 10. Guangdong Center for Disease Control and Prevention, Guangdong, China. 11. Shandong Center for Disease Control and Prevention, Shandong, China. 12. Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fujian, China. 13. Dalian Cancer Registry, Dalian Center for Disease Control and Prevention, Liaoning, China. 14. Haimen Cancer Registry, Haimen Center for Disease Control and Prevention, Jiangsu, China. 15. Qidong Cancer Registry, Qidong Liver Cancer Institute, Jiangsu, China. 16. Zhongshan Cancer Registry, Zhongshan People's Hospital, Guangdong, China. 17. Taixing Cancer Registry, Taixing Center for Disease Control and Prevention, Jiangsu, China. 18. Jianhu Cancer Registry, Jianhu Center for Disease Control and Prevention, Jiangsu, China. 19. Linzhou Cancer Registry, Linzhou Cancer Hospital, Henan, China. 20. Feicheng Cancer Registry, Feicheng People's Hospital, Shandong, China. 21. Cixian Cancer Registry, Cixian Institute for Cancer Prevention and Control, Hebei, China. 22. Changle Cancer Registry, Changle Institute for Cancer Prevention and Control, Fujian, China. 23. Haining Cancer Registry, Haining Institute for Cancer Prevention and Control, Zhejiang, China. 24. Jintan Cancer Registry, Jintan Center for Disease Control and Prevention, Jiangsu, China. 25. Dafeng Cancer Registry, Dafeng Center for Disease Control and Prevention, Jiangsu, China. 26. Ganyu Cancer Registry, Ganyu Center for Disease Control and Prevention, Jiangsu, China. 27. Jiashan Cancer Registry, Jiashan Institute for Cancer Prevention and Control, Zhejiang, China. 28. Sihui Cancer Registry, Tumor Research Institute of Sihui City, Guangdong, China. 29. Donghai Cancer Registry, Donghai Center for Disease Control and Prevention, Jiangsu, China. 30. Guanyun Cancer Registry, Guanyun Center for Disease Control and Prevention, Jiangsu, China. 31. Lianyungang Cancer Registry, Lianyungang Center for Disease Control and Prevention, Jiangsu, China. 32. Yangzhong Cancer Registry, Yangzhong Institute for Cancer Prevention and Control, Jiangsu, China. 33. Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia. 34. Cancer Surveillance Section, International Agency for Research on Cancer, Lyon France. 35. Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA. 36. Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia. 37. National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: hejie@cicams.ac.cn.
Abstract
BACKGROUND: From 2003 to 2005, standardised 5-year cancer survival in China was much lower than in developed countries and varied substantially by geographical area. Monitoring population-level cancer survival is crucial to the understanding of the overall effectiveness of cancer care. We therefore aimed to investigate survival statistics for people with cancer in China between 2003 and 2015. METHODS: We used population-based data from 17 cancer registries in China. Data for the study population was submitted by the end of July 31, 2016, with follow-up data on vital status obtained on Dec 31, 2015. We used anonymised, individual cancer registration records of patients (aged 0-99 years) diagnosed with primary, invasive cancers from 2003 to 2013. Patients eligible for inclusion had data for demographic characteristics, date of diagnosis, anatomical site, morphology, behaviour code, vital status, and last date of contact. We analysed 5-year relative survival by sex, age, and geographical area, for all cancers combined and 26 different cancer types, between 2003 and 2015. We stratified survival estimates by calendar period (2003-05, 2006-08, 2009-11, and 2012-15). FINDINGS: There were 678 842 records of patients with invasive cancer who were diagnosed between 2003 and 2013. Of these records, 659 732 (97·2%) were eligible for inclusion in the final analyses. From 2003-05 to 2012-15, age-standardised 5-year relative survival increased substantially for all cancers combined, for both male and female patients, from 30·9% (95% CI 30·6-31·2) to 40·5% (40·3-40·7). Age-standardised 5-year relative survival also increased for most cancer types, including cancers of the uterus (average change per calendar period 5·5% [95% CI 2·5-8·5]), thyroid (5·4% [3·2-7·6]), cervix (4·5% [2·9-6·2]), and bone (3·2% [2·1-4·4]). In 2012-15, age-standardised 5-year survival for all patients with cancer was higher in urban areas (46·7%, 95% CI 46·5-47·0) than in rural areas (33·6%, 33·3-33·9), except for patients with oesophageal or cervical cancer; but improvements in survival were greater for patients residing in rural areas than in urban areas. Relative survival decreased with increasing age. The increasing trends in survival were consistent with the upward trends of medical expenditure of the country during the period studied. INTERPRETATION: There was a marked overall increase in cancer survival from 2003 to 2015 in the population covered by these cancer registries in China, possibly reflecting advances in the quality of cancer care in these areas. The survival gap between urban and rural areas narrowed over time, although geographical differences in cancer survival remained. Insight into these trends will help prioritise areas that need increased cancer care. FUNDING: National Key R&D Program of China, PUMC Youth Fund and the Fundamental Research Funds for the Central Universities, and Major State Basic Innovation Program of the Chinese Academy of Medical Sciences.
