Cancer Epidemiology最新文献_第3页

The International Classification of Diseases for Oncology, 4th Edition (ICD-O-4): An overview 国际肿瘤疾病分类，第四版（ICD-O-4）：概述

IF 2.3 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2026-04-01 Epub Date: 2026-01-22 DOI: 10.1016/j.canep.2026.102989

Ariana Znaor , Brian Rous , Gabrielle Goldman Levy , Reiko Watanabe , Robert Jakob , Eva Krpelanova , Harshima D. Wijesinghe , Pavitratha Puspanathan , Ian A. Cree , Freddie Bray , Dilani Lokuhetty

Background

The International Classification of Diseases for Oncology (ICD-O) was specifically developed for coding tumours according to their site of origin (topography), microscopic appearance or histology, behaviour and grade (morphology), and is optimal for use in cancer registries. The fourth edition of the ICD-O (ICD-O-4) aims to provide an improved structure of unique codes to existent and newly defined tumour entities and has been harmonised with the International Classification of Diseases 11th Edition (ICD-11).

Methods

Based on an International Association of Cancer Registries (IACR) survey of cancer registries, over 90 % of the respondents (250 of 276) agreed to an update of ICD-O-3.2 morphology by the addition of a fifth digit to the existing four-digit histology code. Following the 5th Edition of the WHO Classification of Tumours (WCT), a beta version of ICD-O-4 was developed and disseminated for open consultation by the International Agency on Research for Cancer (IARC) on the WCT website.

Results

Following closure of the consultation period, the ICD-O-4 codes were finalized. The main changes in comparison to ICD-O-3.2 include the addition of a 5th alphanumeric digit to the histology code, changes in the first four digits of histology codes, changes of behaviour codes (e.g. pituitary adenoma code changed from /1 to /3), a new topography code for gastroesophageal junction (C16.7), detailed codes for extrahepatic bile ducts (C24.2, C24.3) and cystic duct (C24.4), change of the code for anal skin cancer from skin to anus (C44.5 to C21.3) and an optional additional digit in the topography code.

Conclusion

ICD-O-4 is compiled in consultation with pathologists, epidemiologists, public health researchers as well as the cancer registry community. The five-digit histology codes enable a hierarchical and detailed coding of tumours, while the new topography and behaviour codes reflect the evidence base on tumour aetiology, stage and behaviour.

国际肿瘤疾病分类（ICD-O）是专门根据肿瘤的起源位置（地形）、显微外观或组织学、行为和分级（形态学）对肿瘤进行编码而开发的，最适合用于癌症登记。ICD-O第四版（ICD-O-4）旨在为现有和新定义的肿瘤实体提供一种改进的独特代码结构，并已与国际疾病分类第11版（ICD-11）协调一致。方法：根据国际癌症登记处协会（IACR）对癌症登记处的调查，超过90% %的受访者（276人中的250人）同意更新ICD-O-3.2形态学，在现有的四位组织编码基础上增加第五位。继世卫组织肿瘤分类（WCT）第五版之后，制定了ICD-O-4的测试版，并在WCT网站上发布，供国际癌症研究机构（IARC）公开磋商。在咨询期结束后，ICD-O-4规范定稿。与ICD-O-3.2相比，主要变化包括组织编码增加了第5位字母数字，组织编码的前四位数字发生了变化，行为编码发生了变化（如垂体腺瘤编码从/1变为/3），胃食管交界处的新地形图编码（C16.7），肝外胆管（C24.2, C24.3）和胆囊管（C24.4）的详细编码，将肛门皮肤癌的代码从皮肤更改为肛门（C44.5至C21.3），并在地形代码中增加一个可选的附加数字。结论icd - o -4是在与病理学家、流行病学家、公共卫生研究人员以及癌症登记界协商后编制的。五位数的组织学编码能够对肿瘤进行分层和详细的编码，而新的地形和行为编码则反映了基于肿瘤病因学，阶段和行为的证据。

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引用次数: 0

Temporal trends in breast cancer incidence and mortality in Australia: An Age-Period-Cohort analysis 澳大利亚乳腺癌发病率和死亡率的时间趋势：年龄-时期-队列分析

