Time Trends In Survival Research Articles

Age and Grade Trends in Prostate Cancer (1974–2003)

Age and pathologic grade are 2 critical factors used to guide clinical decisions and comparative outcomes studies in prostate cancer. The objective of this investigation was to use the Surveillance, Epidemiology, and End Results (SEER) registry to examine time trends in age and grade. The SEER public-use registry was queried by year of diagnosis from 1974 to 2003 for age at diagnosis (40-49, 50-59, 60-69, 70-79, and 80+ years) and for pathologic grade [well differentiated (WD), moderately differentiated (MD), and poorly differentiated (PD) disease]. Results were tabulated by 5-year interval; a total of 455,170 patients were included in the analysis. Time-trends analyses were performed for age, for grade, and for age and grade simultaneously, in each case applying a multivariate chi test. Five-year cause specific survival (CSS) rates were also tabulated by age and grade. Overall, there was a nonsignificant (P = 0.68) change in distribution of age at diagnosis. However, a significant (P < 0.001) grade migration took place over the study period, principally from WD to MD disease, and occurred across all age groups. Five-year cause specific survival time trends were similar for all age groups, but WD appeared to converge with MD disease in later years. An overall grade migration has occurred in prostate cancer, primarily observed as a shift from WD to MD disease; this may weaken grade-based prognostic categorizations. This migration occurred independent of patient age, reinforcing that the grade migration is likely due to changes in pathologic interpretation rather than to screening-related changes in disease characteristics.

Childhood cancer in Britain: incidence, survival and mortality

Charles Stiller and colleagues at the Childhood Cancer Research Group (CCRG) in Oxford have published the first comprehensive overview of records held in the National Registry of Childhood Tumours (NRCT) since its inception. This is the longest established national population-based childhood cancer registry in the world. As of 2006, it includes nearly 80 000 cases, based on data collected prospectively since 1962 to the present day. Contributions by Gerald Draper, who headed the CCRG from its inception through to 2002, describe the evolution of the Registry with its increasing completeness of case ascertainment and data quality. One of the strengths of the NRCT is the ability within the British National Health Service to ‘flag' survivors so that the NRCT receives notification of their death or development of any subsequent cancer. This means that follow-up for mortality is virtually complete within Great Britain. The NRCT has become an exemplar for establishing childhood cancer registries around the world. It is recognised to have extremely complete data, partly due to notification of cases from multiple sources, aided by the close relationship between the CCRG and the main childhood cancer clinical trials organisation in the UK (UK Children's Cancer Study Group, now known as the Children's Cancer and Leukaemia Group). Owing to the long established high quality of case ascertainment, the NRCT is able to produce robust data on incidence of the main subtypes of childhood cancers and their changes in incidence over a 35-year period. These data confirm those seen across Europe and in some other Western populations that the overall incidence of childhood cancer is increasing by almost 1% per year over the last 30 years. The NRCT provides a valuable resource for further epidemiological research into why this should be. The ability to link records to information held on birth certification, such as parental occupation and extremely accurate location of birth due to the British postal code system, which can be linked to socio-economic status and environmental exposures, provides rich avenues for future research to investigate this phenomenon. There is a detailed analysis of survival by cancer type and subtype for those treated in the most recent era for which 5-year survival are mature (i.e. 1991–2000). These are very valuable data for researchers interested in outcome according to biological basis of disease, due to the very detailed information collected by the CCRG, which is often not available to other cancer registries. These items include extra data on laterality for retinoblastoma and renal tumours and immunophenotyping for leukaemias and lymphomas. For cases diagnosed between 1991 and 2000, such data were complete for >95% and approximately 80% of cases, respectively. Time trends in survival across successive quinquennia from 1966–1970 to 1996–2000 are also presented, showing encouraging and significant improvements for all diagnostic groups. The stubborn subgroups for which survival remains at less than 50% in the most recent period are highlighted. The section on long-term survival for those who have achieved 5-year survival from original diagnosis, according to the quinquennium of their original diagnosis, will be of interest both to patients and to clinicians alike. It is reassuring to see that for the vast majority of childhood cancers, 5-year survival equates to an extremely good chance of much longer term survival, usually far in excess of 90%. Finally, this book presents complete national data on mortality and trends in mortality by tumour type. These are essential to monitor the effectiveness of new therapeutic or preventative strategies. They also emphasise the important relative ranking of childhood cancer as a cause of death in children living in a modern Western society: over 20% of all deaths occurring in 1- to 14-year-olds are due to cancer and this relative proportion is increasing. This means that general child mortality is decreasing faster than childhood cancer mortality, emphasising that there remains much progress to be made. The CCRG have lain before us their international wares and invite interested researchers to collaborate with them and maximise the opportunities for research and increasing the knowledge of childhood cancer aetiology and efficacy of treatment offered by their data collection. This book is an essential reading and a valuable reference source for all those responsible for organising, delivering and evaluating cancer care for children around the world.

