The aim of this study was (i) to update the reporting of colorectal cancer survival differences over time in the German–Danish border region (Schleswig-Holstein, Southern Denmark, and Zealand) and (ii) to assess the extent to which it can be explained by stage and primary treatment. Incident invasive colorectal cancer cases diagnosed from 2004 to 2016 with a follow-up of vital status through 31 December 2017 were extracted from cancer registries. Analyses were conducted by anatomical subsite and for four consecutive periods. Kaplan–Meier curves and log-rank tests were computed. Cox regression models using data from Schleswig-Holstein from 2004 to 2007 as the reference category were run while controlling for age, sex, stage, and treatment. The cox regression models showed decreasing hazard ratios of death for all three regions over time for both anatomical subsites. The improvement was stronger in the Danish regions, and adjustment for age, sex, stage, and treatment attenuated the results only slightly. In 2014–2016, colon cancer survival was similar across regions, while rectal cancer survival was significantly superior in the Danish regions. Regional survival differences can only partially be explained by differing stage distribution and treatment and may be linked additionally to healthcare system reforms and screening efforts.
本研究旨在：(i) 更新德丹边境地区（石勒苏益格-荷尔斯泰因、南丹麦和西兰岛）结直肠癌生存率随时间变化的差异报告；(ii) 评估这些差异在多大程度上可通过肿瘤分期和初始治疗进行解释。研究从癌症登记处提取了2004年至2016年确诊的浸润性结直肠癌病例数据，并追踪其生存状态至2017年12月31日。分析按解剖亚部位及四个连续时间段进行，计算了卡普兰-迈耶曲线和对数秩检验。以2004-2007年石勒苏益格-荷尔斯泰因地区数据为参照，在控制年龄、性别、分期和治疗因素后建立Cox回归模型。结果显示，两个解剖亚部位在三个地区的死亡风险比均随时间推移呈下降趋势，其中丹麦地区的改善更为显著，而年龄、性别、分期和治疗因素的调整仅使结果略有减弱。2014-2016年间，各地区结肠癌生存率趋于相近，但丹麦地区的直肠癌生存率显著更优。区域生存差异仅能部分通过分期分布和治疗差异解释，可能还与医疗体系改革及筛查措施的实施相关。
Colorectal Cancer Survival in German–Danish Border Regions—A Registry-Based Cohort Study
肿瘤(癌症)患者之家