IF 2.3 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2026-04-01 Epub Date: 2026-02-11 DOI: 10.1016/j.canep.2026.103017

Phuong Dung Nguyen , Andrew N. Page , Kate A. McBride , Matthew J. Spittal , Sithum Munasinghe

Background

Breast cancer is the most diagnosed cancer among Australian women. Recently, incidence rates have risen but mortality rates have decreased. The extent to which these changes are the result of cumulative risk factor effects (age-effects), events affecting all women at specific points in time (period effects), or changes in generational risk factors (cohort effects) is unclear. This study investigates whether observed trends in breast cancer incidence and mortality are associated with age, period, or cohort effects.

Methods

Annual Australian breast cancer incidence (1982–2020) and mortality data (1907–2022) were obtained from the Australian Institute of Health and Welfare. Age-Period-Cohort (APC) modelling with a drift in cohort function was used to estimate adjusted age, period and cohort effects.

Results

Age effects showed higher incidence and mortality rates with increasing age, peaking at 75–84 years. Cohort effects showed progressively increasing risk among women born after the 1940s, with higher incidence among younger cohorts. Incidence peaks corresponded with introduction of population-based mammography screening, and also changes in population level risk factors. Period effects (adjusting for cohort effects) were modest, demonstrating reductions in incidence over time, while mortality peaked in the 1990s before declining after 2000.

Conclusion

Increasing age-related breast cancer incidence and mortality reinforce the importance of early prevention. Incidence has shifted due to cohort and period effects with younger generations showing the highest increases in incidence, suggesting generational shifts in breast cancer risk, likely attributable to mammography screening and increased prevalence of modifiable risk factors.

背景乳腺癌是澳大利亚女性中诊断最多的癌症。最近，发病率有所上升，但死亡率有所下降。这些变化在多大程度上是累积风险因素效应（年龄效应）、在特定时间点影响所有妇女的事件（时期效应）或代际风险因素变化（队列效应）的结果，目前尚不清楚。本研究调查观察到的乳腺癌发病率和死亡率趋势是否与年龄、时期或队列效应有关。方法澳大利亚年度乳腺癌发病率（1982-2020年）和死亡率（1907-2022年）数据来自澳大利亚卫生与福利研究所。年龄-时期-队列（APC）模型采用队列函数漂移来估计调整后的年龄、时期和队列效应。结果年龄效应随着年龄的增长，发病率和死亡率较高，在75 ~ 84岁达到高峰。队列效应显示，在20世纪40年代以后出生的女性中，风险逐渐增加，年轻队列的发病率更高。发病率高峰与基于人群的乳房x光检查的引入以及人群水平危险因素的变化相对应。期间效应（调整队列效应）是适度的，表明发病率随着时间的推移而下降，而死亡率在20世纪90年代达到顶峰，2000年后下降。结论随着年龄相关性乳腺癌发病率和死亡率的增加，早期预防的重要性与日俱增。由于队列和时期的影响，发病率发生了变化，年轻一代的发病率增加最多，这表明乳腺癌风险的代际变化，可能归因于乳房x光检查和可改变风险因素的增加。

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引用次数: 0

Temporal trends in prostate cancer incidence, mortality, and survival in the health regions of Sergipe, Brazil, 1996-2022 1996-2022年巴西Sergipe卫生区域前列腺癌发病率、死亡率和生存率的时间趋势。

IF 2.3 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2026-04-01 Epub Date: 2026-02-19 DOI: 10.1016/j.canep.2026.103026

Ana Clara Cruz Santos de Santana , Brenda Evelin Barreto da Silva , Ellen Sabrina Ramos Santos , Jefferson Felipe Calazans Batista , Alex Rodrigues Moura , Carlos Anselmo Lima

Objective

to examine the temporal trends of these indicators across the state’s health regions to provide evidence that supports improvements in public policies and actions aimed at disease control.

