Introduction: The EUROCARE II Study ( Editorial )

This introduction provides a general overview of the aims, methods and procedures used in the EUROCARE II study and the types of analyses presented in each article of this Special Issue of the European Journal of Cancer. The main aims of the EUROCARE II project are the updating of the survival database of the European Cancer Registries, the study of recent trends in relative survival rates and the interpretation of the survival differences observed both in time and across populations. Once having completed the preliminary stage of data checking, a total of 3 473 659 individual records from patients of all cancer sitess diagnosed between 1978 and 1989 and provided by 45 cancer registries in 17 European countries were accepted to build up the EUROCARE database. The quality of these data, in terms of the accuracy of the diagnosis and the validity of vital status assessment, was checked by indirect indicators, based on cross-validation analysis of consistency of the relevant variables. Statistical analysis was based on age- specific relative survival rates, computed for each cancer sites as the ratio of observed survival to the expected survival of the general population of the same area, gender and age, according to the Hakulinen method. An estimate of the European survival was computed as a weighted mean of the corresponding survival of the different countries, using as weights the expected yearly number of incident cases in each country. For comparison purposes, age- standardised survival was also calculated for Europe and for each country involved in the study

Hepatocellular carcinoma: Trends of incidence and survival in Europe and the United States at the end of the 20th century

OBJECTIVES: There is large geographic variation in incidence levels and time trends of hepatocellular carcinoma. We compared population-based liver cancer incidence and survival in European and U.S. populations in order to elucidate geographic differences and time trends for these variables. METHODS: Since comparisons based on cancer registry data are problematic because of variations in liver cancer definition and coding, we considered a subset of cases likely to be mainly hepatocellular carcinoma, suitable for international comparison. Incidence and 5-yr relative survival were calculated from cases diagnosed in five European regions (30,423 cases) and the United States (6,976 cases) in 1982-1994. RESULTS: Age-standardized incidence was highest in southern Europe (12/100,000 in men and 3/100,000 in women in 1992-94) and lowest in northern Europe, where incidence was similar to that of the United States (3/100,000 in men, <1/100,000 in women). Over the study period, incidence remained stable in the United States and most of Europe, except for a notable increase in southern Europe. Five-year relative survival was <10% in Europe, ranging from 8% (southern Europe) to 5% (eastern Europe), and 6% in the United States. Survival increased slightly with time, mainly in southern Europe and was unaffected by sex, but was better in younger patients. CONCLUSIONS: Increasing incidence in southern Europe is probably related to hepatitis B and C infection and increasing alcohol intake, while improving survival may be due to greater surveillance for cirrhosis. The survival gap between clinical and population-based series suggests management is better in centers of excellence. © 2007 by Am. Coll. of Gastroenterology

Trends in cervical cancer survival in Europe, 1983-1994: A population-based study

Objective.: To evaluate trends in survival from cervical cancer in Europe and in European countries participating in the EUROCARE study as a function of age, morphology and stage at diagnosis. Methods.: Relative survival and relative excess risk of death within 5 years of diagnosis, as a function of age, morphology and stage, among 73,022 women aged 15-99 years diagnosed during 1983-1994 and followed up to 1999 in each of 18 European countries participating in the EUROCARE study, using data from 34 population-based cancer registries. Results.: Overall five-year relative survival was 62%, rising by 2% during the period 1983-1994. The highest survival occurred in Northern and Western Europe and the lowest in Central Europe. Survival falls with age at diagnosis, but mainly for localised disease. Survival is higher for adenocarcinoma in younger women, but higher for squamous cell carcinoma in older women. The proportions of younger women, localised cancer and adenocarcinoma all increased. The main improvements in survival were for women under 65, and for metastatic disease. Conclusions.: Survival in Europe has improved slowly but steadily, but the trend is not geographically uniform. Central European countries and the UK saw little or no improvement, and survival in those countries remains the lowest among participating countries in Europe. Further reduction of cervical cancer mortality in Europe may be expected from expansion of screening, and improvement in the treatment of older women, and of metastatic disease. \ua9 2007 Elsevier Inc. All rights reserved

Influence of morphology on survival for non-Hodgkin lymphoma in Europe and the United States

We explored the influence of morphology on geographic differences in 5-year survival for non-Hodgkin lymphoma (NHL) diagnosed in 1990-1994 and followed for 5 years: 16,955 cases from 27 EUROCARE-3 cancer registries, and 22,713 cases from 9 US SEER registries. Overall 5-year relative survival was 56.1% in EUROCARE west, 47.1% in EUROCARE east and 56.3% in SEER. Relative excess risk (RER) of death was 1.05 (95% confidence interval (CI) 1.01-1.10) in EUROCARE west, 1.52 (95% CI 1.44-1.60) in EUROCARE east (SEER reference). Excess risk of death was significantly above reference (diffuse B lymphoma) for Burkitt's and NOS lymphoma; not different for lymphoblastic and other T-cell; significantly below reference (in the order of decreasing relative excess risk) for NHL NOS, mantle cell/centrocytic, lymphoplasmacytic, follicular, small lymphocytic/chronic lymphocytic leukaemia, other specified NHL and cutaneous morphologies. Interpretation of marked variation in survival with morphology is complicated by classification inconsistencies. The completeness and standardisation of cancer registry morphology data needs to be improved