PO.PR01.01 · 预防研究
美国原发灶不明癌（CUP）死亡率作为影像学不平等的替代指标（1999-2023）
Cancer of unknown primary (CUP) mortality as a surrogate for imaging inequity in the United States (1999-2023)
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：原发灶不明癌（CUP）在肿瘤学中仍是一项重大的诊断和临床挑战。尽管影像学技术不断进步，CUP在美国仍占相当数量的癌症死亡。高质量诊断性影像检查的可及性受限，可能延迟原发肿瘤的识别，并造成持续存在的差异。本研究考察了1999年至2023年CUP死亡率的全国、区域及人口学趋势，并评估将死亡模式作为影像学不平等潜在标志物的可能性。我们使用CDC WONDER数据库中的ICD-10编码C80分析了全国死亡数据。变量包括性别、年龄组（15岁及以上）、种族、人口普查区域、都市化状态和州。计算了所有亚组的年龄校正死亡率（AAMR）。评估了1999-2023年的时间趋势。采用ARIMA预测将趋势外推至2035年。1999年至2023年间共发生679,020例CUP死亡。全国AAMR从1999年的13.24降至2023年的7.19。男性死亡率（AAMR：11.83）高于女性（8.82），尽管两者随时间均有下降。死亡集中于45岁及以上的成年人。种族差异显著：黑人（12.09）、白人（10.38）以及美洲印第安人或阿拉斯加原住民人群（9.70）的死亡率几乎是西班牙裔或拉丁裔（6.47）和亚裔美国人或太平洋岛民群体（5.50）的两倍。非都市地区死亡率（9.08）高于都市地区（7.84）。在各区域中，东北部（11.18）、中西部（10.55）和南部（10.08）的死亡率高于西部（8.74）。至2035年的ARIMA预测提示男性（10.64）、女性（8.48）、东北部（10.97）和西部（10.09）的死亡率将上升。CUP死亡率在全国范围内有所下降，但在人口学和地理群体间仍不均衡。农村地区、高负担区域以及历史上诊断可及性有限的人群死亡率较高，提示影像学不平等可能促成了持续存在的差异。某些群体和区域预测死亡率的上升凸显了对以下方面进行针对性投入的必要性：诊断基础设施、更早获得先进影像检查的机会以及公平的肿瘤学服务。未来的研究应整合影像与死亡数据，以完善早期检测和干预策略。
查看英文原文 English abstract
Background: Cancer of Unknown Primary (CUP) remains a major diagnostic and clinical challenge in oncology. Despite advances in imaging, CUP continues to account for a significant number of cancer deaths in the United States. Limited access to high-quality diagnostic imaging may delay identification of the primary tumor and contribute to persistent disparities. This study examines national, regional, and demographic trends in CUP mortality from 1999 to 2023 and evaluates mortality patterns as a potential marker of imaging inequity. We analyzed national mortality data from the CDC WONDER database using ICD-10 code C80. Variables included sex, age group (15+), race, census region, metropolitan status, and state. Age-adjusted mortality rates (AAMR) were calculated for all subgroups. Temporal trends were assessed for 1999-2023. ARIMA forecasting was used to project trends to 2035. A total of 679,020 CUP deaths occurred between 1999 and 2023. The national AAMR declined from 13.24 in 1999 to 7.19 in 2023. Males had higher mortality (AAMR: 11.83) than females (8.82), though both decreased over time. Mortality was concentrated in adults aged 45 years and older. Racial disparities were marked: Black (12.09), White (10.38), and American Indian or Alaska Native populations (9.70) had nearly double the mortality of Hispanic or Latino (6.47) and Asian American or Pacific Islander groups (5.50). Nonmetropolitan areas had higher mortality (9.08) than metropolitan areas (7.84). Among regions, the Northeast (11.18), Midwest (10.55), and South (10.08) showed higher mortality than the West (8.74). ARIMA projections to 2035 suggest rising mortality for males (10.64), females (8.48), the Northeast (10.97), and the West (10.09). CUP mortality has declined nationally but remains uneven across demographic and geographic groups. Higher mortality in rural areas, high-burden regions, and populations with historically limited diagnostic access suggests that imaging inequity may contribute to persistent disparities. The rising projected mortality in select groups and regions underscores the need for targeted investments in diagnostic infrastructure, earlier access to advanced imaging, and equitable oncology services. Future research should integrate imaging and mortality data to refine strategies for early detection and intervention.
利益披露 Disclosure
S. Ahmed, None..
F. Baksh, None..
S. Mustafa, None..
E. Krishnan, None.