Abstract
Global survival studies have shown favorable development in renal cell carcinoma (RCC) treatment but few studies have considered extended periods or covered populations for which medical care is essentially free of charge. We analyzed RCC survival in Finland and Sweden over a 50-year period (1967-2016) using data from the NORDCAN database provided by the local cancer registries. While the health care systems are largely similar in the two countries, the economic resources have been stronger in Sweden. In addition to the standard 1- and 5-year relative survival rates, we calculated the difference between these as a measure of how well survival was maintained between years 1 and 5. Relative 1- year survival rates increased almost linearly in both countries and reached 90% in Sweden and 80% in Finland. Although 5-year survival also developed favorably the difference between 1- and 5-year survival rates did not improve in Sweden suggesting that the gains in 5-year survival were entirely due to gains in 1-year survival. In Finland there was a gain in survival between years 1 and 5, but the gain in 1-years survival was the main contributor to the favorable 5-year survival. Age group specific analysis showed large survival differences, particularly among women. Towards the end of the follow-up period the differences narrowed but the disadvantage of the old patients remained in 5-year survival. The limitations of the study were lack of information on performed treatment and clinical stage in the NORDCAN database. In conclusion, the available data suggest that earlier diagnosis and surgical treatment of RCC have been the main driver of the favorable change in survival during the past 50 years. The main challenges are to reduce the age-specific survival gaps, particularly among women, and push survival gains past year 1.
Highlights
Survival in many cancers, including renal cell carcinoma (RCC), has improved over the past years in the developed countries [1]
RCC is characterized by male excess, ranging from 2- to 4-fold, and known risk factors of smoking, overweight and obesity, and germline mutations in specific genes [4]
The almost linear 1-year survival graphs for Finnish and Swedish patients over the 50 years period suggest that no single event in the care of RCC influenced the improvement of the survival
Summary
Survival in many cancers, including renal cell carcinoma (RCC), has improved over the past years in the developed countries [1]. The key role of clinical randomized trials in selecting the optimal treatment is universally emphasized in enabling these success stories, but for many cancer patients the ‘real world’ cure circumstances may be far from the selected patient populations and controlled treatment protocols of the clinical trials. Many survival studies cover relatively short periods which do not allow assessment of the survival experience over decenniums, which would be important to understand the factors influencing the ‘real world’ survival trends [1,2,3]. Detection and improvements in treatment have contributed to positive trends in RCC survival [6]. Standard treatment for RCC has been surgery with a trend during the recent years towards minimally invasive techniques. After 2006, antiangiogenic drugs have largely replaced cytokine treatments in metastatic RCC (mRCC), their impact in survival has been debatable [6, 7]
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