Laryngeal cancer relative survival trends from 1972 to 2021 in the Nordic countries

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Abstract

Background and purpose

Changes in treatment approaches, characterised by the shift from laryngectomy to a focus on organ-preserving methods may have potentially resulted in lower survival. We aim to identify differences in survival trends for laryngeal cancer (LC) in the Nordic countries over a period of 50 years, and discuss the potential impact of factors such as changes in treatment protocols.

Materials and methods

Five-year relative survival (RS) data from 1972 to 2021 were obtained from the NORDCAN database 2.0 which included 33,692 LC cases, of which 85% were diagnosed among men. In the NORDCAN database, the age-standardised RS is calculated using the Pohar Perme estimator with individual International Cancer Survival Standards weights. Joinpoint regression models were used to assess potential shifts in trend over the years in RS.

Results

While Denmark and Norway demonstrated an increasing trend in 5-year RS from 1972 to 2021, in Finland and Sweden, the 5-year RS among men remained static, without any discernible significant trend. Over the 30-year period from 1992–1996 to 2017–2021, RS improved by 9, 4, 13, and 2 percentage points in Denmark, Finland, Norway, and Sweden, respectively. Among women in Sweden, a linear negative trend was observed, noticeable as a 16 percentage-point decline in 5-year RS from the earliest to the latest period.

Interpretation

The underlying causes for the differences in survival trends remain unclear. Besides differences in treatment protocols, several other factors can affect RS making the interpretation of RS trends challenging.

Related collections

Most cited references 46

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Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. The Department of Veterans Affairs Laryngeal Cancer Study Group.

Gregory Wolf, Susan Gross Fisher, Waun Hong … (1991)

We performed a prospective, randomized study in patients with previously untreated advanced (Stage III or IV) laryngeal squamous carcinoma to compare the results of induction chemotherapy followed by definitive radiation therapy with those of conventional laryngectomy and postoperative radiation. Three hundred thirty-two patients were randomly assigned to receive either three cycles of chemotherapy (cisplatin and fluorouracil) and radiation therapy or surgery and radiation therapy. The clinical tumor response was assessed after two cycles of chemotherapy, and patients with a response received a third cycle followed by definitive radiation therapy (6600 to 7600 cGy). Patients in whom ther was no tumor response or who had locally recurrent cancers after chemotherapy and radiation therapy underwent salvage laryngectomy. After two cycles of chemotherapy, the clinical tumor response was complete in 31 percent of the patients and partial in 54 percent. After a median follow-up of 33 months, the estimated 2-year survival was 68 percent (95 percent confidence interval, 60 to 76 percent) for both treatment groups (P = 0.9846). Patterns of recurrence differed significantly between the two groups, with more local recurrences (P = 0.0005) and fewer distant metastases (P = 0.016) in the chemotherapy group than in the surgery group. A total of 59 patients in the chemotherapy group (36 percent) required total laryngectomy. The larynx was preserved in 64 percent of the patients overall and 64 percent of the patients who were alive and free of disease. These preliminary results suggest a new role for chemotherapy in patients with advanced laryngeal cancer and indicate that a treatment strategy involving induction chemotherapy and definitive radiation therapy can be effective in preserving the larynx in a high percentage of patients, without compromising overall survival.

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To provide a comprehensive evaluation of the quality of the data collected on both solid and non-solid tumours at the Cancer Registry of Norway (CRN). Established quantitative and semi-quantitative methods were used to assess comparability, completeness, accuracy and timeliness of data for the period 1953-2005, with special attention to the registration period 2001-2005. The CRN coding and classification system by and large follows international standards, with some further subdivisions of morphology groupings performed in-house. The overall completeness was estimated at 98.8% for the registration period 2001-2005. There remains a variable degree of under-reporting particularly for haematological malignancies (C90-95) and tumours of the central nervous system (C70-72). For the same period, 93.8% of the cases were morphologically verified (site-specific range: 60.0-99.8%). The under-reporting in 2005 due to timely publication is estimated at 2.2% overall, based on the number of cases received at the registry during the following year. This review suggests the routines in place at the CRN yields comparable data that can be considered reasonably accurate, close-to-complete and timely, thereby justifying our policy of the reporting of annual incidence one year after the year of diagnosis.

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The completeness of the Swedish Cancer Register: a sample survey for year 1998.

Lars Holmberg, Lydia Barlow, Mats Talbäck … (2008)

The Swedish Cancer Register (SCR) is used extensively for monitoring cancer incidence and survival and for research purposes. Completeness and reliability of cancer registration are thus of great importance for all types of use of the cancer register. The aim of the study was to estimate the overall coverage of malignant cancer cases in 1998 and to reveal possible reasons behind non-reporting. We selected all malignant cancer cases in the Hospital Discharge Register (HDR) from 1998 and compared these records to those reported to the SCR. There were 43,761 discharges for 42,010 individuals of whom 3,429 individuals were not recorded in the SCR. From these 3 429 records we randomly selected 202 patients for review of their medical records to determine whether they should have been registered on the SCR as incident cases in 1998. About half of the 202 cases (93 malignant and 8 benign) should have been reported, which translates into an additional 1 579 malignant cases (95% CI 1 349-1 808), or 3.7% of the cases reported in 1998. The crude incidence rate for males and females combined would increase from 493 per 100,000 to 511 (95% CI 508-514) if these cases were taken into account. The overall completeness of the SCR is high and comparable to other high quality registers in Northern Europe. For most uses in epidemiological or public health surveillance, the underreporting will be without major impact. However, for specific research questions our findings have implications, as the degree of underreporting is site specific, increases with age, and does not seem to be random, as diagnoses without histology or cytology verification are overrepresented. An annual comparison of the SCR against the HDR could point to hospitals, geographic areas or specific diagnoses where organizational and administrative changes should be introduced to improve reporting.

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Author and article information

Journal

Journal ID (nlm-ta): Acta Oncol

Journal ID (iso-abbrev): Acta Oncol

Journal ID (publisher-id): AO

Title: Acta Oncologica

Publisher: MJS Publishing on behalf of Acta Oncologica

ISSN (Print): 0284-186X

ISSN (Electronic): 1651-226X

Publication date (Electronic): 04 August 2024

Publication date Collection: 2024

Volume: 63

Electronic Location Identifier: 40823

Affiliations

[a ]Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland

[b ]Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland

[c ]Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer and Research, Helsinki, Finland

[d ]Department of Oral and Maxillofacial Surgery, Lahti Central Hospital, Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland

[e ]Palliative Care Unit, Comprehensive Cancer Center, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland

[f ]Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland

[g ]Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska Hospital, Stockholm, Sweden

Author notes

CONTACT Antti Mäkitie antti.makitie@ 123456helsinki.fi Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki University Hospital, P.O. Box 263, FI-00029 HUS, Helsinki, Finland

Supplemental data for this article can be accessed online at https://doi.org/10.2340/1651-226X.2024.40823

Article

Publisher ID: AO-63-40823

DOI: 10.2340/1651-226X.2024.40823

PMC ID: 11332480

PubMed ID: 39099322

SO-VID: 3a41a535-c6d8-4d20-b984-f644f1e564ff

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work.

History

Date received : 19 May 2024

Date accepted : 4 July 2024

Funding

Funded by: Sigrid Jusélius Foundation

Funded by: Finska Läkaresällskapet

Funded by: State Research Funding for the Helsinki University Hospital

Funding This work was supported by the Sigrid Jusélius Foundation, Finska Läkaresällskapet, and the State Research Funding for the Helsinki University Hospital.

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