Prognoses and improvement for head and neck cancers diagnosed in Europe in early 2000s: The EUROCARE-5 population-based study
Introduction
Head and neck (H&N) cancers accounted for an estimated number of 140,000 new cases and 63,500 deaths in Europe in 2012, about 4% of all cancers arising in Europe [1]. Men have a four times higher risk having a H&N cancer comparing to women [1]. In Europe, the oral cavity and pharyngeal cancers mortality reached a peak during the nineties thereafter clearly reduced, while mortality for laryngeal cancers started to decline in the early eighties reaching very low rates in 2010. The positive trends were more clear for men [2].
H&N cancers are a heterogeneous group of tumour entities anatomically close to each other, but different in terms of aetiology, histology, diagnostic and treatment approaches. About 91% of all H&N cancer are squamous cell carcinomas, 2% are sarcomas and the other 7% are adenocarcinomas, melanomas and not well specified tumours [3]. H&N cancers are mainly associated with tobacco and alcohol use [4]. Other known risk factors are human papillomavirus (HPV) [5] and Epstein-Barr virus (EBV) infections [6], and low consumption of fruit and vegetables [7]. Despite declining smoking prevalence in Europe [8], incidence of epithelial cancers of nasopharynx, hypopharynx and larynx incidence remained quite stable, while those of oropharynx and oral cavity statistically increased [3].
Previous studies on H&N cancers survival showed disparities across Europe [9], [10], with the lowest and the highest figures observed for Eastern and Northern Europe, respectively. Interestingly, differences in anatomical distribution explained a considerable portion of the survival differences by country for patients with H&N cancers. In fact, H&N sub-sites are important determinants of prognosis: among mouth–pharynx sites, hypopharynx, base of tongue, lateral and posterior wall of the oropharynx are characterised by relatively poor survival, while among laryngeal sites, the supraglottic and subglottic sub-sites have poor survival. Due to differing risk factor prevalence, the distribution of sub-sites in European countries is not homogeneous. Incidence of oral cavity and oropharyngeal cancers are lower in the United Kingdom (UK) and Ireland and the Northern countries and higher in the Eastern and Southern European countries [11], [12].
There are other well-established risk factors which are also prognostic factors. It has been shown that H&N cancer related tumours of HPV infection, e.g. tongue base, tonsil and oropharynx, [13] have better prognosis compared with the other H&N sites. The high consumption of fruit and vegetables has been associated with better prognoses for laryngeal [14] and hypopharyngeal cancers [15]. Also, smoking was recognised to influence the efficacy of treatment [16], [17]. Furthermore, for H&N cancer patients, there is a marked socioeconomic gradient in survival between affluent and deprived patients. Survival is substantially higher in more affluent men than in the more deprived [18], [19].
Nasopharyngeal cancer, which is related to viral exposure, is a rare disease in Europe, while is endemic in Southeast Asia. EBV is, together with smoke, alcohol and wood dust related occupations, among the well known risk factors for this tumours [6], [20].
The EUROCARE-5 study assessed cancer survival in the largest European population so far, with a much greater participation of cancer registries from Eastern Europe with respect to previous studies. In this study we analyse survival for patients with H&N cancers (nasal cavities, thyroid and salivary glands excluded) and diagnosed up to the end of 2007 in populations covered by population-based cancer registries participating in EUROCARE-5 [21], in relation to tumour site and sub-site as prognostic factors. Our aim is to assess whether survival differences between countries have changed, and to investigate whether H&N cancer survival changed from previous periods.
Section snippets
Materials and methods
The analysis included first and subsequent malignant H&N cancers diagnosed in adults (age ⩾15 years) up to the end of 2007 and followed up until 31st December 2008. We included tongue and lingual tonsil (topography codes C01–C02), oral cavity (C03–C06), oropharynx and tonsil (C09–C10), nasopharynx (C11), hypopharynx (C12–C13) and larynx (C32) and all H&N tumours combined except larynx (C01–C06, C09–C13). For brevity the first and the third entity will be named ‘tongue’ and ‘oropharynx’ along the
Results
Table 1 shows two indicators of quality of diagnosis: microscopically verified (MV) and unspecified sub-site for larynx (NOS, C32.9) cases. For most countries (except Wales, Croatia, Latvia and Poland), 95% or more cases were MV and about 28% of laryngeal cases were classified as located in a not well defined sub-site of the larynx. Their proportions were more that 70% in Finland, Croatia and Poland.
