Survival differences between the USA and an urban population from China for all cancer types and 20 individual cancers: a population-based study

Ruiying Fu; Ke Sun; Xiaofeng Wang; Bingsheng Liu; Tao Wang; Jakub Morze; Sergiusz Nawrocki; Lan An; Siwei Zhang; Li Li; Shaoming Wang; Ru Chen; Kexin Sun; Bingfeng Han; Hong Lin; Huinan Wang; Dan Liu; Yang Wang; Youwei Li; Qian Zhang; Huijuan Mu; Qiushuo Geng; Feng Sun; Haitao Zhao; Xuehong Zhang; Lingeng Lu; Dan Mei; Hongmei Zeng; Wenqiang Wei

doi:10.1016/j.lanwpc.2023.100799

Survival differences between the USA and an urban population from China for all cancer types and 20 individual cancers: a population-based study

Lancet Reg Health West Pac. 2023 May 23:37:100799. doi: 10.1016/j.lanwpc.2023.100799. eCollection 2023 Aug.

Authors

Ruiying Fu¹, Ke Sun², Xiaofeng Wang², Bingsheng Liu³, Tao Wang³, Jakub Morze^{4

5}, Sergiusz Nawrocki⁶, Lan An¹, Siwei Zhang¹, Li Li¹, Shaoming Wang¹, Ru Chen¹, Kexin Sun¹, Bingfeng Han¹, Hong Lin², Huinan Wang², Dan Liu², Yang Wang², Youwei Li², Qian Zhang², Huijuan Mu⁷, Qiushuo Geng⁸, Feng Sun⁹, Haitao Zhao¹⁰, Xuehong Zhang¹¹, Lingeng Lu^{12

13}, Dan Mei², Hongmei Zeng¹, Wenqiang Wei¹

Affiliations

¹ National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
² Dalian Center for Disease Control and Prevention, Liaoning, 116035, China.
³ School of Public Policy and Administration, Chongqing University, No.174 Shazhengjie, Shapingba District, Chongqing, 400044, China.
⁴ College of Medical Sciences, SGMK University, Olsztyn, Poland.
⁵ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
⁶ Department of Oncology, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-228, Olsztyn, Poland.
⁷ Liaoning Provincial Center for Disease Control and Prevention, Shenyang, 110005, China.
⁸ School of Medical Device, Shenyang Pharmaceutical University, Benxi, 117004, China.
⁹ Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
¹⁰ Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
¹¹ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
¹² Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale Cancer Center, Yale University, New Haven, CT, 06520, USA.
¹³ Yale Cancer Center and Center for Biomedical Data Science, Yale University, 60 College Street, New Haven, CT, 06520, USA.

Abstract

Background: The systematic comparison of cancer survival between China and the USA is rare. Here we aimed to assess the magnitude of survival disparities and disentangle the impact of the stage at diagnosis between a Chinese metropolitan city and the USA on cancer survival.

Methods: We included 11,046 newly diagnosed cancer patients in Dalian Cancer Registry, China, 2015, with the follow-up data for vital status until December 2020. We estimated age-standardised 5-year relative survival and quantified the excess hazard ratio (EHR) of death using generalised linear models for all cancers and 20 individual cancers. We compared these estimates with 17 cancer registries' data from the USA, using the Surveillance, Epidemiology, and End Results database. We further estimated the stage-specific survival for five major cancers by region.

Findings: Age-standardised 5-year relative survival for all patients in Dalian was lower than that in the USA (49.9% vs 67.9%). By cancer types, twelve cancers with poorer prognosis were observed in Dalian compared to the USA, with the largest gap seen in prostate cancer (Dalian: 55.8% vs USA: 96.0%). However, Dalian had a better survival for lung cancer, cervical cancer, and bladder cancer. Dalian patients had a lower percentage of stage Ⅰ colorectal cancer (Dalian: 17.9% vs USA: 24.2%) and female breast cancer (Dalian: 40.9% vs USA: 48.9%). However, we observed better stage-specific survival among stage Ⅰ-Ⅱ lung cancer patients in Dalian than in the USA.

Interpretation: This study suggests that although the overall prognosis for patients was better in the USA than in Dalian, China, survival deficits existed in both countries. Improvement in cancer early detection and cancer care are needed in both countries.

Funding: National Key R&D Program (2021YFC2501900, 2022YFC3600805), Major State Basic Innovation Program of the Chinese Academy of Medical Sciences (2021-I2M-1-010, 2021-I2M-1-046), and Talent Incentive Program of Cancer Hospital of Chinese Academy of Medical Sciences.

Keywords: 5-year relative survival; Population-based study; The United States; Urban China, Dalian.