Material and methods

Ecological study conducted in Sergipe state, Brazil. We used anonymized data on malignant prostate neoplasms (ICD-10 C61) from the Aracaju Cancer Registry (ACR) for 1996–2017. Mortality data were obtained from the Mortality Information System (SIM) for 1996–2022. Age-specific and age-standardized incidence and mortality rates were calculated. The Mortality-to-Incidence Ratio (MIR) and its complement (1–MIR) were used as indirect indicators of five-year survival. Temporal trends were assessed using Joinpoint regression (version 5.3.0), estimating APC, AAPC and 95 % confidence intervals using Monte Carlo permutation tests.

Results

A total of 10,133 prostate cancer cases were recorded from 1996 to 2017. The age-standardized incidence rate increased from 42.4 per 100,000 (1996–2005) to 76.8 per 100,000 (2006–2012), decreasing slightly to 72.3 per 100,000 (2013–2017). The overall annual increase was 6.63 %, with Aracaju showing 6.85 %. Declines occurred only in Nossa Senhora do Socorro from 2007 to 2017 (APC: –1.85; 95 %CI: –3.59; –0.26). Between 1980–2022, age-standardized mortality increased 4.20 % annually (95 %CI: 3.35–4.81), with marked rises in Estância (7.20 %), Propriá (6.02 %), Lagarto (5.53 %), Nossa Senhora da Glória (4.83 %), and Itabaiana (2.89 %). MIR-based survival declined from 76.57 % (1996–1999) to 71.27 % (2015–2017), with increased MIR among adults aged 75 + , decreasing MIR among individuals aged 15–54—especially in the capital—and increases across all age groups in Propriá.

Conclusion

Prostate cancer in Sergipe demonstrates significant regional and age-related disparities in incidence, mortality, and survival. Rising incidence and mortality, along with adverse MIR trends, underscore the need for targeted health policies to improve early detection, treatment access and long-term outcomes.

目的：研究这些指标在全州卫生区域的时间趋势，为支持改善旨在控制疾病的公共政策和行动提供证据。材料和方法：在巴西Sergipe州进行的生态学研究。我们使用了来自Aracaju癌症登记处（ACR） 1996-2017年恶性前列腺肿瘤（icd - 10c61）的匿名数据。1996-2022年的死亡率数据来自死亡率信息系统（SIM）。计算了特定年龄和年龄标准化的发病率和死亡率。死亡率-发病率比（MIR）及其补体（1-MIR）作为5年生存率的间接指标。使用Joinpoint回归（版本5.3.0）评估时间趋势，使用蒙特卡罗排列检验估计APC， AAPC和95 %置信区间。结果：1996 - 2017年共记录前列腺癌病例10133例。年龄标准化发病率从42.4 / 10万（1996-2005）上升到76.8 / 10万（2006-2012），略有下降至72.3 / 10万（2013-2017）。总体年增长率为6.63 %，阿拉卡州为6.85 %。从2007年到2017年，只有Nossa Senhora do Socorro地区出现了下降（APC: -1.85; 95 %CI: -3.59; -0.26）。1980-2022年间，年龄标准化死亡率每年增加4.20 %(95 %CI: 3.35-4.81)，其中est ncia（7.20 %）、propri（6.02 %）、Lagarto（5.53 %）、Nossa Senhora da Glória（4.83 %）和Itabaiana（2.89 %）的增幅显著。基于MIR的生存率从76.57 %（1996-1999年）下降到71.27 %（2015-2017年），75岁成人的MIR增加 + ，15-54岁个体的MIR下降，特别是在首都，而在所有年龄组中都增加了。结论：Sergipe的前列腺癌在发病率、死亡率和生存率方面存在显著的地区和年龄相关差异。发病率和死亡率的上升，以及不利的MIR趋势，突出表明需要制定有针对性的卫生政策，以改善早期发现、治疗机会和长期结果。

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引用次数: 0

Comment on “Association between blood cholesterol profile and risk of lung cancer: A meta-analysis of prospective cohort studies” 对“血液胆固醇水平与肺癌风险之间的关系：前瞻性队列研究的荟萃分析”的评论。

IF 2.3 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2026-04-01 Epub Date: 2026-01-20 DOI: 10.1016/j.canep.2026.103000

