Purpose

Understanding how stage at cancer diagnosis influences cause of death, an endpoint that is not susceptible to lead-time bias, can inform population-level outcomes of cancer screening.

Methods

Using data from 17 US Surveillance, Epidemiology, and End Results registries for 1,154,515 persons aged 50–84 years at cancer diagnosis in 2006–2010, we evaluated proportional causes of death by cancer type and uniformly classified stage, following or extrapolating all patients until death through 2020.

Results

Most cancer patients diagnosed at stages I–II did not go on to die from their index cancer, whereas most patients diagnosed at stage IV did. For patients diagnosed with any cancer at stages I–II, an estimated 26% of deaths were due to the index cancer, 63% due to non-cancer causes, and 12% due to a subsequent primary (non-index) cancer. In contrast, for patients diagnosed with any stage IV cancer, 85% of deaths were attributed to the index cancer, with 13% non-cancer and 2% non-index-cancer deaths. Index cancer mortality from stages I–II cancer was proportionally lowest for thyroid, melanoma, uterus, prostate, and breast, and highest for pancreas, liver, esophagus, lung, and stomach.

Conclusion

Across all cancer types, the percentage of patients who went on to die from their cancer was over three times greater when the cancer was diagnosed at stage IV than stages I–II. As mortality patterns are not influenced by lead-time bias, these data suggest that earlier detection is likely to improve outcomes across cancer types, including those currently unscreened.

中文翻译：

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通过估计癌症和非癌症死亡的特定阶段比例来避免提前期偏差

目的

了解癌症诊断阶段如何影响死亡原因（一个不易受提前时间偏差影响的终点）可以为癌症筛查的人群水平结果提供信息。

方法

我们利用 2006 年至 2010 年美国 17 个监测、流行病学和最终结果登记处针对 1,154,515 名年龄在 50-84 岁的癌症诊断者的数据，评估了按癌症类型划分的死亡原因比例，并统一分类了阶段，跟踪或推断所有患者直至死亡到 2020 年。

结果

大多数在 I-II 期诊断的癌症患者并没有继续死于其指数癌症，而大多数在 IV 期诊断的患者却死于这种癌症。对于在 I-II 期诊断出患有任何癌症的患者，估计有 26% 的死亡是由于指标癌症造成的，63% 是由于非癌症原因造成的，12% 是由于随后的原发性（非指标）癌症造成的。相比之下，对于诊断为任何 IV 期癌症的患者，85% 的死亡归因于指标癌症，13% 为非癌症死亡，2% 为非指标癌症死亡。甲状腺癌、黑色素瘤、子宫癌、前列腺癌和乳腺癌的 I-II 期癌症指数死亡率比例最低，而胰腺癌、肝癌、食道癌、肺癌和胃癌的死亡率最高。

结论

在所有癌症类型中，当癌症在 IV 期被诊断出来时，最终死于癌症的患者比例是 I-II 期的三倍多。由于死亡率模式不受提前时间偏差的影响，这些数据表明，早期检测可能会改善各种癌症类型的结果，包括目前未筛查的癌症类型。