ArticlesSurvival for haematological malignancies in Europe between 1997 and 2008 by region and age: results of EUROCARE-5, a population-based study
Introduction
New targeted drugs for treating haematological malignancies became available from the early 2000s, including anti-CD20 monoclonal antibodies for B-cell lymphomas1, 2 and acute lymphoblastic leukaemia,3 imatinib for chronic myeloid leukaemia,4 and proteasome inhibitors for myeloma.5 These treatments have greatly improved prognosis for chronic myeloid leukaemia, many lymphoid neoplasms and, to a lesser extent, multiple myeloma.2, 6, 7, 8 However these improvements were mainly documented in hospital-based series or controlled trials. Few population-based studies by cancer registries have investigated survival for haematological malignancies.8 Cancer registries include all incident cases in a registry area and thus reflect clinical practice and survival everywhere, not just in centres of excellence or selected groups of patients. Past EUROCARE studies9 have shown substantial differences in population-based survival for haematological malignancies across Europe; however, because of changes in disease classification and definitions of malignancy over recent decades, investigating changes in haematological malignancy survival over time was not possible. The HAEMACARE project10 promoted the standardisation of data registration for haematological malignancies by EUROCARE cancer registries, and encouraged adoption of the updated International Classification of Disease for Oncology.11, 12 As a result, survival time trends can now be estimated in different European populations based on comparable data.
The primary aim of the present study was to investigate changes in 5-year relative survival for adult European patients diagnosed with haematological malignancies by morphology, age at diagnosis, and European region; we were particularly interested in morphologies for which new, more effective treatments became available from the early 2000s. We aimed to corroborate our results with multivariate models to estimate relative excess risks of death in these patients by calendar period, age at diagnosis, and European region, in the 5 years after diagnosis.
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Participants
We included adult (age ≥15 years) patients archived in the EUROCARE-5 database,13 diagnosed with haematological malignancies up to Dec 31, 2007 and followed up to Dec 31, 2008. We used standardised procedures to check data quality and data completeness, as described elsewhere.13 Cases were coded according to the International Classification of Disease for Oncology 3rd edition,11 grouped according to WHO12 and HAEMACARE10, 14 criteria, and divided into four categories according to age at
Results
560 444 haematological malignancies were diagnosed between 1996 and 2007 in the regions covered: 7% from southern Europe, 8% from northern Europe, 9% from eastern Europe, 20% from central Europe, and 56% from the UK (table 1). Only 2·8% of cases overall were recorded on death certificate only or diagnosed at autopsy, with high proportions in Wales (3·2%), Malta (3·3%), England (4·0%), Basel (6·1%), Saarland (8·4%), and Slovakia (14·0%; table 1). Excluding these cases, and grouping the remaining
Discussion
Our data suggest that survival improved for most haematological malignancies over the study period. Multivariate analysis showed a significant decrease in excess risk of death for all malignancies except myelodysplastic syndromes. However, despite this encouraging change, improvements in survival were not uniform across Europe, which could be a result of persisting inequalities in the provision of care. Even after adjustment for age, period, and year of follow-up, survival for most
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