Sushma Narsing Katkuri, Zarine Khan, Rhushvi Thakkar, Archana Dhyani, Hariharan Srinivasan

引用次数: 0

Survival of all cancer sites combined: Partitioning of temporal changes into cancer, non-cancer and case-mix 所有癌症部位合并的生存率：将时间变化划分为癌症、非癌症和病例组合

IF 2.3 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2026-04-01 Epub Date: 2026-01-22 DOI: 10.1016/j.canep.2026.102999

Paul C. Lambert , Yngvar Nilssen , Tor Åge Myklebust , Bjarte Aagnes , Bjørn Møller , Mark J. Rutherford

Quantifying cancer survival is a crucial component of cancer surveillance and control. Survival for all cancers combined is an overall summary to explore differences between population groups and over time. Net survival is the usual measure for reporting survival for all cancers combined. Differences in the cancer site distribution between groups can be adjusted for using standardization. We propose using individual weights incorporated into the Pohar Perme estimator of net survival for standardized all cancers combined survival estimates, rather than a weighted average of stratum specific estimates. This removes sparse data problems, where estimates are unobtainable for some strata. Extending to reference adjusted all-cause survival gives an alternative, interpretable measure, enabling partitioning of all-cause survival differences into those due to cancer site/age/sex distribution differences, other cause mortality differences and cancer mortality differences. We illustrate the methods using data on 749 889 individuals diagnosed with cancer in Norway 1986–2021. Using individual weights gives very similar estimates to traditional and model-based standardization and avoids using ad-hoc sparse data methods. Reference adjusted all-cause survival provides measures with simpler interpretation. For example, between 1986 and 1990 and 2016–2021 there was a 25.9 %age point improvement in 5-year all-cause survival. This improvement was partitioned into changes in the site/age/sex distribution (2.0), changes in other cause mortality rates (4.4) with the majority (19.6) due to improvements in cancer survival. Survival of all cancers combined is easily analyzed non-parametrically using individual weights. Reference adjusted all-cause survival gives a more interpretable measure improving understanding of differences over time/between groups.

量化癌症存活是癌症监测和控制的重要组成部分。所有癌症的生存率总和是一个总体总结，用于探索不同人群之间和不同时期的差异。净生存率是报告所有癌症合并生存率的常用指标。组间癌症部位分布的差异可以通过标准化进行调整。我们建议将个体权重纳入Pohar Perme净生存估计器中，用于标准化的所有癌症联合生存估计，而不是特定地层估计的加权平均值。这消除了数据稀疏的问题，即无法获得某些地层的估计。扩展到参考调整的全因生存提供了一种替代的、可解释的测量方法，使全因生存差异能够划分为癌症部位/年龄/性别分布差异、其他原因死亡率差异和癌症死亡率差异。我们使用挪威1986-2021年诊断为癌症的749889人的数据来说明这些方法。使用单个权重提供了与传统的和基于模型的标准化非常相似的估计，并且避免了使用特别的稀疏数据方法。参考校正全因生存率提供了更简单的解释。例如，在1986年至1990年和2016年至2021年期间，5年全因生存率提高了25.9%。这种改善分为地点/年龄/性别分布的变化（2.0），其他原因死亡率的变化（4.4），其中大多数（19.6）是由于癌症生存的改善。所有癌症合并的生存率很容易使用个体权重进行非参数分析。参考校正的全因生存率提供了一个更可解释的测量方法，提高了对不同时间/组间差异的理解。

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引用次数: 0

Cardiovascular disease mortality among women diagnosed with de novo metastatic breast cancer 新发转移性乳腺癌女性的心血管疾病死亡率

IF 2.3 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2026-04-01 Epub Date: 2026-02-24 DOI: 10.1016/j.canep.2026.103025

Cody Ramin , Gillian Gresham , Jessica Li , Anja Karlstaedt , Mia Hashibe , Andriana P. Nikolova , Katelyn M. Atkins

Background

Women with metastatic breast cancer (mBC) are living longer than in prior decades due to advances in treatment. However, risk of cardiovascular disease (CVD) remains understudied in this patient population.

