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Gatta G.,Fondazione IRCCS Instituto Nazionale Dei Tumori | Zigon G.,Fondazione IRCCS Instituto Nazionale Dei Tumori | Aareleid T.,National Institute for Health Development | Ardanaz E.,Navarra Cancer Registry | And 13 more authors.
Acta Oncologica | Year: 2010

Objective. To identify disparities in the management of colon and rectal cancer across Europe by assessing population-based information from 12 European cancer registries (CR) participating in EUROCARE, together with additional information obtained from individual clinical records. Methods and patients. We considered five indicators: (a) resection with curative intent; (b) post-operative mortality; (c) proportion of stage II/III colon cancer cases given adjuvant chemotherapy; (d) proportion of rectal cancer cases receiving radiotherapy; and (e) proportion of curative intent resections with 12 or more lymph nodes examined. Results. A total of 6 871 colorectal cancer patients, diagnosed between 1996-1998, were examined. Overall 71% of patients received resection with curative intent, range 44-86% by CR; 46% of stage III colon cancer cases (range 24-73% by CR) and 22% of stage II cases (not then recommended) received adjuvant chemotherapy; 12% of rectal cancer cases received adjuvant radiotherapy, range ≤2% in five CRs to >51% in two CRs. For only 29% of curative intent resections were 12 or more lymph nodes examined. Conclusions. This study reveals that, although most patients received surgery with curative intent, disparities in treatment for colorectal cancer across Europe in the late 1990s were unexpectedly large, with many patients not receiving treatments indicated by published clinical trials. Consensus guidelines for CRC management are now becoming available and should be adopted across Europe. It is hoped that dissemination of guidelines will improve the use of scientifically proven treatments for the disease, but this should be monitored by further population-based studies. © 2010 Informa UK Ltd.


Lepage C.,University of Burgundy | Ciccolallo L.,Fondazione IRCCS Instituto Nazionale dei Tumori | Ciccolallo L.,Instituto Nazionale dei Tumori | De Angelis R.,Instituto Superiore Of Sanita | And 64 more authors.
International Journal of Cancer | Year: 2010

The aim of this study was to report on malignant digestive endocrine tumours (MDET) prognosis in several European countries. We analysed survival data from 19 cancer registries in 12 European countries on 3,715 MDET diagnosed between 1985 and 1994. The overall 5-year survival rate was 47.5%. It was 58.1% for differentiated MDET and 8.1% for small-cell MDET (p < 0.001), 55.9% for patients under 65 and 37.0% for older patients. Survival rates for small intestinal and colorectal were higher than for the other sites. The 5-year relative survival rates were 60.3% in Northern Europe, 53.6% in Western Continental Europe, 42.5% in the UK, 37.6% in Eastern Europe (p < 0.001). Among well-differentiated pancreatic tumours, 5-year relative survival was 55.6% for insulinoma, 48.4% for gastrinoma, 33.4% for glucagonoma, 28.8% for carcinoïd tumours and 49.9% for non-functioning tumours. The relative excess risk of death was significantly lower in Western Continental Europe and Northern Europe and significantly higher in Easter European compared to the UK. MDET differentiation, site, geographic area, age and sex, were independent prognostic factors. Overall, in Europe approximately half of the patients with MDET survive 5 years after the initial diagnosis. Prognosis varies with tumour differentiation, anatomic site and histological type. There are significant differences in survival from MDET among European countries, independently of other prognostic factors.


Lepage C.,Digestive Cancer Registry Institute National Of La Sante Et Of La Recherche Medicale U866 | Sant M.,Fondazione Instituto Of Ricovero E Cura A Carattere Scientifico | Verdecchia A.,Instituto Superiore Of Sanita | Forman D.,Northern and Yorkshire Cancer Registry | And 13 more authors.
British Journal of Surgery | Year: 2010

Background: Little is known at a population level about operative mortality after surgery for gastric cancer and whether differences between countries can explain differences in long-term survival. This study compared operative mortality recorded by ten cancer registries in seven European countries. Methods: Non-conditional logistic regression analysis was performed to estimate the independent effect of the studied factors onmortality within 30 days of surgery. A multivariable survival model was employed with and without operative mortality. Results: The overall operative mortality rate in 1611 patients studied was 8.9 (range 5.2-16) per cent. Country of residence was a significant prognostic factor in the multivariable analysis. The likelihood of operative mortality was lower in Italy, France and the UK than in the Netherlands, Spain, Slovenia and Poland. Age, type of gastrectomy and stage at diagnosis were also significant factors. Cancer site was not found to be significant in the multivariable analysis. The overall 5-year relative survival rate varied between 42.0 per cent (Italy) and 24 per cent (Poland); after excluding operative mortality, the 5-year survival rate was 44.3 and 28 per cent respectively. Conclusion: Within Europe, the substantial differences in operative mortality after gastrectomy only partly explain marked differences in survival after gastric cancer resection. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.


