Survival for oesophageal, stomach and small intestine cancers in Europe 1999–2007: Results from EUROCARE-5
Introduction
This article focuses on European relative survival (RS) estimates and trends for oesophageal, stomach and small intestine cancer patients, diagnosed up to 2007, with follow-up to 31st December 2008, as part of EUROCARE-5. Regional variation in RS estimates throughout Europe has been consistently reported for cancer patients, including upper gastrointestinal tract cancers, diagnosed in 1990–1994 [1], 1995–1999 [2] and 1999–2007 [3].
Oesophageal cancer ranks as the eighth most common cancer worldwide with approximately five cases per 100,000 diagnosed in Europe annually [4]. Two main histological subtypes, adenocarcinoma (OAC) and squamous cell carcinoma (OSCC), display regional variation in incidence across Europe [5]. Stomach cancer is the third most common cause of cancer death globally [6]. Wide variation in stomach cancer incidence across Europe has been reported with recent declines in most European countries as a result of lifestyle changes, Helicobacter pylori detection and cancer treatment. Incidence of non-cardia tumors is high in Southern Europe [7] which, correspondingly, has the best 5-year patient survival [3]. While the small intestine comprises 90% of the length of the bowel, small intestine cancers are rare with an age-standardised incidence rate of two per 100,000 person-years in the United States of America (USA) [8] with lower incidence rates reported within Europe [9]. Small intestine cancers exhibit a diverse histology with adenocarcinomas, carcinoid (now classified as neuroendocrine), lymphomas and sarcomas being most common [10]. Incidence of small intestine cancers, particularly neuroendocrine malignancies, have increased in the USA [11], [12] and Sweden [13], likely as a result of improved detection and classification. Neuroendocrine small intestine cancers are the most common histological subtype and confer superior prognosis compared to other small intestine entities [12]. Incidence of epithelial small intestine cancers is reportedly highest in Northern and lowest in Eastern Europe [14]; possibly due to geographic differences in diagnostic testing and variable capture by cancer registries.
Section snippets
Methods
Methods used for the analysis of EUROCARE-5 data are described in a dedicated paper in this EJC issue [15]. Briefly, survival data were obtained from 29 countries, 21 with 100% national coverage, from 87 cancer registries. Countries were grouped into Northern, Central, Southern and Eastern Europe and Ireland and United Kingdom (UK).
All patients diagnosed with a primary and malignant oesophageal, stomach or small intestine cancer, as identified by topography codes C15, C16 (cardia C16.0 and
Results
Oesophageal, stomach and small intestine cancers were more common in men than women, Table 1. Some countries in Eastern Europe had a high percentage of DCO cases. Elsewhere in Europe the highest DCO rates were reported in Germany. Mean age at diagnosis for oesophageal, stomach and small intestine cancers ranged from 60.7–71.6, 66.8–73.1 and 60.5–68.9 years, respectively, Table 1.
Discussion
European wide variation in patient survival was observed for all three cancer sites investigated between regions. Country-specific patient survival also displayed a wide variation with several countries showing inconsistent estimates to their region, including Denmark, the Netherlands, Bulgaria and Croatia. Survival of patients improved modestly from 1999–2001 until 2005–2007 for all cancer sites. Oesophageal and stomach cancer 5-year RS for Europe remained very poor. Small intestine cancer had
Conclusions
This article presents overall patient survival for three anatomical sub-sites: oesophagus, stomach and small intestine. They provide some indication of areas that need further investigation to determine the drivers of the variation in survival of cancer patients across Europe. More in-depth investigation by anatomic sub-site and histology could explain the variability observed and are planned using additional data from EUROCARE-5. The historic nature of these large collaborative studies means
Role of funding source
The study was funded by the Compagnia di San Paolo, the Fondazione Cariplo Italy, the Italian Ministry of Health (Ricerca Finalizzata 2009, RF-2009-1529710) and the European Commission (European Action Against Cancer, EPAAC, Joint Action No20102202). The Northern Ireland Cancer Registry is supported by the Public Health Agency for N. Ireland. Dr. Michael Cook is funded by US Federal Funds. The Compagnia di San Paolo, the Fondazione Cariplo Italy, the Italian Ministry of Health (Ricerca
Conflict of interest statement
None declared.
Acknowledgements
We thank Chiara Margutti, Simone Bonfarnuzzo and Camilla Amati for secretarial assistance.
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