Cancer Survival Trends in Osaka, Japan: the Influence of Age and Stage at Diagnosis

Five-year survival is an important index for evaluating the overall effectiveness of cancer diagnosis and treatment. The aim of this study was to monitor trends in 5-year cancer survival in Osaka, Japan, during 1975-94, with adjustment for trends in age and stage at diagnosis. Five-year crude survival was estimated for cancers of the stomach (39,697 patients), lung (17,400 patients) and breast (11,988 women) in four consecutive 5-year periods, with adjustment for age and/or stage, using the age and stage distribution of cases diagnosed during 1975-79 as standard weights. We estimated the impact of adjusting for either age or stage alone by their proportionate impact on the trend in fully (age- and stage-) adjusted survival. The absolute increase in unadjusted 5-year survival over 20 years was about 20% for stomach cancer, 14% for breast cancer and 5% for lung cancer. Lack of age adjustment would have caused proportionate under-estimation of these trends by 13-14% (stomach), 7% (breast), 14% (lung, men) and 4% (lung, women). Lack of adjustment for the trend toward earlier stage would have caused proportionate over-estimation (152%, men: 133%, women) of stomach cancer survival trends, which seemed more influenced by earlier diagnosis than more effective treatment. For breast cancer, the 31% over-estimation of trend from lack of stage adjustment suggests the impact of earlier diagnosis, while the improvement of survival after additional adjustment for age may be due to more effective treatment. Failure to adjust for stage led to a proportionate 21% under-estimation of lung cancer survival trends for men, and 4% over-estimation for women. This study confirms the importance of adjusting for trends in age and stage distribution when evaluating time trends in cancer survival.

Oesophageal cancer in The Netherlands: Increasing incidence and mortality but improving survival

Aim Oesophageal cancer is highly lethal with a 5-year relative survival of 10–15%. An increasing incidence has been reported for several parts of the Western world. We studied time trends in incidence, mortality and survival for oesophageal cancer in the Netherlands during 1989–2003. Methods Data on incidence and survival were obtained from the Netherlands Cancer Registry and mortality data from Statistics Netherlands. Results The age standardised incidence increased by 3.4% ( p < 0.001) and 1.9% ( p = 0.003) per year for males and females, respectively. This increase was almost exclusively caused by oesophageal adenocarcinomas. Age standardised mortality increased 2.5% ( p < 0.001) per year among males and 1.7% ( p = 0.002) per year among females. Relative survival improved significantly from 8.1% in 1989–1993 to 12.6% in 1999–2003 ( p < 0.001). Adjusted for age, stage, tumour location and surgery, the excess risk of death decreased by 22%. Conclusion Oesophageal carcinoma incidence is rising in the Netherlands. Mortality increased at a slightly lower pace due to improving survival.

