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Cancer survival comparisons between cohorts are often assessed by estimates of relative or net survival. These measure the difference in mortality between those diagnosed with the disease and the general population. For such comparisons methods are needed to standardize cohort structure (including age at diagnosis) and all-cause mortality rates in the general population. Standardized non-parametric relative survival measures are evaluated by determining how well they (i) ensure the correct rank ordering, (ii) allow for differences in covariate distributions, and (iii) possess robustness and maximal estimation precision. Two relative survival families that subsume the Ederer-I, Ederer-II, and Pohar-Perme statistics are assessed. The aforementioned statistics do not meet our criteria, and are not invariant under a change of covariate distribution. Existing methods for standardization of these statistics are either not invariant to changes in the general population mortality or are not robust. Standardized statistics and estimators are developed to address the deficiencies. They use a reference distribution for covariates such as age, and a reference population mortality survival distribution that is recommended to approach zero with increasing age as fast as the cohort with the worst life expectancy. Estimators are compared using a breast-cancer survival example and computer simulation. The proposals are invariant and robust, and out-perform current methods to standardize the Ederer-II and Pohar-Perme estimators in simulations, particularly for extended follow-up.

Estimation of relative survival has become the first and the most basic step when reporting cancer survival statistics. Standard estimators are in routine use by all cancer registries. However, it has been recently noted that these estimators do not provide information on cancer mortality that is independent of the national general population mortality. Thus they are not suitable for comparison between countries. Furthermore, the commonly used interpretation of the relative survival curve is vague and misleading. The present article attempts to remedy these basic problems. The population quantities of the traditional estimators are carefully described and their interpretation discussed. We then propose a new estimator of net survival probability that enables the desired comparability between countries. The new estimator requires no modeling and is accompanied with a straightforward variance estimate. The methods are described on real as well as simulated data.

•We propose an update of a global standard for cancer survival comparisons entitled the World Cancer Patient Population (WCPP), constructed from the current global age distributions of cancer patients.•From an analysis of the 36 major cancer types, three standards of age-specific weights are derived to enable age-adjusted comparisons of cancer-specific survival.•Around two-thirds of cancer sites were described by one standard, representing the majority of epithelial cancers more often diagnosed at older age groups.•The two other standards represent a number of non-epithelial cancers that are more common among younger and older age groups, respectively. This study addresses the need for a global cancer patient-based standard population that adjusts for the expected age structure of different cancers, thus aiding the comparison of survival estimates worldwide. Counts of age-specific incidence for 36 cancer sites in 185 countries for the year 2018 were extracted from IARC’s GLOBOCAN database of national estimates. We used a multinomial mixture regression to identify clusters of cancer sites with similar age-specific profiles. An updated standard entitled the World Cancer Patient Population (WCPP) is presented, derived from the current estimated global numbers of cancer patients that comprises three sets of age-specific weights. Around two-thirds of cancer sites were described by a unique standard, representing the majority of epithelial cancers more often diagnosed at older age groups. The two other standards represent a number of non-epithelial cancer types, and cancers common at younger and older age groups, respectively. The WCPP proposed here provides a contemporary and global means to estimate age-standardised survival for international benchmarking purposes.

Background The relative survival field has seen a lot of development in the last decade, resulting in many different and even opposing suggestions on how to approach the analysis. Methods We carefully define and explain the differences between the various measures of survival (overall survival, crude mortality, net survival and relative survival ratio) and study their differences using colon and prostate cancer data extracted from the national population-based cancer registry of Slovenia as well as simulated data. Results The colon and prostate cancer data demonstrate clearly that when analysing population-based data, it is useful to split the overall mortality in crude probabilities of dying from cancer and from other causes. Complemented by net survival, it provides a complete picture of cancer survival in a given population. But when comparisons of different populations as defined for example by place or time are of interest, our simulated data demonstrate that net survival is the only measure to be used. Conclusions The choice of the method should be done in two steps: first, one should determine the measure of interest and second, one should choose among the methods that estimate that measure consistently.

