Survival in patients with primary liver cancer, gallbladder and extrahepatic biliary tract cancer and pancreatic cancer in Europe 1999-2007: Results of EUROCARE-5

BACKGROUND

The EUROCARE study collects and analyses survival data from population-based cancer registries (CRs) in Europe in order to provide data on between-country differences in survival and time trends in survival.

METHODS

This study analyses data on liver cancer, gallbladder and extrahepatic biliary tract cancers ("biliary tract cancers"), and pancreatic cancer diagnosed in 2000-2007 from 88 CRs in 29 countries. Relative survival (RS) was estimated overall, by region, sex, age and period of diagnosis using the complete approach. Time trends in 5-year RS over 1999-2007 were also analysed using the period approach.

RESULTS

The prognosis of the studied cancers was poor. Age-standardised 5-year RS was 12% for liver cancer, 17% for biliary tract cancers and 7% for pancreatic cancer. There were some between-country differences in survival. In general, RS was low in Eastern Europe and high in Central and Southern Europe. For all sites, 5-year RS was similar in men and women and decreased with advancing age. No substantial changes in survival were reported for pancreatic cancer over the period 1999-2007. On average, there was a crude increase in 5-year RS of 3 percentage points between the periods 1999-2001 and 2005-2007 for liver cancer and biliary tract cancers.

CONCLUSIONS

The major changes in imaging techniques over the study period for the diagnosis of the three studied cancers did not result in an improvement in the prognosis of these cancers. In the near future, new innovative treatments might be the best way to improve the prognosis in these cancers.

Long-term survival, prevalence, and cure of cancer: a population-based estimation for 818 902 Italian patients and 26 cancer types

Original, population-based estimates of indicators of long-term survival and cure in cancer patients are provided. More than a quarter of cancer patients in Italy have reached death rates similar to those of the general population. Nearly three quarters of them will not die as a result of cancer. These estimates are potentially helpful to health-care planners, clinicians, and patients.

Background

Persons living after a cancer diagnosis represent 4% of the whole population in high-income countries. The aim of the study was to provide estimates of indicators of long-term survival and cure for 26 cancer types, presently lacking.

Patients and methods

Data on 818 902 Italian cancer patients diagnosed at age 15–74 years in 1985–2005 were included. Proportions of patients with the same death rates of the general population (cure fractions) and those of prevalent patients who were not at risk of dying as a result of cancer (cure prevalence) were calculated, using validated mixture cure models, by cancer type, sex, and age group. We also estimated complete prevalence, conditional relative survival (CRS), time to reach 5- and 10-year CRS >95%, and proportion of patients living longer than those thresholds.

Results

The cure fractions ranged from >90% for patients aged <45 years with thyroid and testis cancers to <10% for liver and pancreatic cancers of all ages. Five- or 10-year CRS >95% were both reached in <10 years by patients with cancers of the stomach, colon–rectum, pancreas, corpus and cervix uteri, brain, and Hodgkin lymphoma. For breast cancer patients, 5- and 10-year CRSs reached >95% after 19 and 25 years, respectively, and in 15 and 18 years for prostate cancer patients. Five-year CRS remained <95% for >25 years after cancer diagnosis in patients with liver and larynx cancers, non-Hodgkin lymphoma, myeloma, and leukaemia. Overall, the cure prevalence was 67% for men and 77% for women. Therefore, 21% of male and 31% of female patients had already reached 5-year CRS >95%, whereas 18% and 25% had reached 10-year CRS >95%.

Conclusions

A quarter of Italian cancer patients can be considered cured. This observation has a high potential impact on health planning, clinical practice, and patients' perspective.

Estimate of population coverage with the prostate specific antigen (PSA) test to screen for prostate cancer in a metropolitan area of northern Italy

The use of the prostate specific antigen (PSA) test in the period 1999-2000 in a population of 311 822 men, aged 40 years or more, resident in Milan, Italy, was examined. Data were drawn from the outpatient database of the local health information system. A total of 139 350 PSA tests were used in 83 943 subjects. Overall, 26.9% of the male population aged 40 or older, with no history of prostate cancer, received a PSA test in the 2 year study period. For subjects older than 50 the rate rose to 34%. Results show a high coverage of the male population in northern Italy with screening using the PSA test for prostate cancer.