Time trends of breast cancer survival in Europe in relation to incidence and mortality

Increasing breast cancer survival, observed in most western countries, is not easily interpreted: it could be due to better treatment, more effective treatment due to earlier diagnosis or simply lead-time bias. Increased diagnostic activity (e.g., screening) can inflate both incidence and survival. To understand interrelations between incidence, mortality and survival trends and their consequences, we analyzed survival trends in relation to mortality and incidence. Starting with observed survival from EUROCARE, mortality from WHO and using the MIAMOD method, we estimated breast cancer incidence trends from 1970 to 2005 in 10 European countries. To smooth out peaks in incidence and survival due to early diagnosis activity, survival trends were assumed similar to those observed by EUROCARE in 1983-1994. The following patterns emerged: (1) increasing survival with increasing incidence and declining or stable mortality (Sweden, Finland); (2) slight survival increase, marked incidence increase and slight mortality decrease (Denmark, the Netherlands and France); (3) increasing survival, marked decrease in mortality and tendency to incidence stabilization (UK); (4) marked survival increase, steady or decreasing mortality and moderate increases in incidence (Spain, Italy); (5) stable survival, increasing incidence and mortality (Estonia). In most countries survival increased, indicating a real advantage for patients when accompanied by decreasing or stable mortality, and attributable to improved cancer care (Sweden, UK, France, Italy and Spain). In Finland (with high survival), the Netherlands and Denmark, increasing mortality and incidence indicate increasing breast cancer risk, probably related to life-style factors. In Estonia, low and stable survival in the context of increasing incidence and mortality suggests inadequate care.

Variation in relative survival of thyroid cancers in Europe: Results from the analysis on 21 countries over the period 1983–1994 (EUROCARE-3 study)

We described the relative survival of thyroid cancer cases diagnosed in Europe during the period 1990–1994 and analysed time trends in relative survival during the period 1983–1994 using the EUROCARE-3 database. Relative survival of thyroid cancers is one of the highest amongst cancer sites, with age-standardised relative survival rates of 74% in men and 82% in women over the period 1990–1994, with marked differences between countries. The higher relative survival rates are observed in Scandinavian countries and the lower rates are observed in the UK and the countries of Eastern Europe. Relative survival is higher in women than in men, and decreases with age whatever the histological group. There are significant differences in relative survival according to histological type. Relative survival has slightly increased over the period 1983–1994 only when all histological types have been considered together. Time trend was, however, non-existent when the different histological groups were taken into account except during the most recent period of observation. One possible explanation for the differences in relative survival between countries and sex may probably be found in the changes in thyroid classification and diagnosis techniques. When these changes are not homogeneous, the distribution of thyroid cancers by histology and by stage at diagnosis may be very different. The only way to understand these differences is to conduct specific studies including a description of stage at diagnosis, diagnosis procedures used for staging and details of treatment.

Leukaemia incidence and survival in children and adolescents in Europe during 1978–1997. Report from the Automated Childhood Cancer Information System project

Leukaemias constitute approximately one-third of cancers in children (age 0–14 years) and 10% in adolescents (age 15–19 years). Geographical patterns (1988–1997) and time trends (1978–1997) of incidence and survival from leukaemias in children ( n = 29,239) and adolescents ( n = 1929) were derived from the ACCIS database, including data from 62 cancer registries in 19 countries across Europe. The overall incidence rate of leukaemia in children was 44 per million person-years during 1988–1997. Lymphoid leukaemia (LL) accounted for 81%, acute non-lymphocytic leukaemia (ANLL) for 15%, chronic myeloid leukaemia (CML) for 1.5% and unspecified leukaemia for 1.3% of cases. Adjusted for sex and age, incidence of childhood LL was significantly lower in the East and higher in the North than in the British Isles. The overall incidence among adolescents was 22.6 per million person-years. The incidence of LL was rising in children (0.6% per year) and adolescents (1.9% per year). During 1988–1997 5-year survival of children with leukaemias was 73% (95% CI 72–74) and approximately 44% for infants and adolescents. Similar differences in survival between children and adolescents were observed for LL, much less so for ANLL. Survival differed between regions; prognosis was better in the North and West than the East. Remarkable improvements in survival occurred in most of the subgroups of patients defined by diagnostic subgroup, age, sex and geographic categories during the period 1978–1997. For children with ANLL most improvements in survival were observed in the 1990s.

