Trends in survival after childhood cancer in Europe, 1978–1997: Report from the Automated Childhood Cancer Information System project (ACCIS)


      This study, originating in the Automated Childhood Cancer Information System (ACCIS), evaluated the time trend in survival after childhood cancer in Europe. The study included more than 72,000 childhood cancer cases aged 0–14 years diagnosed in 1978–1997 and followed-up in 30 population-based cancer registries with a long history of registration and follow-up, in 15 European countries. Survival was analysed using an actuarial life-table method. Five-year cumulative survival probability increased significantly over the study period for all tumour types combined, from 54% for cases diagnosed in the period 1978–1982 to 75% in 1993–1997. Significant improvement was also observed in 10-year survival. Comparing the results for the period 1993–1997 with those for 1978–1982, the largest relative increase in survival was seen for hepatic tumours (32%) and the largest reduction in mortality for non-Hodgkin’s lymphomas (60%). Least progress was seen for central nervous system (CNS) tumours. The improvement was statistically significant in all European regions and was most rapid in the East. The ranking among the European regions did not change over the study period, with highest survival in the North and the West and lowest in the East. Extended data collection is necessary to evaluate future time trends and changes in differences between European regions.


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        • Stiller C.A.
        Population based survival rates for childhood cancer in Britain 1980–91.
        Br Med J. 1994; 309: 1612-1616
        • Kramarova E.
        • Plesko I.
        • Black R.
        • Obsitnikova A.
        Improving survival for childhood cancer in Slovakia.
        Int J Cancer. 1996; 65: 594-600
        • Pannelli F.
        • Mosciatti P.
        • Felici L.
        • Magnani C.
        • Pascucci C.
        • Pastore G.
        Andamento nel tempo della sopravvivenza per tumori infantili in Italia nel periodo 1978–94, primo rapporto dai registri Tumori Italiani.
        Epidemiol Prev. 2001; 25: 354-375
        • Viscomi S.
        • Pastore G.
        • Mosso M.L.
        • et al.
        Population-based survival after childhood cancer diagnosed during 1970–98, a report from the Childhood Cancer Registry of Piedmont (Italy).
        Hematologica. 2003; 88: 974-983
      1. Ries L.A. Eisner M.P. Kosary C.L. Childhood cancer by the ICCC. SEER cancer statistics review, 1975–2001. National Cancer Institute, Bethesda, MD2004
        • Ajiki W.
        • Tsukuma H.
        • Oshima A.
        Survival rates of childhood cancer patients in Osaka, Japan.
        Jpn J Clin Oncol. 2004; 34: 50-54
        • Reedijk A.M.J.
        • Janssen-Heijnen M.L.G.
        • et al.
        Increasing incidence and improved survival of cancer in children and young adults in Southern Netherlands, 1973–99.
        Eur J Cancer. 2005; 41: 760-769
      2. Capocaccia R, Gatta G, Magnani C, Stiller C, Coebergh J-W, editors. Childhood cancer survival in Europe 1978–92, the Eurocare Study. Eur J Cancer 2001;37 (Special Issue).

        • Gatta G.
        • Capocaccia R.
        • Stiller C.
        • Kaatsch P.
        • Berrino F.
        • Terenziani M.
        • and the EUROCARE Working Group
        Childhood cancer survival trends in Europe.
        I Clin Oncol. 2005; 23: 3742-3751
        • Levi F.
        • La Vecchia C.
        • Negri E.
        • Lucchini F.
        Childhood cancer mortality in Europe, 1955–95.
        Eur J Cancer. 2001; 37: 785-809
        • Reddy A.T.
        Advances in biology and treatment of childhood brain tumours. Review.
        Curr Neurol Neurosci Rep. 2001; 1: 137-143
        • Chan K.W.
        Acute lymphoblastic leukaemia. Review.
        Curr Probl Pediatr Adolesc Health Care. 2002; 32: 40-49
        • Thornton Jr., A.F.
        • Sandler H.M.
        • Ten Haken R.K.
        • et al.
        The clinical utility of magnetic resonance imaging in 3-dimensional treatment planning of brain neoplasm.
        Int J Radiat Oncol Biol Phys. 1992; 24: 767-775
        • Stiller C.A.
        Centralization of treatment and survival rates for cancer.
        Arch Dis Child. 1988; 63: 23-30
        • Steliarova-Foucher E.
        • Stiller C.
        • Kaatsch P.
        • et al.
        Geographical patterns and time trends of cancer incidence and survival among children and adolescents in Europe since 1970s, the ACCIS project.
        Lancet. 2004; 364: 2087-2105
      3. Kramárová E, Stiller CA, Ferlay J, et al. International classification of childhood cancer 1996. IARC technical report No.29. Lyon: International Agency for Research of Cancer; 1996.

      4. Ferlay J. IARCtools. 1997. Available from:

      5. Percy C. Van Holten V. Muir C.S. International classification of diseases for oncology. 2nd ed. World Health Organisation, Geneva1992
        • Gehan E.A.
        Estimating survival functions from the life table.
        J Chronic Diseases. 1969; 21: 629-644
        • Kalbfleisch J.D.
        • Prentice R.L.
        The statistical analysis of failure time data.
        John Wiley & Sons, New York1980
        • Peto R.
        • Pike M.C.
        • Armitage P.
        • et al.
        Design and analysis of randomized clinical trials requiring prolonged observation of each patient, II, analysis and examples.
        Br J Cancer. 1977; 35: 1-39
      6. Parkin DM, Kramarova E, Draper GJ, et al., editors. International incidence of childhood cancer, vol II. International Agency for Research on Cancer, Scientific Publication No. 144. Lyon: IARC; 1998.

      7. Sant, M, Gatta G. The EUROCARE database. In: Berrino F, Sant M, Verdecchia A, et al., editors. Survival of cancer patients in Europe. The EUROCARE study. IARC Scientific Publications No. 132. Lyon: IARC; 1995, p. 15–31.

        • Working Party on Leukemia in Children
        Improvement in treatment for children with acute lymphoblastic leukaemia, Medical Research Council. UK ALL trials.
        Lancet. 1986; i: 408-411
        • Smith M.
        • Arthur D.
        • Camitta B.
        • et al.
        Uniform approach to risk classification and treatment assignment for children with acute lymphoblastic leukemia.
        J Clin Oncol. 1996; 14: 18-24
        • Stiller C.A.
        • Eatock E.M.
        Survival from acute non-lmphocytic leukemia, 1971–88, a population based study.
        Arch Dis Child. 1994; 70: 219-223
        • Pastore G.
        • Magnani C.
        • Verdecchia A.
        • et al.
        Survival of childhood lymphomas in Europe, 1978–92, a report from the EUROCARE study.
        Eur J Cancer. 2001; 37: 703-710
        • Magnani C.
        • Aareleid T.
        • Viscomi S.
        • Pastore G.
        • Berrino F.
        • and The EUROCARE Working Group
        Variation in survival of children with CNS malignancies diagnosed in Europe between 1978 and 1992, the EUROCARE study.
        Eur J Cancer. 2001; 37: 711-721
        • Spix C.
        • Aareleid T.
        • Stiller C.
        • Magnani C.
        • Kaatsch P.
        • Michaelis J.
        Survival of children with neuroblastoma time trends and regional differences in Europe, 1978–92.
        Eur J Cancer. 2001; 37: 722-729
        • Pritchard-Jones K.
        • Pritchard J.
        Success of clinical trials in childhood Wilms’ tumour around the world.
        Lancet. 2004; 364: 1468-1470