Five-year age-standardised RS was the poorest for hypopharynx and the highest for larynx
Discussion
During the period 1999–2007, 5-year survival for patients with oral cavity, oropharyngeal and hypopharyngeal cancer significantly improved by 3–5% (absolute difference), while for larynx it remained stable.
Over the last decade, there has been a substantial improvement in diagnosis, staging and treatment of patients with H&N cancers, and overall the natural history of H&N cancers has also evolved. Current management based on multimodality approach, is still quite complex, and often deals with
Role of funding source
Compagnia di San Paolo, Fondazione Cariplo Italy, Italian Ministry of Health (Ricerca Finalizzata 2009, RF-2009-1529710) and European Commission for two projects: (i) European Action Against Cancer, EPAAC, Joint Action No 20102202, and (ii) ‘Information network on rare cancers’, Grant No. 2000111201.
The funding sources had no role in study design, in the collection, analysis and interpretation of data, in the writing of the report, and in the decision to submit the article for publication.
Conflict of interest statement
None declared.
Acknowledgements
We thank Riccardo Capocaccia for the data interpretation and comments; Lucia Buratti, Chiara Margutti, Simone Bonfarnuzzo and Camilla Amati for secretarial assistance.
References (43)
- et al.
Cancer mortality in Europe, 2005–2009, and an overview of trends since 1980
Ann Oncol
(2013) - et al.
Variation in survival for adults with nasopharyngeal cancer in Europe, 1978–1989. EUROCARE Working Group
Eur J Cancer
(1998) - et al.
Rare cancers of the head and neck area in Europe
Eur J Cancer
(2012) - et al.
Variation in survival of patients with head and neck cancer in Europe by the site of origin of the tumors
Eur J Cancer
(1998) - et al.
Prognoses for head and neck cancers in Europe diagnosed in 1995–1999: a population-based study
Ann Oncol
(2011) - et al.
Human papillomavirus related head and neck cancer survival: a systematic review and meta-analysis
Oral Oncol
(2012) - et al.
The EUROCARE-5 study on cancer survival in Europe: database, quality checks and methods of statistical analysis
Eur J Cancer
(2015) - et al.
Standard cancer patient population for age standardizing survival ratios
Eur J Cancer
(2004) - et al.
Incidence and survival trends of head and neck squamous cell carcinoma in the Netherlands between 1989 and 2011
Oral Oncol
(2014) - et al.
Meta-analyses of chemotherapy in head and neck cancer (MACH-NC): an update
Int J Radiat Oncol Biol Phys
(2007)
The advantage of women in cancer survival: an analysis of EUROCARE-4 data
Eur J Cancer
Delays in treatment of oral cancer: a review of the current literature
Oral Surg Oral Med Oral Pathol Oral Radiol
Total exposure and exposure rate effects for alcohol and smoking and risk of head and neck cancer: a pooled analysis of case-control studies
Am J Epidemiol
Human papillomavirus infection as a risk factor for squamous-cell carcinoma of the head and neck
N Engl J Med
The enigmatic epidemiology of nasopharyngeal carcinoma
Cancer Epidemiol Biomarkers Prev
The tobacco atlas
Tobacco and diet as determinant of survival in male laryngeal cancer patients
Int J Cancer
Lifestyle habits as prognostic factors in survival of laryngeal and hypopharyngeal cancer: a multicentric European study
Int J Cancer
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Sources of support (grants): Compagnia di San Paolo, Fondazione Cariplo Italy, Italian Ministry of Health (Ricerca Finalizzata 2009, RF-2009-1529710) and European Commission for two projects: (i) European Action Against Cancer, EPAAC, Joint Action No 20102202, and (ii) ‘Information network on rare cancers’, Grant No. 2000111201.