Non-Hodgkin’s lymphoma incidence and survival in European children and adolescents (1978–1997): Report from the Automated Childhood Cancer Information System project

Non-Hodgkin’s lymphomas (NHLs) constitute a large and heterogeneous group of malignant tumours. This paper describes and interprets geographical patterns (1988–1997) and time trends (1978–1997) of NHL incidence and survival in European children and adolescents. All 7702 lymphomas that were not Hodgkin’s, were extracted from the Automated Childhood Cancer Information System (ACCIS) database and included in different analyses. In children under 15 years of age and for the period 1988–1997, the overall NHL age-adjusted incidence rate was 9.4 per million and has been increasing over 20 years by 0.9% per year on average ( P = 0.002). In adolescents aged 15–19 years, the age-specific incidence rate was 15.9 per million, increasing annually by 1.7% ( P = 0.007). Five-year survival of children diagnosed in 1988–1997 was 77%, ranging from 58% in the East to 83% in the West. A substantial increase in survival was observed in all European regions. Systematic monitoring and evaluation of childhood and adolescent data on NHL will contribute to further improvement in public health policy for the young population of Europe.

Hodgkin’s disease incidence and survival in European children and adolescents (1978–1997): Report from the Automated Cancer Information System project

This paper reports the geographical patterns and time trends of incidence and survival of Hodgkin’s disease (HD) in children and adolescents in Europe over the period 1978–1997. Data on 4230 HD cases were gathered from 62 paediatric or general cancer registries in 19 European countries by the Automated Cancer Information System (ACCIS). European annual incidence rates in 1988–1997 were estimated at 5.8 per million in children (world age-standardised) and at 29.7 per million in adolescents, with higher rates in the East and South. Incidence rates increased steeply with age, while the male predominance, marked for the youngest children, vanished in the highest age groups. Over the period 1978–1997 incidence rates increased in age groups 10–14 years (+1% per year) and 15–19 years (+3.5% per year), mainly due to the nodular sclerosis subtype. Age and sex distribution of cases remained unchanged with time. The overall 5-year survival rate was higher in children (93%, 95% confidence interval (CI) 92–94) than in adolescents (89% (95% CI 87–91)) for the period 1988–1997. Five-year survival increased significantly in all regions from 87% to 93% in children and from 80% to 88% in adolescents between 1978–1982 and 1993–1997. In future, detailed documentation of cases in the cancer registries with respect to standardised diagnostic subtypes, stage of extension, and treatments, will help to refine interpretation of international and temporal variations in incidence and survival.

Time Trends in Fetal and Infant Survival in Babies of Preeclamptic Pregnancies. Norway, 1967–2003

Time Trends in Fetal and Infant Survival in Babies of Preeclamptic Pregnancies. Norway, 1967–2003

Updating long-term childhood cancer survival trend with period and mixed analysis: Good news from population-based estimates in Italy

An empirical evaluation of long-term period survival analysis was performed using data from the Childhood Cancer Registry of Piedmont, Italy. The aim was to update survival time trends and provide 25-year projections for children currently diagnosed with cancer. The observed survival experiences up to 15 years after diagnosis of five quinquennial cohorts (cohort analysis) were compared to the corresponding estimates obtained by period analysis. The two methods generally produced very similar findings, although period analysis estimates were slightly lower than those obtained from cohort analysis. We then used mixed analysis to assess time trends in long-term survival. This showed that the probability of surviving 25 years after a cancer in childhood has more than doubled compared to cohort analysis estimates from patients diagnosed more than 25 years ago (73% vs. 32%), providing further evidence of an ongoing improvement in prognosis.