Survival data analysis results are usually communicated through the overall survival probability. Alternative measures provide additional insights and may help in communicating the results to a wider audience. We describe these alternative measures in two data settings, the overall survival setting and the relative survival setting, the latter corresponding to the particular competing risk setting in which the cause of death is unavailable or unreliable. In the overall survival setting, we describe the overall survival probability, the conditional survival probability and the restricted mean survival time (restricted to a prespecified time window). In the relative survival setting, we describe the net survival probability, the conditional net survival probability, the restricted mean net survival time, the crude probability of death due to each cause and the number of life years lost due to each cause over a prespecified time window. These measures describe survival data either on a probability scale or on a timescale. The clinical or population health purpose of each measure is detailed, and their advantages and drawbacks are discussed. We then illustrate their use analyzing England population-based registry data of men 15-80 years old diagnosed with colon cancer in 2001-2003, aiming to describe the deprivation disparities in survival. We believe that both the provision of a detailed example of the interpretation of each measure and the software implementation will help in generalizing their use.

Background Colorectal cancer (CRC) is globally one of the most common cancers. Although studies have found a significant prognostic impact of cancer location for right-sided colon cancers compared with those of the left-side, evidence is lacking in a Japanese population. Therefore, we investigated 5-year net survival in colon cancer by tumor site in a Japanese population. Methods Diagnoses obtained between 2006 and 2008 in 21 population-based cancer registries from the Monitoring of Cancer Incidence in Japan (MCIJ) project were used. Colon cancer patients were categorized as having right-sided (C18.0–18.4) or left-sided colon cancer (C18.5-C18.7). We calculated the 5-year net survival for subjects diagnosed from 2006 until 2008 by anatomical subsite according to sex, age groups, tumor stage at diagnosis. We applied the excess mortality model to calculate excess hazard ratios (EHRs) and 95% confidential intervals (CIs) with and without adjustment for age, sex and cancer stages to evaluate the effect of location of colon cancer. Results This study analyzed a total of 62,350 colon cancer subjects. Five-year net survivals for subjects with left- and right-sided colon cancer were 74.0% (95% CI, 73.4–74.7%) and 70.4% (95% CI, 69.7–71.0%), respectively. Compared with left-sided colon cancers, the EHR for right-sided colon cancers was 1.20 (95% CI, 1.16–1.25) after adjustment for age, sex and stage. Conclusion Our study found that the net survival for right-sided colon cancer was significantly lower than that for left-sided colon cancer. The anatomical site of cancer in the colon might be an important stratification factor in future studies of colon cancer.

•Time trend analysis of papillary thyroid cancer showed a dramatic increase.•This increase has slowed down within in recent years, especially at younger ages.•There is a strong geographic disparity in incidence between areas in France.•10-years net survival is high and has improved between 1989 and 2004. Over the past few decades, the incidence of thyroid cancer has dramatically increased in many countries. This increase was mainly seen in papillary cancer. The role of diagnostic practices and the effects of other risk factors were suggested to explain this increase. We provide a descriptive analysis in terms of changes in incidence, geographical distribution, and survival to check the relevance of assumptions about the increase. A detailed analysis of changes in incidence recorded in French cancer registries between 1982 and 2010 was performed taking into account age, period, and birth cohort. The geographical distribution of the incidence in the 2006–2010 period was estimated from the standardized incidence ratios. The net survival was estimated to evaluate the effects of sex, age, and period of diagnosis in patients diagnosed between 1989 and 2004 and followed-up until 2013. The incidence of papillary cancer has increased sharply over the 1982–2010 period; the average annual rate of increase was 7.8% in men and 7.2% in women. The increase has slowed in the recent period in people aged less than 50 at the time of diagnosis. It has also slowed in the cohorts born 1945 and after. There was a strong geographic disparity in incidence between areas covered by cancer registries. Finally, the net survival was very high; the 10-year net survival was 96% and improved progressively from 82% in patients diagnosed between 1989 and 1993 to 95% in those diagnosed between 1999 and 2004. The increased incidence results most probably from the effect of medical practice, although other risk factors seem also involved, but to a lesser extent. The increase seems to have slowed down in the recent years, especially in the youngest age groups. This observation suggests a recent trend towards saturation of the effects of medical practices in post-1945 cohorts associated with an effect of the gradual dissemination of the recommendations relative to the management of thyroid nodules.

