What reasons lie behind long-term survival differences for gastric cancer within Europe?
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.


CONCLUSIONS
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.
Bouvier
Anne-Marie
AM
Digestive Cancer Registry (INSERM U866), Dijon, France.
Sant
Milena
M
Verdecchia
Arduino
A
Forman
David
D
Damhuis
Ronald
R
Willem Coebergh
Jan
J
Crocetti
Emanuele
E
Crosignani
Paolo
P
Gafa
Lorenzo
L
Launoy
Guy
G
Martinez-Garcia
Carmen
C
Plesko
Ivan
I
Pompe-Kirn
Vera
V
Rachtan
Jadwiga
J
Velten
Michel
M
Vercelli
Marina
M
Zwierko
Maria
M
Esteve
Jacques
J
Faivre
Jean
J
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D055088:Early Detection of Cancer / Q000401:mortality*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011787:Quality of Health Care; D012042:Registries; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology; D016019:Survival Analysis