Hepatocellular Carcinoma: Trends of Incidence and Survival in Europe and the United States at the End of the 20th Century
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Abstract:
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.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.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.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.Keywords:
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Liver Cancer
The aim of the study was to evaluate the 5-year relative survival rates of patients with all malignant cancers in the Swietokrzyskie Voivodeship who were diagnosed with cancer during the period 1995-2007, which is when the Swietokrzyskie Cancer Centre began and developed its comprehensive oncological care in the region. 41,104 patients from the Swietokrzyskie Voivodeship who were registered in the Swietokrzyskie Cancer Registry in that period of time were included in the analysis of the survival rates. Relative survival was calculated using the Hakulinen and Brenner methods. These methods are recommended by the European Network of Cancer Registries for the population-based cancer registries where cause of death is unknown. The results were referred to the European average of relative survival rates calculated for all malignant cancers combined, as well as selected cancers calculated within the EUROCARE-4 project. The survival rates of patients diagnosed from 2003 to 2007 do not differ significantly from the European average, and are even higher for both sexes combined (56.0% v. 48.3%), and cancers of cervix and corpus uteri, as well as lung cancer for men and women combined. The 5-year relative survival rates for all malignances of patients in the Swietokrzyskie Voivodeship diagnosed from 2003 to 2007 increased by 9.7 percentage points in comparison to previous years 1995-2002. A significant improvement was seen in prostate cancer (28.1 percentage points), rectum cancer (13.1) and colon cancer (11.0). The improvement of the survival rates reflects the improvement in curability due to the development of the Swietokrzyskie Cancer Centre.
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The department of health-Rizal cancer registry (DOH-RCR) was the first population-based cancer registry in the Philippines, established in 1974. Even though cancer is reportable by legislation, cancer registration is pursued by active methods. Data on survival from cancer of the breast registered in 1996-1997 are reported. Followup was carried out by passive and active methods. The proportion of cases with a histological confirmation of cancer diagnosis was 90%; death certificates only (DCOs) constituted 6%; 81% of the total registered were included for the survival analysis. Complete follow-up at five years from the incidence date was 30%. Relative survival rates at one, three and five years were 89%, 56% and 37%, respectively. Five-year age-standardized relative survival was 35%. Five-year relative survival by age group did not display any pattern or trend, and was fluctuating. A majority of cases were diagnosed with a regional spread of disease (44%) followed by localized stage (17%). Five-year absolute survival ratesby extent of disease were localized (65%), regional (35%), distant metastasis (12%) and unknown (35%). Thetrend of 5-year survival for breast cancer decreased from 46% in 1987 to 37% in 1996-1997.
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Early detection of hepatocellular carcinoma (HCC) is crucial in providing more effective therapies. As routine laboratory variables are readily accessible, this study aimed to develop a simple non-invasive model for predicting hepatocellular cancer.Two groups of patients were recruited: an estimation group (n = 300) and a validation group (n = 625). Each comprised two categories: hepatocellular cancer and liver cirrhosis. Logistic regression analyses and receiver operating characteristic (ROC) curves were used to develop and validate the HCC-Mark model comprising AFP, high-sensitivity C-reactive protein, albumin and platelet count. This model was tested in cancer patients classified by the Barcelona Clinic Liver Cancer (BCLC), Cancer of Liver Italian Program (CLIP) and Okuda systems, and was compared with other non-invasive models for predicting hepatocellular cancer.HCC-Mark produced a ROC AUC of 0.89 (95% CI 0.85-0.90) for discriminating hepatocellular carcinoma from liver cirrhosis in the estimation group and 0.90 (0.86-0.90) in the validation group (both p < 0.0001). This AUC exceeded all other models, that had AUCs from 0.41 to 0.81. AUCs of HCC-Mark for discriminating patients with a single focal lesion, absent macrovascular invasion, tumour size <2 cm, BCLC (0-A), CLIP (0-1) and Okuda (stage Ι) from cirrhotic patients were 0.88 (0.85-0.90), 0.87 (0.85-0.89), 0.89 (0.85-0.93), 0.87 (0.84-0.89), 0.85 (0.82-0.87) and 0.86 (0.83-0.89), respectively (all p < 0.0001).HCC-Mark is an accurate and validated model for the detection of hepatocellular cancer and certain of its clinical features.
