净生存的解释：我们估计的与我们认为我们估计的
Interpreting Net Survival: What We Estimate Versus What We Think We Estimate
AI总结：
净生存应解释为移除了普通人口其他原因死亡的生存，而非因果反事实，因治疗引起的其他原因死亡无法通过分层消除。
摘要：
净生存通常被定义为“如果癌症是唯一可能的死亡原因，则生存”，这对应于仅癌症特异性死亡的估计量。Pohar Perme估计量通过从观察到的总死亡率中移除一般人口其他原因死亡来针对这一目标，但只有在癌症患者经历与其他人口相同的其他原因死亡时才能实现。然而，由于基线健康差异和治疗引起的效应，癌症患者往往经历升高的其他原因死亡。利用最近将总死亡率分解为四个组成部分（癌症死亡、基线健康差异、治疗引起的其他原因死亡以及一般人口其他原因死亡）的理论工作，我们表明Pohar Perme估计量提供了癌症死亡、基线差异和治疗引起的死亡之和，当存在任何超额来源时，它都未能达到其预期的估计量。从Botta等人处，我们提供了实证证据，显示其他原因死亡的相对风险从1.0（结直肠癌）到4.0+（头颈癌），并计算显示当相对风险超过1.0时，净生存可能显著低估癌症特异性生存概率。关键的是，治疗引起的其他原因死亡代表了从癌症到死亡不可消除的因果路径，无法通过更好的分层来消除。我们建议将净生存解释为“一般人口其他原因死亡被移除的生存”，而不是作为因果反事实，呼吁在癌症流行病学中使用更精确的语言。
英文摘要：
Net survival is conventionally defined as ``survival if cancer were the only possible cause of death'', an estimand corresponding to cancer-specific mortality alone. The Pohar Perme estimator targets this by removing general population other-cause mortality from observed total mortality, but achieves it only when cancer patients experience the same other-cause mortality as the general population. However, cancer patients often experience elevated other-cause mortality due to baseline health differences and treatment-induced effects. Using recent theoretical work decomposing total mortality into four components (cancer deaths, baseline health differences, treatment-induced other-cause deaths, and general population other-cause mortality), we show that the Pohar Perme estimator delivers the sum of cancer deaths, baseline differences, and treatment-induced deaths, falling short of its intended estimand whenever either source of excess is present. From Botta \textit{et al}, we present empirical evidence showing relative risk of other-cause deaths ranging from 1.0 (colorectal cancer) to 4.0+ (head and neck cancers), and calculations demonstrating that net survival can substantially underestimate cancer-specific survival probability when relative risk exceeds 1.0. Critically, treatment-induced other-cause deaths represent irreducible causal pathways from cancer to death that cannot be eliminated through better stratification. We recommend interpreting net survival as ``survival where general population other-cause mortality is removed'' rather than as a causal counterfactual, and call for more precise language in cancer epidemiology.
机构、总结、中文摘要均由AI分析而来，可能存在错误，请以论文正文为准。