BACKGROUND: From 2003 to 2005, standardised 5-year cancer survival in China was much lower than in developed countries and varied substantially by geographical area. Monitoring population-level cancer survival is crucial to the understanding of the overall effectiveness of cancer care. We therefore aimed to investigate survival statistics for people with cancer in China between 2003 and 2015. METHODS: We used population-based data from 17 cancer registries in China. Data for the study population was submitted by the end of July 31, 2016, with follow-up data on vital status obtained on Dec 31, 2015. We used anonymised, individual cancer registration records of patients (aged 0-99 years) diagnosed with primary, invasive cancers from 2003 to 2013. Patients eligible for inclusion had data for demographic characteristics, date of diagnosis, anatomical site, morphology, behaviour code, vital status, and last date of contact. We analysed 5-year relative survival by sex, age, and geographical area, for all cancers combined and 26 different cancer types, between 2003 and 2015. We stratified survival estimates by calendar period (2003-05, 2006-08, 2009-11, and 2012-15). FINDINGS: There were 678 842 records of patients with invasive cancer who were diagnosed between 2003 and 2013. Of these records, 659 732 (97·2%) were eligible for inclusion in the final analyses. From 2003-05 to 2012-15, age-standardised 5-year relative survival increased substantially for all cancers combined, for both male and female patients, from 30·9% (95% CI 30·6-31·2) to 40·5% (40·3-40·7). Age-standardised 5-year relative survival also increased for most cancer types, including cancers of the uterus (average change per calendar period 5·5% [95% CI 2·5-8·5]), thyroid (5·4% [3·2-7·6]), cervix (4·5% [2·9-6·2]), and bone (3·2% [2·1-4·4]). In 2012-15, age-standardised 5-year survival for all patients with cancer was higher in urban areas (46·7%, 95% CI 46·5-47·0) than in rural areas (33·6%, 33·3-33·9), except for patients with oesophageal or cervical cancer; but improvements in survival were greater for patients residing in rural areas than in urban areas. Relative survival decreased with increasing age. The increasing trends in survival were consistent with the upward trends of medical expenditure of the country during the period studied. INTERPRETATION: There was a marked overall increase in cancer survival from 2003 to 2015 in the population covered by these cancer registries in China, possibly reflecting advances in the quality of cancer care in these areas. The survival gap between urban and rural areas narrowed over time, although geographical differences in cancer survival remained. Insight into these trends will help prioritise areas that need increased cancer care. FUNDING: National Key R&D Program of China, PUMC Youth Fund and the Fundamental Research Funds for the Central Universities, and Major State Basic Innovation Program of the Chinese Academy of Medical Sciences.
Authors: Matthijs Oudkerk; ShiYuan Liu; Marjolein A Heuvelmans; Joan E Walter; John K Field Journal: Nat Rev Clin Oncol Date: 2020-10-12 Impact factor: 66.675