title: Prognoses and improvement for head and neck cancers diagnosed in Europe in early 2000s: The EUROCARE-5 population-based study.
abstract: BACKGROUND
  Head and neck (H&N) cancers are a heterogeneous group of malignancies, affecting various sites, with different prognoses. The aims of this study are to analyse survival for patients with H&N cancers in relation to tumour location, to assess the change in survival between European countries, and to investigate whether survival improved over time.
  
  
  METHODS
  We analysed about 250,000 H&N cancer cases from 86 cancer registries (CRs). Relative survival (RS) was estimated by sex, age, country and stage. We described survival time trends over 1999-2007, using the period approach. Model based survival estimates of relative excess risks (RERs) of death were also provided by country, after adjusting for sex, age and sub-site.
  
  
  RESULTS
  Five-year RS was the poorest for hypopharynx (25%) and the highest for larynx (59%). Outcome was significantly better in female than in male patients. In Europe, age-standardised 5-year survival remained stable from 1999-2001 to 2005-2007 for laryngeal cancer, while it increased for all the other H&N cancers. Five-year age-standardised RS was low in Eastern countries, 47% for larynx and 28% for all the other H&N cancers combined, and high in Ireland and the United Kingdom (UK), and Northern Europe (62% and 46%). Adjustment for sub-site narrowed the difference between countries. Fifty-four percent of patients was diagnosed at advanced stage (regional or metastatic). Five-year RS for localised cases ranged between 42% (hypopharynx) and 74% (larynx).
  
  
  CONCLUSIONS
  This study shows survival progresses during the study period. However, slightly more than half of patients were diagnosed with regional or metastatic disease at diagnosis. Early diagnosis and timely start of treatment are crucial to reduce the European gap to further improve H&N cancers outcome.
authors.affiliation: Evaluative Epidemiology, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venzian 1, Milan, Italy. Electronic address: gemma.gatta@istitutotumori.mi.it.
authors.forename: Gemma
authors.initials: G
authors.lastname: Gatta
authors.affiliation: Evaluative Epidemiology, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venzian 1, Milan, Italy. Electronic address: laura.botta@istitutotumori.mi.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Botta
authors.affiliation: Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.G., Hospitales Universitarios de Granada/Universidad de Granada, 18080 Cuesta del Observatorio 4, Campus Universitario de Cartuja, Granada, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro 3-5, 28029 Madrid, Spain. Electronic address: mariajose.sanchez.easp@juntadeandalucia.es.
authors.forename: María José
authors.initials: MJ
authors.lastname: Sánchez
authors.affiliation: Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast 2012, University Road Belfast, BT7 1NN Northern Ireland, UK. Electronic address: l.anderson@qub.ac.uk.
authors.forename: Lesley Ann
authors.initials: LA
authors.lastname: Anderson
authors.affiliation: Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità,Viale Regina Elena 299, Rome, Italy. Electronic address: daniela.pierannunzio@iss.it.
authors.forename: Daniela
authors.initials: D
authors.lastname: Pierannunzio
authors.affiliation: Head and Neck Cancer Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venzian 1, Milan, Italy. Electronic address: lisa.licitra@istitutotumori.mi.it.
authors.forename: Lisa
authors.initials: L
authors.lastname: Licitra
keywords: Europe; Head and neck cancers; Hypopharynx; Larynx; Nasopharynx; Oral cavity; Oropharynx; Population-based study; Survival; Tongue