Elsevier

European Journal of Cancer

Volume 51, Issue 15, October 2015, Pages 2144-2157
European Journal of Cancer

Survival for oesophageal, stomach and small intestine cancers in Europe 1999–2007: Results from EUROCARE-5

https://doi.org/10.1016/j.ejca.2015.07.026Get rights and content

Abstract

Background

European regional variation in cancer survival was reported in the EUROCARE-4 study for patients diagnosed in 1995–1999. Relative survival (RS) estimates are here updated for patients diagnosed with cancer of the oesophagus, stomach and small intestine from 2000 to 2007. Trends in RS from 1999–2001 to 2005–2007 are presented to monitor and discuss improvements in patient survival in Europe.

Materials and methods

EUROCARE-5 data from 29 countries (87 cancer registries) were used to investigate 1- and 5-year RS. Using registry-specific life-tables stratified by age, gender and calendar year, age-standardised ‘complete analysis’ RS estimates by country and region were calculated for Northern, Southern, Eastern and Central Europe, and for Ireland and United Kingdom (UK). Survival trends of patients in periods 1999–2001, 2002–2004 and 2005–2007 were investigated using the ‘period’ RS approach. We computed the 5-year RS conditional on surviving the first year (5-year conditional survival), as the ratio of age-standardised 5-year RS to 1-year RS.

Results

Oesophageal cancer 1- and 5-year RS (40% and 12%, respectively) remained poor in Europe. Patient survival was worst in Eastern (8%), Northern (11%) and Southern Europe (10%). Europe-wide, there was a 3% improvement in oesophageal cancer 5-year survival by 2005–2007, with Ireland and the UK (3%), and Central Europe (4%) showing large improvements.

Europe-wide, stomach cancer 5-year RS was 25%. Ireland and UK (17%) and Eastern Europe (19%) had the poorest 5-year patient survival. Southern Europe had the best 5-year survival (30%), though only showing an improvement of 2% by 2005–2007.

Small intestine cancer 5-year RS for Europe was 48%, with Central Europe having the best (54%), and Ireland and UK the poorest (37%). Five-year patient survival improvement for Europe was 8% by 2005–2007, with Central, Southern and Eastern Europe showing the greatest increases (⩾9%).

Conclusions

Survival for these cancer sites, particularly oesophageal cancer, remains poor in Europe with wide variation. Further investigation into the wide variation, including analysis by histology and anatomical sub-site, will yield insights to better monitor and explain the improvements in survival observed over time.

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.

References (45)

  • C. Maringe et al.

    Stage at diagnosis and ovarian cancer survival: evidence from the International Cancer Benchmarking Partnership

    Gynecol Oncol

    (2012)
  • C. Bosetti et al.

    Cancer mortality in Europe, 2005–2009, and an overview of trends since 1980

    Ann Oncol

    (2013)
  • J. Lortet-Tieulent et al.

    Convergence of decreasing male and increasing female incidence rates in major tobacco-related cancers in Europe in 1988–2010

    Eur J Cancer

    (2015)
  • C. Castro et al.

    Patterns and trends in esophageal cancer mortality and incidence in Europe (1980–2011) and predictions to 2015

    Ann Oncol

    (2014 Jan)
  • M. Arnold et al.

    Recent trends in incidence of five common cancers in 26 European countries since 1988: analysis of the European cancer observatory

    Eur J Cancer

    (2015)
  • A.A. Zeeneldin et al.

    Small intestinal cancers among adults in an Egyptian district: a clinicopathological study using a population-based cancer registry

    J Egypt Natl Cancer Inst

    (2013)
  • G.D. Demetri

    Identification and treatment of chemoresistant inoperable or metastatic GIST: experience with the selective tyrosine kinase inhibitor imatinib mesylate (STI571)

    Eur J Cancer

    (2002)
  • M.R. Andersen et al.

    Eurocourse Work Package 2 Group. Cancer registration, public health and the reform of the European data protection framework: abandoning or improving European public health research?

    Eur J Cancer

    (2015 Jun)
  • D. Robinson et al.

    Interpreting international comparisons of cancer survival: the effects of incomplete registration and the presence of death certificate only cases on survival estimates

    Eur J Cancer

    (2007)
  • P. Baili et al.

    Survival for all cancer patients diagnosed between 1999 and 2007 in Europe: results of EUROCARE-5, a population-based study

    Eur J Cancer

    (2015)
  • C. Bosetti et al.

    Trends in oesophageal cancer incidence and mortality in Europe

    Int J Cancer

    (2008)
  • M. Arnold et al.

    Global incidence of oesophageal cancer by histological subtype in 2012

    Gut

    (2015)
  • Cited by (136)

    View all citing articles on Scopus
    View full text