[Latent pathology of the thyroid: an epidemiological and statistical study of thyroids sampled during 507 consecutive autopsies]

In order to highlight the occult pathology of the thyroid in the aged, the authors examined all the glands withdrawn from 507 consecutive autopsies on subjects of 67.10 years of median age. In 10 tables there are weight and measurements of the thyroids, macro and microscopic details and pathologic appearances. Adenomas were found in 17.1% of cases and histologically besides the known cases referred also to the Hürtle cells type, 4 clear cells adenomas and 5 adenolipomas were found. In 27.42% the subjects were affected or were dead for a malignant extrathyroidal neoplasm, and in 26% of these there was a metastasis in the thyroid. Never a primitive thyroid carcinoma, macroscopically and clinically evident, but in 53 thyroid glands, 54 occult carcinomas (OC) were found, particularly 37 papillary and 17 medullary. IN 57% of 165 histologically treated thyroids, to evidence C-cells, hyperplasia of these cells was found associated with various pathologic conditions, more in aged subjects. In 147 glands were found 170 nodules of various number of cells, at times positive for calcitonin. These solid cellular nodes (SCN) were evaluated as nodular C-cells hyperplasia. Besides isolated cases of acute thyroiditis (also the mycotic type), of tubercular thyroiditis and Hashimoto's, in 12% of the glands a lymphocytic chronic thyroiditis was found, frequently with Hürtle cells. Others observations were: basophilic thickening of colloid also with calcium oxalate crystals, lipoid degeneration of follicular cells and fat interfollicular and interlobular infiltration, thyroid amyloidosis, inner and media elastic calcification of thyroid arteries, presence of cysts with squamous cells coating, parathyroid glands and cartilage intrathyroidal plaques.

[Occult carcinoma of the thyroid gland: an epidemiological study of autopsy material]

The occurrence of occult thyroid carcinoma at autopsy was examined in 507 consecutive autopsies performed over one-year in subjects without clinical evidence of thyroid cancer, from different regions of Italy, including areas of endemic goiter. We found 54 (10.65%) occult thyroid carcinomas. In 37 cases the histologic pattern was of the papillary type, with diameter ranging between 176 and 6000 microns, 12 of these cases showed a typical papillary pattern, 6 had a marked fibrosis, 2 had a cystic pattern, one showed a lymphoid stroma, and 17 had a follicular pattern. The remaining 17 cases were medullary carcinomas, with a diameter ranging from 50 to 1600 microns. The percentage of occult thyroid carcinomas reported in the present study may constitute real value of the occurrence of this tumor in the Italian population.

[Critical reflections on differentiated carcinoma of the thyroid: difficulties, doubts and differential-diagnosis problems]

This work reviews the problems associated with the diagnosis of well differentiated carcinomas of the thyroid (follicular and papillary), which anatomically and clinically can show characteristics not readily distinguishable from those found in thyroid hyperplasia and adenomas. Some features of atypical adenomas and Hurthle cell tumors are detailed, in particular the borderline malignancy of the latter. We have examined the histological parameters useful in diagnosis of follicular carcinoma (cellular polymorphism and size variability with increased and atypical mitoses, invasion of the capsule and vessels, metastasis to lymph nodes and distant organs) and of papillary carcinoma (true papillae, large and crowded nuclei displaying a "ground glass" appearance with grooves and cytoplasmic inclusions and psammoma bodies). The limitations of these parameters are discussed with emphasis on frozen section examination when the lack of time limits examination to few and small tissue fragments. Invasion of the capsule and vessels is not easily detected and the "ground glass" nucleus and presence of grooves are not evident. The biological behavior of well differentiated carcinomas is discussed and, although unpredictable and variable in the single case, is generally that of a slow growing tumor. It is partially influenced by the age of the patient, size and stage of the tumor, invasion of the capsule and vessels and metastatic spread. We have observed that the biological behavior, apparently different in the follicular and papillary forms, appears identical for both tumors when a large number of cases are analyzed. Mention is made of the various surgical choices (total thyroidectomy, subtotal thyroidectomy, lobectomy, different surgical procedures which take into account the various risk factors). No statistically significant differences in recurrences and metastatic spread are obtained by electing more or less aggressive surgery with or without extensive dissection of cervical lymph nodes.

Immunohistochemical study of solid cell nests of the thyroid gland found from an autopsy study

An immunohistochemical study was performed to identify the histogenesis of solid cell nests (SCN) found in 30 of 202 thyroids obtained at autopsy. Immunoperoxidase staining was used to detect the presence of calcitonin, thyroglobulin, thyroxin, low and high molecular weight keratins, and carcinoembryonic antigen (CEA). Results showed that cells forming solid nests had immunoreactivity for calcitonin, low molecular weight keratin, and CEA, but not for thyroglobulin, thyroxin and high molecular weight keratin. Thus, SCN do not result from tangentially cut thyroid follicles (absence of staining for thyroglobulin and thyroxin), nor from a squamous metaplastic process (absence of staining for high molecular weight keratin), but instead they are formed by C-cells because they showed calcitonin immunoreactivity, and neurosecretory granules.