Elsevier

European Journal of Cancer

Volume 34, Issue 14, December 1998, Pages 2167-2175
European Journal of Cancer

Original Paper
Survival of patients with oesophageal and gastric cancers in Europe

https://doi.org/10.1016/S0959-8049(98)00329-3Get rights and content

Abstract

The EUROCARE study is a European Union project to collect survival data from population-based cancer registries and analyse them according to standardised procedures. We investigated and compared oesophageal and gastric cancer survival in 17 countries between 1985 and 1989. Time trends in survival over the 1978–1989 period were also investigated in 13 countries. The overall European 1-year relative survival rates were 33% for oesophageal cancer and 40% for gastric cancer. The corresponding 5-year relative survival rates were 10 and 21%, respectively. Important intercountry survival differences exist within Europe for oesophageal and gastric cancer. Taking the European average as the reference, the relative risk (RR) of death at 5 years was at least 30% higher in Denmark, Poland, Estonia and Slovenia for oesophageal cancer and in Denmark, England, Scotland and Poland for gastric cancer. In the other countries survival figures were close to the European average. Gender had little influence on survival, whilst age at diagnosis was inversely related to prognosis. There was a slight improvement between 1978 and 1989 in 5-year overall relative survival rates for both oesophageal cancer (RR=0.80, 95% confidence interval (CI) 0.72–0.90) and gastric cancer (RR=0.88, 95% CI 0.82–0.94). Differences in quality of care and stage at diagnosis can explain in part the differences in survival found in the EUROCARE countries. Significant improvement in prognosis has still to be achieved.

Introduction

Oesophageal and gastric cancers remain common and serious diseases. Data on survival from these cancers have mostly been provided by specialised hospital units or from clinical trial series, with unavoidable selection bias, particularly with respect to elderly and those with comorbidity. Population-based series recording all cases diagnosed in a well-defined population allow the assessment of the real prognosis of oesophageal and gastric cancers. International comparisons of survival estimates after cancer diagnosis are now possible with the data collected by cancer registries over recent years[1]. These data can address questions of whether survival rates differ between countries and whether they are improving with time. The first EUROCARE study based on combined data from 11 countries provided survival rates for cancer patients diagnosed during the 1978–1985 period. The collaboration across Europe in the EUROCARE study has now been extended to 17 countries. The aim of this study was to review, within the framework of this programme, the prognosis of oesophageal and gastric cancers diagnosed between 1985 and 1989 in different countries with a special interest in intercountry comparison and to determine time trends in survival over the 1978–1989 period.

Section snippets

Patients and methods

This study included oesophageal cancers (ICD-9 150) and gastric cancers (ICD-9 151) registered during the 1978–1989 period in areas covered by cancer registries in 17 European countries. Only primary newly diagnosed malignant invasive tumours were considered. In situ cancers or tumours of uncertain malignancy were excluded as well as lymphomas. Cases known by death certificates only (DCO) or discovered incidentally at autopsy were excluded from the survival analysis. Description of the cancer

Inter-country differences in survival

Overall survival rates were poor. The European weighted survival, calculated from the pool of all cancer registries was 33% at 1 year and 10% at 5 years. Even though survival rates were low, there were important differences between countries in the relative survival rates (Table 2). The highest 1-year relative survival rates (more than 35%) were reported in The Netherlands, France and Switzerland, and the lowest (less than 25%) in Slovakia and Denmark. Five-year relative survival rates were

Discussion

In European countries the prognosis of patients with oesophageal and gastric cancers remains poor. In this study, the 5-year relative European weighted survival for the 1985–1989 period was 10% for oesophageal cancers and 21% for gastric cancer. Hospital series often provide more optimistic data[4]. They are of limited value because of unavoidable selection bias, in particular in case selection and patient’s characteristics[5].

One of the main findings of this study was the extensive variation

Acknowledgements

The EUROCARE study was financed through the BIOMED programme of the European Union and the Fondation de France financed the French part of the study on gastric cancer care.

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1

The EUROCARE Working Group for this study is listed in the Appendix A.

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