Improved Survival in Hematologic Malignancies in Europe Between 1997 and 2008
As reported by Sant et al in The Lancet Oncology, the population based EUROCARE-5 study has shown significantly improved survival in hematologic malignancies in Europe between 1997 and 2008. Although improved, survival was poorer in Eastern Europe compared with other regions.
Study Details
This retrospective study involved data from 560,444 patients aged ≥ 15 years from 20 European countries diagnosed with 11 hematologic malignancies up to December 2007 and followed through December 2008. Survival was assessed as relative survival—ie, the ratio of observed survival in the patient group to expected survival in a comparable group in the general population. Relative excess risk of death for each malignancy was also analyzed.
Survival Improvements
For the periods 1997 to 1999 vs 2006 to 2008, age-standardized 5-year relative survival rates for all of Europe increased (all P < .0001 for trend except where noted) from 42.0% to 55.4% for diffuse large B-cell lymphoma, 58.9% to 74.3% for follicular lymphoma, 32.3% to 54.4% for chronic myeloid leukemia, 50.1% to 61.9% (P = .0038, estimate not age-standardized) for acute promyelocytic leukemia, 75.1% to 79.3% for Hodgkin lymphoma, 66.1% to 69.0% for chronic lymphocytic leukemia/small lymphocytic lymphoma, 29.8% to 39.6% for multiple myeloma/plasmacytoma, 29.8% to 41.1% for precursor lymphoblastic leukemia/lymphoma, 12.6% to 14.8% for acute myeloid leukemia (excluding acute promyelocytic leukemia), and 70.3% to 74.9% for other myeloproliferative neoplasms (excluding chronic myeloid leukemia).
There was no significant increase in 3-year relative survival for myelodysplastic syndromes, which was 48.9% in 2003 to 2005 vs 48.8% in 2006 to 2008 (P = .5010).
Regional Differences
Survival increased slightly in Southern Europe, more in the United Kingdom, and to a greater degree in Northern, Central, and Eastern Europe. However, survival in Eastern Europe was lower vs other regions; compared with the United Kingdom, 5-year relative excess risk of death ranged from 1.04 to 2.01 among malignancies.
Survival decreased with increasing age. Increases across the study period were noted in all age groups, but were generally small in patients aged ≥ 75 years apart from a 10% increase observed in follicular lymphoma, diffuse large B-cell lymphoma, and chronic myeloid leukemia in this age group.
The investigators concluded, “These trends are encouraging. Widespread use of new and more effective treatment probably explains much of the increased survival. However, the persistent differences in survival across Europe suggest variations in the quality of care and availability of the new treatments. High-resolution studies that collect data about stage at diagnosis and treatments for representative samples of cases could provide further evidence of treatment effectiveness and explain geographic variations in survival.”
Milena Sant, MD, of Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, is the corresponding author for The Lancet Oncology article.
The study was funded by Compagnia di San Paolo, Fondazione Cariplo, European Commission, and Italian Ministry of Health. For full disclosures of the study authors, visit www.thelancet.com.
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