There is little evidence on variation in radiotherapy use in different countries, although it is a key treatment modality for some patients with cancer. Here we aimed to examine such variation. This population-based study used data from Norway, the four UK nations (England, Northern Ireland, Scotland, and Wales), nine Canadian provinces (Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, Prince Edward Island, and Saskatchewan), and two Australian states (New South Wales and Victoria). Patients aged 15–99 years diagnosed with cancer in eight different sites (oesophageal, stomach, colon, rectal, liver, pancreatic, lung, or ovarian cancer), with no other primary cancer diagnosis occurring within the 5 years before to 1 year after the index cancer diagnosis or during the study period were included in the study. We examined variation in radiotherapy use from 31 days before to 365 days after diagnosis and time to its initiation, alongside related variation in patient group differences. Information was obtained from cancer registry records linked to clinical or patient management system data, or hospital administration data. Random-effects meta-analyses quantified interjurisdictional variation using 95% prediction intervals (95% PIs). Between Jan 1, 2012, and Dec 31, 2017, of 902 312 patients with a new diagnosis of one of the studied cancers, 115 357 (12·8%) did not meet inclusion criteria, and 786,955 were included in the analysis. There was large interjurisdictional variation in radiotherapy use, with wide 95% PIs: 17·8 to 82·4 (pooled estimate 50·2%) for oesophageal cancer, 35·5 to 55·2 (45·2%) for rectal cancer, 28·6 to 54·0 (40·6%) for lung cancer, and 4·6 to 53·6 (19·0%) for stomach cancer. For patients with stage 2–3 rectal cancer, interjurisdictional variation was greater than that for all patients with rectal cancer (95% PI 37·0 to 84·6; pooled estimate 64·2%). Radiotherapy use was infrequent but variable in patients with pancreatic (95% PI 1·7 to 16·5%), liver (1·8 to 11·2%), colon (1·6 to 5·0%), and ovarian (0·8 to 7·6%) cancer. Patients aged 85–99 years had three-times lower odds of radiotherapy use than those aged 65–74 years, with substantial interjurisdictional variation in this age difference (odds ratio [OR] 0·38; 95% PI 0·20–0·73). Women had slightly lower odds of radiotherapy use than men (OR 0·88, 95% PI 0·77–1·01). There was large variation in median time to first radiotherapy (from diagnosis date) by cancer site, with substantial interjurisdictional variation (eg, oesophageal 95% PI 11·3 days to 112·8 days; pooled estimate 62·0 days; rectal 95% PI 34·7 days to 77·3 days; pooled estimate 56·0 days). Older patients had shorter median time to radiotherapy with appreciable interjurisdictional variation (−9·5 days in patients aged 85–99 years 65–74 years, 95% PI −26·4 to 7·4). Large interjurisdictional variation in both use and time to radiotherapy initiation were observed, alongside large and variable age differences. To guide efforts to improve patient outcomes, underlying reasons for these differences need to be established. International Cancer Benchmarking Partnership (funded by the Canadian Partnership Against Cancer, Cancer Council Victoria, Cancer Institute New South Wales, Cancer Research UK, Danish Cancer Society, National Cancer Registry Ireland, The Cancer Society of New Zealand, National Health Service England, Norwegian Cancer Society, Public Health Agency Northern Ireland on behalf of the Northern Ireland Cancer Registry, DG Health and Social Care Scottish Government, Western Australia Department of Health, and Public Health Wales NHS Trust).

中文翻译：

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放射治疗在食管癌、胃癌、结肠癌、直肠癌、肝癌、胰腺癌、肺癌和卵巢癌患者中的应用：国际癌症基准合作伙伴关系 (ICBP) 的一项基于人群的研究

尽管放疗对于某些癌症患者来说是一种关键的治疗方式，但几乎没有证据表明不同国家放疗使用情况存在差异。在这里，我们的目的是研究这种变化。这项基于人口的研究使用了来自挪威、英国四个国家（英格兰、北爱尔兰、苏格兰和威尔士）、加拿大九个省（艾伯塔省、不列颠哥伦比亚省、曼尼托巴省、新不伦瑞克省、纽芬兰和拉布拉多省、新斯科舍省、安大略省、普林斯省）的数据。爱德华岛和萨斯喀彻温省）以及澳大利亚的两个州（新南威尔士州和维多利亚州）。年龄在 15-99 岁之间，被诊断患有 8 个不同部位癌症（食管癌、胃癌、结肠癌、直肠癌、肝癌、胰腺癌、肺癌或卵巢癌）的患者，且在治疗前 5 年内至治疗后 1 年内没有诊断出其他原发癌症癌症诊断或研究期间的指数均被纳入研究。我们检查了诊断前 31 天至诊断后 365 天以及开始放疗时间的放疗使用变化，以及患者组差异的相关变化。信息是从与临床或患者管理系统数据或医院管理数据相关的癌症登记记录中获取的。随机效应荟萃分析使用 95% 预测区间 (95% PI) 量化辖区间差异。 2012年1月1日至2017年12月31日期间，在902 312名新诊断出所研究癌症之一的患者中，115 357名（12·8%）不符合纳入标准，786,955名患者被纳入分析。放射治疗的使用存在很大的跨辖区差异，95% 的 PI 很宽：食道癌为 17·8 至 82·4（汇总估计为 50·2%），直肠癌为 35·5 至 55·2（45·2%） ，肺癌为 28·6 至 54·0 (40·6%)，胃癌为 4·6 至 53·6 (19·0%)。对于 2-3 期直肠癌患者，辖区间差异大于所有直肠癌患者（95% PI 37·0 至 84·6；汇总估计值 64·2%）。胰腺癌（95% PI 1·7 至 16·5%）、肝脏（1·8 至 11·2%）、结肠癌（1·6 至 5·0%）和卵巢癌患者的放射治疗使用频率较低，但差异较大（0·8 至 7·6%）癌症。 85-99 岁患者接受放射治疗的几率比 65-74 岁患者低三倍，且该年龄差异存在显着的跨辖区差异（比值比 [OR] 0·38；95% PI 0·20–0· 73）。女性接受放射治疗的几率略低于男性（OR 0·88，95% PI 0·77–1·01）。不同癌症部位到首次放疗的中位时间（从诊断日期算起）存在很大差异，并且存在显着的跨辖区差异（例如，食管 95% PI 11·3 天至 112·8 天；汇总估计 62·0 天；直肠 95%） PI 34·7 天至 77·3 天；汇总估计 56·0 天）。老年患者的放疗中位时间较短，且具有明显的辖区差异（85-99 岁和 65-74 岁患者为 -9·5 天，95% PI -26·4 至 7·4）。观察到放射治疗的使用和开始时间存在较大的辖区差异，以及巨大且可变的年龄差异。为了指导改善患者治疗结果的努力，需要确定这些差异的根本原因。国际癌症基准合作伙伴关系（由加拿大抗癌合作伙伴关系、维多利亚癌症委员会、新南威尔士州癌症研究所、英国癌症研究中心、丹麦癌症协会、爱尔兰国家癌症登记处、新西兰癌症协会、英格兰国家卫生服务中心、挪威癌症协会资助）协会、北爱尔兰公共卫生局（代表北爱尔兰癌症登记处）、苏格兰政府健康和社会关怀总署、西澳大利亚卫生部和威尔士 NHS 公共卫生信托基金。