Elsevier

European Journal of Cancer

Volume 41, Issue 15, October 2005, Pages 2321-2330
European Journal of Cancer

Stage-specific survival of epithelial cancers in North-Holland/Flevoland, The Netherlands

https://doi.org/10.1016/j.ejca.2005.03.037Get rights and content

Abstract

While stage is the most important factor for determining cancer survival, population-based survival data according to stage are rarely presented. We present such data for a large population diagnosed with cancer in the area covered by the Amsterdam Cancer Registry for the period 1989–2001 (n = 108,251). Cases were grouped according to the TNM-classification. For all sites, a close correlation between stage at diagnosis and survival was observed. The stage-specific 5-year relative survival rate (RSR) ranged from close to 100% for stage I carcinoma of the salivary glands, thyroid, colon/rectum, skin, breast, female genitals, prostate and urethra to ⩽1% for stage IV carcinoma of the oesophagus, stomach, liver, gallbladder, pancreas and lung. Between 1989–1991 and 1999–2001, we observed an increase in the stage-specific RSR for carcinoma of colon/rectum (stages II–IV), lung (stages I–II), breast (stages I–III) and prostate (stages II–IV). Changes in diagnostic (breast, prostate) and staging procedures (lung), surgery (rectum, prostate) and adjuvant treatment (breast, colon) are likely to have contributed to this increase.

Introduction

Information on the prognosis of cancer patients is important for both patients and their clinicians. The EUROCARE-3 study provides age- and site-specific survival rates for many European countries [1]. However, the prognosis of a cancer patient is also influenced by many other factors, such as morphological type, treatment and co-morbidity 2, 3. For epithelial cancers, stage is the most important factor, and most survival differences between populations can be explained by differences in stage distribution 4, 5. Moreover, stage-specific survival rates are essential for the interpretation of differences in survival rates between sexes or changes in the overall survival rates over time, as the overall survival will change as a result of changes in stage distribution. Unfortunately, data on stage-specific survival is unavailable in the majority of the European cancer registries, and this hampers the comparison of survival rates between registries and the explanation of survival changes over time.

The nationwide Netherlands Cancer Registry collects stage information for all relevant cancer sites and, consequently, is uniquely positioned to examine population-based survival according to stage. In this paper, we present stage-specific survival rates for all major epithelial cancers as well as melanoma skin cancer, based on a very large population-based cohort of cancer patients in the north-western part of The Netherlands.

Section snippets

Amsterdam cancer registry

The Amsterdam Cancer Registry (ACR) is a regional, population-based cancer registry with complete regional coverage since 1st January 1988. The region of the ACR covers the major part of 2 out of 12 provinces of The Netherlands: North-Holland and Flevoland. Its population was 2.84 million on 31st December 2001, approximately 17% of the total population of The Netherlands. The ACR is part of the nationwide Netherlands Cancer Registry, whose data are included in Cancer Incidence in Five Continents

Results

Out of a total of 108,251 patients with a primary cancer of one of the selected tumour sites (Table 1), TNM-stage was available for 95% of the cases (98,210 epithelial cancers as well as 4718 skin melanomas). A total of 1554 non-epithelial cancers (other than skin melanoma) of the selected tumour sites were registered (1% of the cases). A total of 3769 cancers (3%) were not microscopically confirmed, mostly cancers of the pancreas (1043 cases) and the lung (925 cases). The highest percentage of

Discussion

The Amsterdam Cancer Registry is one of few population-based cancer registries worldwide collecting data on stage and follow-up. The excellent population registers in The Netherlands enabled us to obtain near complete data on the vital status of 108,000 cancer patients diagnosed in 1989–2001. Stage-specific 5-year RSRs ranged from close to 100% for stage I carcinoma of the salivary glands, thyroid, colon/rectum, skin, breast, female genital organs, prostate and urethra to 1% or less for stage

Conflict of interest statement

None declared.

Acknowledgements

We thank the registration clerks of the Amsterdam Cancer Registry for collecting and checking the data.

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