Methods

We identified 33,239 women diagnosed with de novo mBC between 2000 and 2020 (aged 20–84, survived ≥1 year) from 17 Surveillance, Epidemiology, and End Results Program registries. We estimated standardized mortality ratios (SMRs) and cumulative incidence, accounting for competing risks, for CVD mortality overall and by key characteristics.

Results

Over 3.1 median years of follow-up, 724 women with mBC died of CVD (554 heart disease; 127 cerebrovascular disease; 43 other CVD). Overall, women with mBC had an elevated risk of CVD mortality compared to women in the general population after accounting for age, year, and race/ethnicity (SMR=1.45, 95 % CI=1.34–1.55). SMRs for women with mBC were further elevated among those aged < 50 years at diagnosis (3.48, 95 % CI=2.67–4.46), non-Hispanic Asian American and Pacific Islander and Black women (2.18, 95 % CI=1.60–2.90; 2.14, 95 % CI=1.79–2.52, respectively), more recently diagnosed women (1.57, 95 % CI=1.32–1.86), and those with triple negative tumors (2.51, 95 % CI=1.71–3.57). Among women aged < 50 years, SMRs were further elevated among those recently diagnosed (5.44, 95 % CI=2.90–9.31) and within the first five years after diagnosis (5.02, 95 % CI=3.63–6.76). Approximately 1 in 60 women died from CVD within five years following their mBC diagnosis (cumulative incidence: 1.73 %, 95 % CI=1.58–1.88 %) with the highest cumulative incidence among those aged 50 years or older (2.13 %, 95 % CI=1.95–2.33 %).

Conclusions

Women with mBC have significantly elevated CVD mortality and further research is warranted to address this heightened risk.

背景：由于治疗的进步，患有转移性乳腺癌（mBC）的女性比过去几十年的寿命更长。然而，心血管疾病（CVD）的风险在这一患者群体中仍未得到充分研究。方法：我们从17个监测、流行病学和最终结果项目登记处中确定了2000年至2020年期间诊断为新生mBC的33239名女性（年龄20-84岁，存活≥1年）。我们估计了标准化死亡率（SMRs）和累积发病率，考虑到竞争风险，CVD总体死亡率和关键特征。结果：在3.1年的中位随访中，724名mBC女性死于CVD（554名心脏疾病，127名脑血管疾病，43名其他CVD）。总体而言，考虑到年龄、年龄和种族/民族因素，与普通人群中的女性相比，患有mBC的女性心血管疾病死亡风险较高（SMR=1.45, 95 % CI=1.34-1.55）。结论：患有mBC的女性心血管疾病死亡率显著升高，需要进一步的研究来解决这一增加的风险。

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引用次数: 0

Estimates of cancer incidence to 2025 in Italy: Numbers and rates 到2025年意大利癌症发病率的估计：数字和比率。

IF 2.3 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2026-04-01 Epub Date: 2026-02-09 DOI: 10.1016/j.canep.2026.102990

Sabrina Fabiano , Viviana Perotti , Paolo Contiero , Andrea Tittarelli , Maria Teresa Pesce , Stefano Guzzinati , Fabrizio Stracci , Diego Serraino , Walter Mazzucco , Luigino Dal Maso

Objectives

We forecasted the incidence of malignant tumours in Italy in 2025, using the most representative estimates of incidence rates and recent trends in cancer incidence available. A comparison with estimates for 2025 obtained using different assumptions and data sets is also presented.

Methods

34 cancer registries (81 % of the Italian population) were used to estimate incidence rate trends in 2013–2017, by cancer types, sex, and age. The stratified incidence rates were projected until 2025 by applying trends in the same strata, using a linear regression model with the calendar year as an independent variable.

Results

We estimated 362,100 new cancer cases in Italy in 2025 (182,300 in men, 179,800 in women). Prostate is the most frequent cancer site in men (31,200 cases; age-standardised incidence rates-ASR=92.3 per 100,000), followed by lung (27,100, ASR=80.9), bladder, and colon-rectum (23,000 cases each; ASR=69.0). 55,900 women were estimated to be diagnosed with breast cancer (ASR=159.0 per 100,000), 18,900 with colorectal (ASR=47.0) and 16,400 with lung cancers (ASR=41.0).