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Population-based study of short- and long-term survival from colorectal cancer in Denmark, 1977–1999
Abstract Background Survival rates for patients with colorectal cancer have been lower in Denmark than in other European countries. The aim of this study was to examine temporal trends in relative survival from colorectal cancer between 1977 and 1999. Methods All patients diagnosed with colorectal cancer between 1977 and 1999 were identified using the nationwide population-based Danish Cancer Registry. Patients were linked with the Danish Central Population Registry to obtain data on survival to December 2002, and to select ten population controls per patient. Results A total of 69 562 patients with colorectal cancer were identified, of whom 49·2 per cent were men. Six-month relative survival after diagnosis increased from 69·7 per cent in 1977–1982 to 77·7 per cent in 1995–1999. Five-year relative survival rates increased from 37·8 to 46·8 per cent respectively. Women had slightly higher 5-year relative survival than men throughout the study period. Rectal tumours were associated with better survival than colonic tumours until 2 years after diagnosis, after which tumour location had no impact on survival. Conclusion Relative survival of patients with colorectal cancer has improved in Denmark between 1977 and 1999, most probably reflecting better management of the disease.
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Macao Cancer Registry was established in 2003. It is population-based and has been collecting cancer reports from all possible settings where pathological and management services are available. To get a better idea over the prognosis and survival of all and major cancer sites, a survival analysis was here performed to estimate the relative survival rates of cancers diagnosed and registered during 2003 to 2005 with a follow-up of vital status till 31 Dec, 2008.3,244 cancer cases diagnosed and registered during 2003-2005 in Macao Cancer Registry were considered for analysis. Cases of in-situ carcinoma, extreme age and poor data quality were deliberately excluded, leaving 2,623 newly diagnosed cancers eligible. Vital status of registered cases through 31 December 2008 was confirmed by matching with death certificates and review from the Hospital Information System (HIS) of the only public hospital. Observed survival rates were calculated using a Life Table method, and relative survival rates were examined using an algorithm written in SAS by Paul Dickman with minor adaptations. Apart from general relative survival rates, specific rates by sex and age strata were also estimated.3-year and 5-year relative survival rates of all cancers were 61% and 56% respectively for both sexes; (54% and 47%, respectively, for males and 68% and 64%for females). The 3-year relative survival rates for major cancer sites ranged from 21% to 90%, with lung cancer showing the lowest and female breast cancer the highest. 5-year relative survival rates for major cancer sites ranged from 18% to 85%, with liver cancer showing the lowest and again female breast cancer the highest. Female cancer patients had higher relative survival than males across the 5-year follow up period, with a sex difference of nearly 15%.Comparison of survival rates from this first trial in Macao, deriving survival statistics from population-based cancer registration, with other Asian countries/cities, like Taiwan, Singapore and Japan, showed Macao and Taiwan to have the closest estimates for 3-year relative survival. Random variation was found to exist in the stratification of sex and age in certain cancer sites due to scarce case numbers in the subgroups. It is important to note that the 3-year survival rates are relatively more consistent and reliable than 4-year or 5-year ones. Promotion of reporting cancer stage by physicians as well as improvement in data quality of cancer registration are essential to allow further informative statistics derived from the cancer registry with reference to cancer prevention.
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The aim of this study is to analyze the upper aerodigestive cancer survival in Umbria, a central Italian region, in the periods 1978-82 and 1994-98. The cases' data diagnosed in the period 1978-82 were derived from an ad hoc survey carried out in Umbria and for the years 1994-98 from Umbria Population-based Registry (RTUP). In the period 1994-98 the relative survival has lightly improved compared with the previous one. Comparison among five year relative standardized survival for head and neck, oesophagus and larynx, in Umbria region and in the other Italian registries, shows a quite high survival that could be further improved with an early diagnosis and, consequently, less destroying treatments.
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Relative survival rates are suitable for the comparison of survival information between patient groups with different age structures. They are well established as a common method for analysis of cancer registry data. In the following, the method for the estimation of the relative survival and the central components of the implementation of this method with SAS are presented. Examples of results of the described program are presented and the program is compared with a selection of other technical solutions.
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