Abstract
The difference in incidence of oral cavity cancer (OCC) between Taiwan and the Netherlands is striking. Different risk factors and treatment expertise may result in survival differences between the two countries. However due to regulatory restrictions, patient-level analyses of combined data from the Netherlands and Taiwan are infeasible. We implemented a software infrastructure for federated analyses on data from multiple organisations. We included 41,633 patients with single-tumour OCC between 2004 and 2016, undergoing surgery, from the Taiwan Cancer Registry and Netherlands Cancer Registry. Federated Cox Proportional Hazard was used to analyse associations between patient and tumour characteristics, country, treatment and hospital volume with survival. Five factors showed differential effects on survival of OCC patients in the Netherlands and Taiwan: age at diagnosis, stage, grade, treatment and hospital volume. The risk of death for OCC patients younger than 60 years, with advanced stage, higher grade or receiving adjuvant therapy after surgery was lower in the Netherlands than in Taiwan; but patients older than 70 years, with early stage, lower grade and receiving surgery alone in the Netherlands were at higher risk of death than those in Taiwan. The mortality risk of OCC in Taiwanese patients treated in hospitals with higher hospital volume (≥ 50 surgeries per year) was lower than in Dutch patients. We conducted analyses without exchanging patient-level information, overcoming barriers for sharing privacy sensitive information. The outcomes of patients treated in the Netherlands and Taiwan were slightly different after controlling for other prognostic factors.
Highlights
The difference in incidence of oral cavity cancer (OCC) between Taiwan and the Netherlands is striking
Our findings showed that increasing age, male gender, higher stage, poorer differentiation grade, surgery with adjuvant radiation and/or chemotherapy, and location were all significant prognostic factors for shorter survival in both the Netherlands and Taiwan
After adjusting for other prognostic factors, including age, gender, period of diagnosis, stage, location, grade, treatment, and hospital volume, patients with OCC in Taiwan had slightly better outcomes than those in the Netherlands (HR, 1.06; 95% CI 1.01–1.12)
Summary
The difference in incidence of oral cavity cancer (OCC) between Taiwan and the Netherlands is striking. Due to regulatory restrictions, patient-level analyses of combined data from the Netherlands and Taiwan are infeasible. Five factors showed differential effects on survival of OCC patients in the Netherlands and Taiwan: age at diagnosis, stage, grade, treatment and hospital volume. The GDPR poses restrictions on data sharing with parties outside the European economic area, including Taiwan In collaborations such as Eurocare, Globocan and RARECARE, cancer registries are sharing patient-level data to facilitate large scale international epidemiological r esearch[7,8,9]. The infrastructure allows to deploy existing algorithms as described in literature and combine them into a series of analyses It does not assume a prescribed data format, which makes it suitable for cancer registries
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