Conclusions

Our estimates were slightly lower than those based on other assumptions and/or different datasets (i.e., ECIS/GLOBOCAN ones). More effective anti-smoking campaigns are needed to halt the predicted increase in smoking-related cancers among women.

目的：我们预测2025年意大利恶性肿瘤的发病率，使用最具代表性的发病率估计和癌症发病率的最新趋势。还提出了与使用不同假设和数据集获得的2025年估计数的比较。方法：采用34个癌症登记处（占意大利人口的81% %），按癌症类型、性别和年龄估计2013-2017年的发病率趋势。采用以历年为自变量的线性回归模型，应用同一地层的趋势预测到2025年的分层发病率。结果：我们估计2025年意大利有362100例新发癌症病例（男性182300例，女性179800例）。前列腺是男性中最常见的癌症部位（31,200例，年龄标准化发病率-ASR=92.3 / 100,000），其次是肺癌（27,100例，ASR=80.9），膀胱和结肠直肠（各23,000例，ASR=69.0）。估计有55900名女性被诊断为乳腺癌（ASR=159.0 / 100000）， 18900名女性被诊断为结直肠癌（ASR=47.0）， 16400名女性被诊断为肺癌（ASR=41.0）。结论：我们的估计略低于基于其他假设和/或不同数据集（即ECIS/GLOBOCAN数据集）的估计。需要更有效的反吸烟运动来阻止女性中与吸烟有关的癌症的预期增长。

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引用次数: 0

Risk score development for pancreatic cancer in Chinese men: A population-based cohort study 中国男性胰腺癌风险评分发展：一项基于人群的队列研究

IF 2.3 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2026-04-01 Epub Date: 2026-01-16 DOI: 10.1016/j.canep.2026.102994

Jie Cai , Hongda Chen , Yuhan Zhang , Bin Lu , Ming Lu , Chenyu Luo , Lei You , Min Dai

Background

Pancreatic cancer (PC) is a malignant tumor without effective screening methods in the general population. This study aimed to develop a PC risk score to identify men at high risk for PC for early intervention.

Methods

Based on a prospective cohort study conducted in China in 2006, 90,402 men with at least two fasting blood glucose (FBG) measurements were included in this study. The PC risk model was developed using Cox regression, including the risk factors for age, total cholesterol, FBG and body mass index (BMI) change rate. The power of discrimination was examined using Harrell’s C-index and time-dependent area under curves (AUCs).

Results

During the 10-year follow-up period, 82 men developed PC (total person-years: 821,346). Age, total cholesterol level, FBG and BMI change rate were included in the final PC risk model, with a C-index of 0.754 (95 % CI 0.709–0.799). After internal validation, the AUCs of the model in different years (2, 5, 8, and 10 years) were > 0.700 in all men and in men without diabetes. In the derived scoring system (score range:-2–10), there was an approximately 40 % increased risk (Hazard ratio, 1.415; 95 % CI, 1.291–1.550) with every 1-point increase. Participants with the top 20 % scores (6–10 points) had a 30-fold increased risk of PC compared with individuals in the lowest score group (-2 – -1 points).

Conclusions

A scoring system for identifying high-risk men with PC was developed, which may be helpful for early detection and intervention of PC in the future.