Verhoeven R.H.A.,Comprehensive Cancer Center South | Gondos A.,German Cancer Research Center | Janssen-heijnen M.L.G.,Comprehensive Cancer Center South | Janssen-heijnen M.L.G.,Viecuri Medical Center | And 17 more authors.
Annals of Oncology | Year: 2013

Background: Despite high curability, some testicular cancer (TC) patient groups may have increased mortality. We provide a detailed age- and histology-specific comparison of population-based relative survival of TC patients in Europe and the USA. Design: Using data from 12 European cancer registries and the USA Surveillance, Epidemiology and End Results 9 database, we report survival trends for patients diagnosed with testicular seminomas and nonseminomas between 1993-1997 and 2003-2007. Additionally, a model-based analysis was used to compare survival trends and relative excess risk (RER) of death between Europe and the USA adjusting for differences in age and histology. Results: In 2003-2007, the 5-year relative survival of patients with testicular seminoma was at least 98% among those aged <50 years, survival of patients with nonseminoma remained 3%-6% units lower.Despite improvements in the relative survival of nonseminoma patients aged ≥50 years by 13%-18% units, survival remained markedly lower than the survival of seminoma patients of the same age. Model-based analyses showed increased RERs for nonseminomas, older, and European patients. Conclusions: There remains little room for survival improvement among testicular seminoma patients, especially for those aged <50 years. Older TC patients remain at increased risk of death, which seems mainly attributable to the lower survival among the nonseminoma patients. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Neppl-Huber C.,German Cancer Research Center | Zappa M.,Clinical and Descriptive Epidemiology Unit | Coebergh J.W.,Erasmus University Rotterdam | Rapiti E.,Geneva Cancer Registry | And 16 more authors.
Annals of Oncology | Year: 2012

Background: We describe changes in prostate cancer incidence, survival and mortality and the resulting impact in additional diagnoses and avoided deaths in European areas and the United States. Methods: Using data from 12 European cancer registries and the Surveillance, Epidemiology and End Results program, we describe changes in prostate cancer epidemiology between the beginning of the PSA era (USA: 1985-1989, Europe: 1990-1994) and 2002-2006 among patients aged 40-64, 65-74, and 75+. Additionally, we examine changes in yearly numbers of diagnoses and deaths and variation in male life expectancy. Results: Incidence and survival, particularly among patients aged <75, increased dramatically, yet both remain (with few exceptions in incidence) lower in Europe than in the United States. Mortality reductions, ongoing since the mid/late 1990s, were more consistent in the United States, had a distressingly small absolute impact among patients aged 40-64 and the largest absolute impact among those aged 75+. Overall ratios of additional diagnoses/avoided deaths varied between 3.6 and 27.6, suggesting large differences in the actual impact of prostate cancer incidence and mortality changes. Ten years of remaining life expectancy was reached between 68 and 76 years. Conclusion: Policies reflecting variation in population life expectancy, testing preferences, decision aids and guidelines for surveillance-based management are urgently needed. © The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Bouvier A.-M.,French Institute of Health and Medical Research | Sant M.,Fondazione IRCCS | Verdecchia A.,Instituto Superiore Of Sanita | Forman D.,Northern and Yorkshire Cancer Registry | And 15 more authors.
European Journal of Cancer | Year: 2010

Background: Wide geographic variations in survival for gastric cancer in Europe have been reported. The aim of this study was to analyse the effect of stage at diagnosis, treatment and cancer characteristics on long-term survival for gastric cancer in populations covered by cancer registries. Methods: We analysed survival in 4620 cases of gastric cancer from 17 European population-based cancer registries from 8 countries. Univariate and multivariate regression of relative survival were performed. Results: Five-year relative survival varied between 10.6% and 24.0%, while 10-year survival ranged from 7.7% to 23.0%. After adjustment for age and sex, the regional excess hazard ratio (EHR) of death was significantly higher in Ragusa, Granada, Yorkshire, Slovakia, Slovenia and Poland than in France, Northern Italy, The Netherlands and the Basque Country. After further adjustment for surgical resection versus no resection (a proxy of stage), the EHR of death remained significantly higher only in Granada and Yorkshire than in the reference country (France). After adjustment for stage, the EHR was significantly higher only in Yorkshire (EHR: 1.51; 95% confidence interval (CI): 1.29-1.77). The EHR in this area was limited to the first year following diagnosis. Conclusion: Differences across Europe in gastric cancer survival depend to a large extent on differences in stage at diagnosis. However they do not explain all variations. Quality of management and treatment can explain some differences. © 2010 Elsevier Ltd. All rights reserved.


Stiller C.A.,University of Oxford | Trama A.,Instituto Nazionale dei Tumori | Brewster D.H.,Scottish Cancer Registry | Verne J.,Public Health England | And 100 more authors.
Cancer Epidemiology | Year: 2014

Kaposi sarcoma (KS) is a virus-related malignancy which most frequently arises in skin, though visceral sites can also be involved. Infection with Kaposi sarcoma herpes virus (KSHV or HHV-8) is required for development of KS. Nowadays, most cases worldwide occur in persons who are immunosuppressed, usually because of HIV infection or as a result of therapy to combat rejection of a transplanted organ, but classic Kaposi sarcoma is predominantly a disease of the elderly without apparent immunosuppression. We analyzed 2667 KS incident cases diagnosed during 1995-2002 and registered by 75 population-based European cancer registries contributing to the RARECARE project. Total crude and age-standardized incidence rate was 0.3 per 100,000 per year with an estimated 1642 new cases per year in the EU27 countries. Age-standardized incidence rate was 0.8 per 100,000 in Southern Europe but below 0.3 per 100,000 in all other regions. The elevated rate in southern Europe was attributable to a combination of classic Kaposi sarcoma in some Mediterranean countries and the relatively high incidence of AIDS in several countries. Five-year relative survival for 2000-2002 by the period method was 75%. More than 10,000 persons were estimated to be alive in Europe at the beginning of 2008 with a past diagnosis of KS. The aetiological link with suppressed immunity means that many people alive following diagnosis of KS suffer comorbidity from a pre-existing condition. While KS is a rare cancer, it has a relatively good prognosis and so the number of people affected by it is quite large. Thus it provides a notable example of the importance of networking in diagnosis, therapy and research for rare cancers. © 2014 Elsevier Ltd.

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