Epidemiology

Survival from rare cancers low in some European countries

Last Updated: 2005-12-16 14:11:16 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Younger patients, women, and patients living in northern Europe are likely to survive most rare cancers longer than those who are older, male, or reside in other regions of Europe, investigators report.

Treatment outcomes for some cancers are difficult to gauge because of their rarity, lead author Dr. Gemma Gatta from the National Cancer Institute in Milan, Italy, and her associates explain in their report, published online in The Lancet Oncology on December 13. To better understand the epidemiology of 14 such malignancies, they garnered data from 18 European countries registered in EUROCARE.

The analysis included survival data for 59,021 adult patients diagnosed between 1983 and 1994, and followed until 1999. Rare cancers were defined as those with an annual crude incidence rate of less than 2 per 100,000.

Average 5-year survival was > 65% for placental choriocarcinoma, thyroid medullary carcinoma, ovarian germ-cell cancer, lung carcinoid, and cervical adenocarcinoma. It was only intermediate (35% to 65%) for testicular cancer at age 65 or older, sarcoma of extremities, digestive-system endocrine cancers, anal squamous-cell carcinoma, and uterine sarcoma.

For carcinoma of the adrenal-gland cortex and bladder squamous-cell carcinoma ranged from 20% to 33% at 5 years. Outcomes were worst for angiosarcoma of the liver and mesothelioma (5% to 6%).

After adjustment for age, geographic group, period of diagnosis and clinical variables, men generally exhibited worse survival. The relative excess risk of death compared to women was 0.85 for one cancer, but from 1.15 up to 2.08 for seven others.

Age was also a factor. For patients ages 55 to 74 years, the relative excess risk compared to younger patients ranged from 1.18 to 6.81. For individuals over age 75, the relative excess risk ranged from 1.59 to 10.56 compared to the youngest age group.

As noted, survival was usually higher in northern Europe than in other geographic groups. However, for bladder carcinoma, adrenal-cortex carcinoma, and placental choriocarcinoma, survival was higher in western Europe. In the UK, survival from mesothelioma was worse than for the rest of Europe.

Dr. Gatta's group posits that discrepancies in survival according to country may be related to access to diagnostic facilities, specialized treatments, biomarker monitoring or imaging.

"Further investigation is needed to ascertain why survival from (cancers with effective treatments) is low in some European countries, particularly for older patients," the investigators conclude.

Lancet Oncology 2005.