胰腺癌（PC）是一种在普通人群中缺乏有效筛查方法的恶性肿瘤。本研究的目的是建立一个前列腺癌风险评分，以确定早期干预的前列腺癌高风险男性。方法基于2006年在中国进行的一项前瞻性队列研究，90402名至少有两次空腹血糖（FBG）测量的男性被纳入本研究。采用Cox回归建立PC风险模型，包括年龄、总胆固醇、FBG、BMI变化率等危险因素。采用Harrell’s c指数和随时间变化的曲线下面积（auc）来检验鉴别力。结果在10年随访期间，82名男性发展为PC（总人年：821,346）。最终的PC风险模型纳入年龄、总胆固醇水平、FBG和BMI变化率，c -指数为0.754（95 % CI 0.709-0.799）。经过内部验证，该模型在不同年份（2、5、8和10年）的auc在所有男性和非糖尿病男性中为>； 0.700。在衍生评分系统（评分范围：-2-10）中，每增加1分，风险增加约40 %（风险比，1.415;95 % CI, 1.291-1.550）。得分最高的20个 %（6-10分）的参与者患PC的风险是得分最低组（2 -1分）的30倍。结论建立了一套识别高危男性PC的评分系统，有助于今后对PC的早期发现和干预。

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引用次数: 0

Cardiovascular disease as a contributing cause of cancer mortality: A population-based analysis of United States death certificate data (1999–2020) 心血管疾病是癌症死亡的一个重要原因：美国死亡证明数据的基于人群的分析（1999-2020年）

IF 2.3 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2026-04-01 Epub Date: 2026-01-21 DOI: 10.1016/j.canep.2026.102991

Sanchit Mehta , Lovy Arora , Netra Agarwal , Asha Khubchandani

Background

Emerging evidence suggests a complex bidirectional relationship between cardiovascular disease (CVD) and cancer. However, population-level data characterizing the burden of cardiovascular comorbidities at the time of cancer-attributable death remains limited. We analyzed the association between the presence of cardiovascular disease on death certificates and cancer mortality patterns across demographic groups using national mortality data from 1999 to 2020.

Methods

Using CDC WONDER multiple cause-of-death data, we analyzed records of adults ≥ 18 years with cancer as the underlying cause of death. CVD comorbidity was defined as any cardiovascular condition (ICD-10 I00-I99) listed as a contributing cause. We calculated age-adjusted mortality rates (AAMR) per 100,000 population and rate ratios, stratified by demographics and cancer types.

Results

Among 13,847,293 cancer deaths, 4521,847 (32.6 %) had cardiovascular disease listed as a contributing cause. The overall AAMR for cancer deaths with CVD was 47.75 per 100,000 (95 % CI: 47.66–47.85). Males showed higher rates than females (62.26 vs 37.22 per 100,000, rate ratio 1.67). Non-Hispanic Black populations had the highest burden (57.10 per 100,000), while Asian/Pacific Islander populations had the lowest (30.80 per 100,000). For lung cancer, mortality rates were substantially higher when CVD was present, with rate ratios ranging from 1.70 to 2.43; however, this association is likely attributable to profound unmeasured confounding by shared risk factors such as smoking.

Conclusions

Cardiovascular disease is listed as a contributing factor in nearly one-third of all cancer deaths, with distinct demographic patterns. These findings highlight the significant burden of cardiovascular comorbidities documented on death certificates at the end of life for cancer patients.

背景：越来越多的证据表明，心血管疾病（CVD）和癌症之间存在复杂的双向关系。然而，在癌症导致死亡时，描述心血管合并症负担的人群水平数据仍然有限。我们使用1999年至2020年的全国死亡率数据，分析了不同人口群体中死亡证明上心血管疾病的存在与癌症死亡率模式之间的关系。方法使用CDC WONDER多死因数据，分析≥ 18岁以癌症为潜在死亡原因的成人记录。CVD合并症被定义为任何被列为诱因的心血管疾病（ICD-10 00- i99）。我们计算了每10万人的年龄调整死亡率（AAMR）和按人口统计学和癌症类型分层的死亡率比率。结果在13847293例癌症死亡中，4521847例（32.6% %）将心血管疾病列为导致死亡的原因。心血管疾病导致癌症死亡的总体AAMR为47.75 / 100,000（95 % CI: 47.66-47.85）。男性的发病率高于女性（62.26 vs 37.22 / 10万，发病率比1.67）。非西班牙裔黑人人口负担最高（每10万人中有57.10人），而亚洲/太平洋岛民人口负担最低（每10万人中有30.80人）。对于肺癌，当存在心血管疾病时，死亡率要高得多，死亡率比在1.70到2.43之间；然而，这种关联可能是由于吸烟等共同风险因素造成的严重的无法测量的混杂。结论心血管疾病被列为近三分之一的癌症死亡的一个因素，具有独特的人口统计学模式。这些发现强调了癌症患者临终时死亡证明上记录的心血管合并症的重大负担。