Small intestinal cancer in England &amp; Wales and Scotland: time trends in incidence, mortality and survival

Time trends in mortality from small intestinal cancer have not been studied for the 1990s. To examine secular trends in incidence of, mortality from, and survival from, small intestinal cancer in England & Wales and Scotland from 1975 to 2002, considering also histological type (incidence), subsite (incidence) and indices of social deprivation (incidence and survival). Data were extracted from the Scottish Cancer Registry database and the General Register Office for Scotland, and from the National Cancer Intelligence Centre at the Office for National Statistics for England & Wales. Incidence rates for small intestinal cancer increased for both England & Wales and Scotland over the study period. They were highest among older individuals and generally greater for males than for females. Despite the increase in incidence rates, mortality rates from small intestinal tumours tended to remain stable over the study period, and the general trend was towards increasing survival. Indices of social deprivation were not obviously related to the incidence of small intestinal cancer and did not influence survival. Incidence rates for small intestinal cancer for both England & Wales and Scotland increased in the last quarter of the 20th century, but survival rates improved and mortality rates declined.

Time trends of incidence, mortality, and relative survival of invasive skin melanoma in Lithuania

The aim of this study was to provide insights into the descriptive epidemiology of invasive skin melanoma in Lithuania by analyzing population-based incidence (1978-2002) and mortality (1990-2002) time trends, and relative survival based on 3485 skin melanoma. We calculated age-standardized incidence and mortality rates (cases per 100,000) using the European Standard Population and calculated period estimates of relative survival. The incidence rates increased from 1978 (men: 1.7, women: 2.3) to 2002 (men: 5.0, women: 7.0). The incidence increase over time is accompanied by cohort effects among both men and women. Mortality rates increased from 1990 (men: 1.2, women: 1.7) to 2002 (men: 2.3, women: 2.2). Relative 5-year survival rates among men were 10% lower than among women. The overall difference in survival was mainly due to a more favourable survival among women aged 60-74 years. Overall prognosis was less favourable among men, most likely due to diagnoses at later stages.

Geographical Patterns and Time Trends of Cancer Incidence and Survival Among Children and Adolescents in Europe Since the 1970s (the ACCIS Project): An Epidemiological Study

Geographical Patterns and Time Trends of Cancer Incidence and Survival Among Children and Adolescents in Europe Since the 1970s (the ACCIS Project): An Epidemiological Study

Trends in survival from primary central nervous system lymphoma, 1975–1999

The age-adjusted incidence of primary central nervous system lymphoma (PCNSL) has increased since the 1970s, and treatment for this disease has evolved considerably. The objective of this study was to examine time trends in overall survival and disease-specific mortality in a population-based cohort of patients with PCNSL. We identified patients diagnosed with PCNSL from 1975-1999 in the Surveillance, Epidemiology, and End Results (SEER) cancer registries. To assess time trends, year of diagnosis was classified in 5-year intervals: 1975-1980, 1981-1985, 1986-1990, 1991-1995, and 1996-1999. Overall survival distributions were estimated via Kaplan-Meier methodology and a competing risk analysis was used to assess PCNSL-specific mortality. We used information on underlying cause of death to distinguish likely immunocompetent patients from those whose PCNSL was related to human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). We also examined survival stratified by age at diagnosis. From 1975-1999, 2462 patients were diagnosed with PCNSL in SEER. Median survival was 4 months (95% CI 4, 5) for the entire cohort and 9 months (95% CI 8, 11) for the immunocompetent cohort (n = 1565). In the immunocompetent cohort, 965 of 1323 (73%) deaths were attributed to PCNSL. No significant time trend was observed in either overall or PCNSL-specific survival. Overall survival for patients with PCNSL has not improved consistently in the past three decades despite important therapeutic advances during this time. Although results from clinical trials suggest progress in the treatment of PCNSL, survival improvements are not reflected in this population-based cohort.

