年齡標準化死亡調整發生率：一種新的癌症負擔指標

Abstract

背景 傳統的癌症負擔指標如發生率、死亡率和存活率各有其局限性，往往無法全面反映癌症的真實影響。僅使用發生率可能會忽視較罕見但致命的癌症。死亡率可能受到死因資料不準確的影響，且反映的是死亡日期而非診斷日期。存活率可能會低估致命性較低但更常見的癌症的影響。 方法 本研究提出了一種新指標：年齡標準化死亡調整發生率（ASFAIR），結合年齡標準化發生率與五年相對存活率。該指標應用於2000年至2015年間的台灣癌症數據，並與傳統指標進行比較，以突顯傳統指標的缺陷。此外，還對39個國家的乳癌防治情況進行了國際比較。 結果 在台灣，ASFAIR揭示了癌症排名和趨勢的顯著變化。對於男性來說，最初領先的結直腸癌在死亡調整後上升速度顯著放緩。肺癌超過肝癌成為最常見的癌症，而肝癌的下降趨勢更加明顯。對於女性而言，乳癌在調整後從首位跌至第四位，而肺癌儘管其增長趨勢放緩，仍成為最主要的癌症。胰臟癌進入前十，呈現出令人擔憂的上升趨勢。在國際上，乳癌的排名在調整後顯著變化，美國和加拿大在調整前的高排名下降，而巴西和哥倫比亞在美洲的排名上升。西歐在調整前有最高乳癌發生率，但在調整後出現顯著下降。 結論 本研究提出的新指標，ASFAIR，通過結合發生率和存活率數據，提供了一個全面且準確的衡量癌症負擔的指標。相比傳統指標，它更有效地揭示了各種癌症的真實影響。我們的研究結果顯示了其在台灣及國際上的穩健性和實用性，建議使用ASFAIR來補充現有的癌症負擔衡量指標，以進行更準確和全面的全球評估。

Background: Traditional cancer burden measures like incidence rates, mortality rates, and survival probabilities each have limitations, often missing the true impact of cancer. Using incidence rates can overlook less common but lethal cancers. Mortality rates can be hampered by inaccuracies in cause-of-death data and reflect the death date rather than the diagnosis date. Survival probabilities can underestimate the impact of less lethal but more common cancers. Methods: This study proposed a new measure: the age-standardized fatality-adjusted incidence rate (ASFAIR), combining age-standardized incidence rates with five-year relative survival rates. This measure was applied to cancer data from Taiwan for the period 2000-2015 and compared with traditional metrics to highlight their deficiencies. An international comparison of breast cancer burden across 39 countries was also conducted. Results: In Taiwan, ASFAIR revealed notable changes in cancer rankings and trends. For men, colorectal cancer, initially leading, saw its rise slow significantly after fatality adjustment. Lung cancer overtook liver cancer as the most common, with liver cancer’s declining trend becoming more pronounced. Among women, breast cancer fell from first to fourth rank post-adjustment, with lung cancer emerging as the top cancer despite its increasing trend decelerating. Pancreatic cancer entered the top 10 with a worrying upward trajectory. Internationally, breast cancer rankings shifted significantly post-adjustment, with the U.S. and Canada dropping from high pre-adjustment ranks while Brazil and Colombia rose to the forefront in the Americas. Western Europe, initially dominating the highest rates, experienced notable reductions post-adjustment. Conclusion: The proposed new measure, ASFAIR, provides a comprehensive and accurate metric for assessing cancer burden by integrating incidence and survival data. It reveals the true impact of various cancers more effectively than traditional measures. Our findings demonstrate its robustness and utility, both in Taiwan and internationally, suggesting that ASFAIR should be adopted as a complement to existing cancer burden measures for more accurate and comprehensive assessments worldwide.