Survival Differences Between the USA and an Urban Population from China for All Cancer Types and 20 Individual Cancers - A Population-Based Study

Sep 24, 2026

Background: Systematic comparison of cancer survival between China and the USA is rare. This study assesses the magnitude of survival disparities and separates the role of stage at diagnosis between a Chinese metropolitan city and the USA for all cancers and 20 individual cancer types. Methods: Newly diagnosed patients from Dalian Cancer Registry (2015; 11,046 cases) were followed for vital status through December 2020 to estimate age-standardised 5-year relative survival and excess hazard ratios using generalized linear models. Stage-specific survival for five major cancers was also estimated by region and compared with 17 US cancer registries from the SEER database. Findings: Overall 5-year relative survival was lower in Dalian than in the USA (49.9% vs 67.9%). By cancer type, 12 cancers had poorer outcomes in Dalian, with the largest gap for prostate cancer, while Dalian showed better survival for lung, cervical, and bladder cancers. Interpretation: Although the USA had better overall prognosis, survival deficits existed in both countries, highlighting needs for improved early detection and cancer care in both settings.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Background

Methods

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Articles 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,a,n Ke Sun,b,n Xiaofeng Wang,b,n Bingsheng Liu,c Tao Wang,c Jakub Morze,d,e Sergiusz Nawrocki,f Lan An,a Siwei Zhang,a Li Li,a Shaoming Wang,a Ru Chen,a Kexin Sun,a Bingfeng Han,a Hong Lin,b Huinan Wang,b Dan Liu,b Yang Wang,b Youwei Li,b Qian Zhang,b Huijuan Mu,g Qiushuo Geng,h Feng Sun,i Haitao Zhao,j Xuehong Zhang,k Lingeng Lu,l,m Dan Mei,b,∗∗ Hongmei Zeng,a,∗ and Wenqiang Weia aNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China bDalian Center for Disease Control and Prevention, Liaoning, 116035, China cSchool of Public Policy and Administration, Chongqing University, No.174 Shazhengjie, Shapingba District, Chongqing, 400044, China dCollege of Medical Sciences, SGMK University, Olsztyn, Poland eDepartment of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA fDepartment of Oncology, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-228, Olsztyn, Poland gLiaoning Provincial Center for Disease Control and Prevention, Shenyang, 110005, China hSchool of Medical Device, Shenyang Pharmaceutical University, Benxi, 117004, China iDepartment of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China jPeking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China kChanning Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA lDepartment of Chronic Disease Epidemiology, Yale School of Public Health, Yale Cancer Center, Yale University, New Haven, CT, 06520, USA mYale Cancer Center and Center for Biomedical Data Science, Yale University, 60 College Street, New Haven, CT, 06520, USA Summary 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 stagespeciﬁc 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. Abbreviations: AJCC, American Joint Committee on Cancer; CI, Conﬁdence interval; EHR, Excess hazard ratio; GDP, Gross Domestic Product; ICD-10

FAQs

What was the main purpose of comparing cancer survival between China and the USA?

The study quantified survival disparities and clarified how much differences relate to stage at diagnosis between a Chinese metropolitan city and the USA.

How was survival measured in this research?

Age-standardised 5-year relative survival was estimated, and excess hazard ratios of death were calculated using generalized linear models. Stage-specific survival was estimated for five major cancers by region.

What did the study find about overall survival differences?

Five-year relative survival for all patients in Dalian was lower than in the USA (49.9% vs 67.9%).

Did the study observe differences in survival patterns across cancer types?

Yes. Twelve cancers were worse in Dalian than in the USA, while lung, cervical, and bladder cancers had better survival in Dalian; prostate cancer showed the largest gap.

Sep 24, 2026

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