Improved survival in cancer of the colon and rectum in Sweden

Aims To analyse time-trends in survival of patients with colon and rectal cancer in Sweden. Patients and methods Data including all patients diagnosed with adenocarcinoma of the colon and rectum between 1960 and 1999, from the Swedish Cancer Registry, were analysed. The observed and relative survival rates were calculated according to the Hakulinen cohort method. Results Five-year relative survival rate for cancer of the colon improved significantly from 39.6% in 1960–1964 to 57.2% in 1995–1999 and for rectal cancer from 36.1 to 57.6%, respectively. Corresponding observed survival improved from 31.2 to 44.3% for colon cancer and from 28.4 to 45.4% for rectal cancer. The largest improvement of survival were seen during the later part of the period observed. Conclusion The survival of patients with colon and rectal cancer in Sweden continues to improve, especially in rectal cancer, which now has a 5-year observed and relative survival rate comparable to that for colon cancer. The survival improvement in rectal cancer is probably a result of the implementation of total mesorectal excision and pre-operative radiotherapy.

Childhood Cancer Survival Trends in Europe: A EUROCARE Working Group Study

EUROCARE collected data from population-based cancer registries in 20 European countries. We used this data to compare childhood cancer survival time trends in Europe. Survival in 44,129 children diagnosed under the age of 15 years during 1983 to 1994 was analyzed. Sex- and age-adjusted 5-year survival trends for 10 common cancers and for all cancers combined were estimated for five regions (West Germany, the United Kingdom, Eastern Europe, Nordic countries, and West and South Europe) and Europe as a whole. Europe-wide trends for 14 rare cancers were estimated. For all cancers combined, 5-year survival increased from 65% for diagnoses in 1983 to 1985 to 75% in 1992 to 1994. Survival improved for all individual cancers except melanoma, osteosarcoma, and thyroid carcinoma; although for retinoblastoma, chondrosarcoma, and fibrosarcoma, improvements were not significant. The most marked improvements (50% to 66%) occurred in Eastern Europe. For common cancers, the greatest improvements were for leukemia and lymphomas, with risk of dying reducing significantly by 5% to 6% per year. Survival for CNS tumors improved significantly from 57% to 65%, with risk reducing by 3% per year. Risk reduced by 4% per year for neuroblastoma and 3% per year for Wilms' tumor and rhabdomyosarcoma. The survival gap between regions reduced over the period, particularly for acute nonlymphocytic leukemia, CNS tumors, and rhabdomyosarcoma. For rare Burkitt's lymphoma, hepatoblastoma, gonadal germ cell tumors, and nasopharyngeal carcinoma, risk reductions were at least 10% per year. These gratifying improvements in survival can often be plausibly related to advances in treatment. The prevalence of European adults with a history of childhood cancer will inevitably increase.

Increasing incidence and improved survival of cancer in children and young adults in Southern Netherlands, 1973–1999

The aim of this study was to describe time trends in incidence, treatment and survival of children (0–14 years) and young adults (15–24 years) with cancer in an area in the Netherlands with a long registration period. Between 1973 and 1999, the population-based Eindhoven Cancer Registry (ECR) recorded 852 children and 1162 young adults with a malignancy and they were actively followed up until 1 July, 2003. The world standardised incidence rates for both children and young adults showed an increasing trend until 1997 and this flattened off afterwards (estimated annual percentage change [EAPC] = 3.1%, P = 0.66 for children and EAPC = 3.6%, P = 0.06 for young adults). Lymphomas in children and testicular malignancies and melanomas in young adults seemed to increase in particular. Better detection probably led to higher completeness for gliomas. Initial treatment for leukaemias and lymphomas in children has changed, protocols prescribe more chemotherapy and less radiotherapy. For all cancers combined, the 10-year survival rate for children significantly improved from 53% (95% confidence interval [95% CI] 45–61%) in 1973–1982 to 75% (95% CI 69–81%) in 1993–1999 ( P-value < 0.05). The 10-year survival rate for young adults significantly improved from 57% (95% CI 49–65%) to 81% (95% CI 77–85%) ( P-value < 0.05). We demonstrated significantly higher five-year survival rates for children with Hodgkin’s disease (HD) and young adults with HD, non-seminoma or melanoma diagnosed in 1993–1999.