•Comorbidities negatively influence colorectal cancer (CRC)-specific survival.•Only few studies have used relative survival (RS) techniques to estimate this association.•The presence of comorbidities at the time of CRC diagnosis was significantly associated with lower survival.•Comorbidities should be registered at the time of CRC diagnosis and be used as predictors in survival models. It is established that comorbidities negatively influence colorectal cancer (CRC)-specific survival. Only few studies have used the relative survival (RS) setting to estimate this association, although RS has been proven particularly useful considering the inaccuracy in death certification. This study aimed to investigate the impact of non-cancer comorbidities at CRC diagnosis on net survival, using cancer registry data. We included 1076 CRC patients diagnosed between 2000 and 2001 in the canton of Zurich. The number and severity of comorbidities was expressed using the Charlson Comorbidity Index (CCI). Multiple imputation was performed to account for missing information and 10-year net survival was estimated by modeling the excess hazards of death due to CRC, using flexible parametric models. After imputation, approximately 35 % of the patients were affected by comorbidities. These appeared to decrease the 10-year net survival; the estimated excess hazard ratio for patients with one mild comorbidity was 2.14 (95 % CI 1.60−2.86), and for patients with one more severe or more than one comorbidity was 2.43 (95 % CI 1.77−3.34), compared to patients without comorbidities. Our analysis suggested that non-cancer comorbidities at CRC diagnosis significantly decrease the 10-year net survival. Future studies should estimate net survival of CRC including comorbidities as prognostic factor and use a RS framework to overcome the uncertainty in death certification.

Background This cross-sectional cohort study aimed to estimate the incidence of hepatocellular carcinoma (HCC) and evaluate population-based net survival (NS) and relative survival ratios (RSR) among HCC patients in Kuwait. Methods Data from confirmed HCC cases diagnosed between 2008 and 2020, along with population data, were used to calculate age-standardized incidence rates (ASIR) per 10⁵ person-years using the world standard population as the reference. The Pohar-Perme estimator and annual all-cause mortality life tables were used to compute 1-, 3-, and 5-year NS, while the life table approach was applied to estimate RSR. Results A total of 439 HCC patients were included. The overall ASIR (per 10⁵ person-years) was 7.66 (95% CI: 6.97–8.40), higher in males (9.14; 95% CI: 8.22–10.13) than females (3.71; 95% CI: 3.69–5.63). Cumulative NS estimates (%) decreased over time and were consistently lower among males (1-year: 47.1; 95% CI: 41.1–54.1; 3-year: 23.5; 95% CI: 17.2–32.0; 5-year: 10.8; 95% CI: 5.4–21.7) than females (1-year: 54.6; 95% CI: 43.8–69.6; 3-year: 40.9; 95% CI: 26.6–62.8; 5-year: 26.3; 95% CI: 10.4–66.7). Similarly, RSRs were lower among males than females at 1-year (0.45 vs. 0.67), 3-year (0.22 vs. 0.56), and 5-year (0.15 vs. 0.25). Conclusion Marked sex differences were observed in HCC incidence, NS, and RSR, with female patients demonstrating more favorable survival outcomes at 1-, 3-, and 5-year. Further studies are needed to clarify the biological, clinical, and health-system factors contributing to these disparities.

Background To clarify the long-term prognoses of elderly upper tract urothelial carcinoma (UTUC) patients after surgery. Methods We used a hospital-based cancer registry data in Japan to extract patients with pT1-3N0M0 UTUC diagnosed in 2009 who underwent surgery, and classified them by age group (≤ 64, 65–74, ≥ 75 years old). We estimated the 10-year overall survival (OS) by a Kaplan-Meier analysis. For cancer survival estimation, we calculated the 10-year net survival (NS) by Pohar-Preme method using the Japanese life tables. Results A total of 1139 UTUC patients (564 renal pelvic cancer [RPC] and 575 ureteral cancer [UrC]) were identified. The 10-year OS rates for elderly RPC patients (≥ 75 years old) were significantly worse than for younger patients (≤ 64 years old) in pT1 (43.1% vs. 80.1%) and pT2-3 (34.2% vs. 67.3%) stages. In contrast, the 10-year NS rates were comparable between elderly and younger RPC groups in pT1 (93.3% vs. 87.0%) and T2-3 (77.4% vs. 73.7%) stages. While the 10-year NS and OS rates of patients with pT1 UrC had similar trends as RPC patients, the NS and OS rates of elderly patients with pT2-3 UrC were significantly worse than younger patients. Conclusions Among resectable UTUC, except for pT2-3 UrC patients, estimated cancer survival rates for elderly patients were similar to younger patients. These findings may be useful in shared decision making by informing discussions about treatment strategies with elderly patients and their families.