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引用次数: 0

Normalized breast cancer survival outcomes in U.S. tumor registries 美国肿瘤登记处规范化的乳腺癌生存结果

IF 2.3 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2026-04-01 Epub Date: 2026-02-13 DOI: 10.1016/j.canep.2026.103015

Tori C. Nierenberg , Kerri-Anne Crowell , Samantha M. Thomas , Kelley Chan , Rachel A. Greenup , Jennifer K. Plichta

Background

This study normalized the National Cancer Database (NCDB) and Surveillance, Epidemiology, End Results Program (SEER) populations to mirror the USCS population and examined survival outcomes in breast cancer following normalization.

Methods

Patients diagnosed with stage I-IV breast cancer (2010–2018) were selected from the NCDB and SEER. Rates obtained from the USCS were used to normalize the NCDB and SEER cohorts, using patient weighted frequencies for variables (age, sex, race/ethnicity, etc). Overall survival was estimated using the Kaplan-Meier method before and after normalization.

Results

The USCS included 2473,739 patients, the NCDB 1441,556, and SEER 504,938. There were minimal differences between the cohorts based on age or sex. There were notable differences in the racial/ethnic composition (Hispanic: USCS 8.3 %, NCDB 5.9 %, SEER 11.7 %; p < 0.001). There were minimal differences in tumor biomarkers, but significant differences in extent of disease (local: USCS 66.1 %, NCDB 80.2 %, SEER 68.4 %; distant: USCS 6 %, NCDB 3.9 %, SEER 3.9 %; p < 0.001). Variables that were similar without weighting (age, sex, tumor biomarkers), had similar OS after weighting. However, when the NCDB and SEER were weighted by stage, HR status and race/ethnicity combined, slight changes were seen in 5-year OS (NCDB regional: unweighted 76.8 % vs weighted 77.0 %, SEER regional: unweighted 79.7 % vs weighted 78.5 %; p < 0.001).

Conclusions

US tumor registries provide data for a large sampling of breast cancer patients. Despite significant differences in case coverage based on race/ethnicity and stage, OS remained similar following normalization to the USCS, suggesting that analyses using these data sets may be generalizable to the population.

本研究标准化了国家癌症数据库（NCDB）和监测、流行病学、最终结果计划（SEER）人群，以反映USCS人群，并检查了标准化后乳腺癌的生存结果。方法从NCDB和SEER中选择2010-2018年诊断为I-IV期乳腺癌的患者。使用患者加权频率（年龄、性别、种族/民族等），使用USCS获得的比率对NCDB和SEER队列进行归一化。在归一化前后使用Kaplan-Meier法估计总生存率。结果USCS纳入2473、739例患者，NCDB纳入1441、556例，SEER纳入504938例。基于年龄或性别的队列之间的差异很小。在种族/民族组成方面存在显著差异（西班牙裔：USCS 8.3 %,NCDB 5.9 %,SEER 11.7 %;p <； 0.001）。肿瘤生物标志物差异很小，但疾病程度差异显著（局部：USCS 66.1% %,NCDB 80.2 %,SEER 68.4% %；远处：USCS 6 %，NCDB 3.9 %,SEER 3.9 %;p <； 0.001）。未加权的相似变量（年龄、性别、肿瘤生物标志物）加权后的OS相似。然而，当NCDB和SEER按分期、HR状态和种族/民族组合加权时，在5年OS中观察到轻微的变化（NCDB区域：未加权76.8 % vs加权77.0 %，SEER区域：未加权79.7 % vs加权78.5 %;p <； 0.001）。结论美国肿瘤登记处为大量乳腺癌患者提供了数据。尽管基于种族/民族和分期的病例覆盖率存在显著差异，但标准化后的OS与USCS相似，表明使用这些数据集进行分析可能可推广到人群。

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引用次数: 0