Geographical patterns and time trends of cancer incidence and survival among children and adolescents in Europe since the 1970s (the ACCIS project): an epidemiological study

Cancer is rare before age 20 years. We aimed to use the European database of childhood and adolescent cancer cases, within the Automated Childhood Cancer Information System project, to estimate patterns and trends of incidence and survival within Europe. Comparable, high-quality data from 63 European population-based cancer registries consisted of 113000 tumours in children and 18243 in adolescents diagnosed in 1970-99. Incidence rates and survival were compared by region (east vs west), period, and malignant disease. In the 1990s, age-standardised incidence rates were 140 per million for children (0-14 years) and 157 per million for ages 0-19 years. Over the three decades, overall incidence increased by 1.0% per year (p<0.0001) in children (increases for most tumour types), and by 1.5% (p<0.0001) in adolescents (15-19 years; notable increases were recorded for carcinomas, lymphomas, and germ-cell tumours). Overall 5-year survival for children in the 1990s was 64% in the east and 75% in the west, with differences between regions for virtually all tumour groups; 5-year survival was much the same in adolescents. Survival has improved dramatically since the 1970s in children and adolescents, more so in the west than in the east. Our results are clear evidence of an increase of cancer incidence in childhood and adolescence during the past decades, and of an acceleration of this trend. Geographical and temporal patterns suggest areas for further study into causes of these neoplasms, as well as providing an indicator of progress of public-health policy in Europe.

1045 Rare tumour survival in adult European patients

1045 Citation: European Journal of Cancer Supplements; Vol. 1, No. 5, September 2003, page S312 Rare tumour survival in adult European patients G. Gatta, L. Ciccolallo, P. Casali Istituto Nazionale per lo Studio e la Cura dei Tum, Epidemiology Unit, Milan, Italy Background: Most rare tumours present major clinical problems. Their rarity renders in depth study of natural history and identification of optimum treatment guidelines problematic, and early and accurate diagnosis sometimes difficult. Publications on these tumours typically derive from centres of excellence, which do not reflect the situation at the population level. The EUROCARE database presents a unique opportunity to investigate rare cancers in Europe at the population level. The aim of this communication is to describe survival of adult European patients with some rare tumours according to major demographic and clinical variables. Survival time trends and, depending of the number of cases, survival variations in different regions and countries will also be presented. Material and methods: The European survival figures for the period of diagnosis 1983-94 were derived from the EUROCARE database. The data were contributed by about 65 registries in 21 countries. The rare tumour chosen was on the basis the criteria reported above: very low incidence, treatment problems, follow-up difficulties, geographic variation, lack of literature. The rare cancer sites selected were: angiosarcoma of liver, mesothelioma, adenocarcinoma of cervix, sarcoma of uterus, anal squamous carcinoma, testis cancer in old men, soft tissue sarcoma of limb. Results: Five-year relative survival for these rare cancers diagnosed between 1983-94 will be analysed and will be described by sex, age, period of diagnosis and large regions. When available stage and therapy will be introduced in the analysis. Conclusions: The EUROCARE project provides a unique opportunity to study uncommon cancer survival at the population level. Topography with morphological codes will be considered in order to identify rare diagnostic categories of interest. For most rare cancers in the EUROCARE database, the proportion of microscopically confirmed cases is high, indicating good quality data and also the existence of detailed information on morphology.