Dansk Gynækologisk Cancer Gruppe (DGCG) DMCG.dk Repræsentantskabsmøde Onsdag, den 4. marts 2014 Resultater og erfaringer fra DGCG Claus K. Professor, overlæge dr. med. formand for DGCD Gynækologisk klinik, Rigshospitalet Lene Lundvall Formand for DGCG, Klinikchef, overlæge, Gynækologisk klinik, Rigshospitalet Ib Jarle Christensen Biostatistiker, Senior forsker, Molekylær Enheden, Patologi afdelingen. Herlev Universitets Hospital.
DGCG baggrund 1979 Odense: udvalg der skulle udarbejde nye retningslinier for behandling af ovariecancer i Danmark. 1981 gynækologer, onkologer og patologer DACOVA. Op til 2002 blev ovariecancer opereret på 58 forskellige gynækologiske afdelinger i Danmark Trods verdens højeste incidens, der skulle give rutine, var DK overlevelsen blandt de dårligste i verden. I 2000 følte man, at der var behov for en mere formel struktur og henvendte sig til de relevante selskaber: Dansk Selskab for Gynækologi og Obstetrik, Dansk Selskab for Patologi og Histologi, Dansk Selskab for Onkologi Dansk Selskab for Medicinsk Onkologi. De ni personer udgjorde herefter forretningsudvalget i DGC Dansk Gynækologisk Cancer
Dansk Gynækologisk Cancer Gruppe (DGCG)
Dansk Gynækologisk Cancer Gruppe (DGCG) Figur 1. Aldersstandardiseret dødelighed og incidens i henhold til Nordcan 7
Dansk Gynækologisk Cancer Gruppe (DGCG) Borderline tumorer??????
Figur 2. 5 års relativ overlevelse fra Nordcan Dansk Gynækologisk Cancer Gruppe (DGCG)
Dansk Gynækologisk Cancer Gruppe (DGCG) DGC Database (DGCD) National registration of: 2005: Ovarian, tubal, peritoneal cancer and borderline tumors Endometrial cancer and atypia Cervical cancer Above + Vulva and vaginal cancer Trofoblast diseases Nursing data 2013/14: From 2004 the Pelvic Mass biobank. From 2014 total DGCG in Dansk Cancer Biobank
Hvad er der så sket til nu? Løbende centralisering til 4 højt specialiserede afdelinger i Danmark for 91 % af patienterne. DGCG retningslinier for behandling af alle gynækologiske cancer sygdomme Introduktion af kræftpakker Uddannelse af gyn-onkologiske kirurger- Expertuddannelse, EBCOG, extensiv kirurgi stigning i antallet af makroradikalt opererede 5 års fjernelse af lymfeknuder MDT DGCD Medicinsk behandling næsten uændret (dog bevacizumab)
Ovarie cancer kræftpakke Såfremt RMI 200 henvisning til et af 4 centre (Rigshospitalet, Odense, Skejby, Ålborg). Center: PET/CT. MDT Fastlagte tidsforløb
5% bedre overlevelse ved centralisering Fagö-Olsen CL, C, Kehlet H, Christensen IJ, Ottesen B. Centralized treatment of advanced stages of ovarian cancer improves survival: a nationwide Danish survey. Acta Obstet Gynecol Scand. 2011; (90): 273-79
DMCG.dk Benchmarking Consortium DMCG.dk Benchmarking Consortium Kapitel 1: Brystkræft 1995-2012 Kapitel 2: Lungekræft 2001-2012 Kapitel 3: Tyktarm- og endetarmkræft 2001-2012 Kapitel 4: Æggestokkræft 1995-2012 Claus, formand for DGCD, professor, overlæge, dr. med., gynækologisk klinik, Rigshospitalet Lene Lundvall, formand for DGCG, Klinikchef, overlæge, gynækologisk klinik, Rigshospitalet Ib Jarle Christensen, Biostatistiker, Senior forsker. Molekylær Enheden, Patologi afdelingen. Herlev Hospital /Berit Mosgaard, Gyn RH
Dansk Gynækologisk Cancer Gruppe (DGCG ) Opgørelse af 9.972 patienter i perioden 1995* -2012 med diagnosen DC56 (ovary) *Data from 1995-2004 is from the Danish National Patient Register (NPR). Incident ovarian cancer was defined as first-time registration of ICD-10 code DC56 and with a histologically verified ovarian cancer in the Danish Pathology Register. Data for 2005-2012 is linked from the NPR, the Danish Pathology Register and the DGCD (Dansk gynækologisk cancer database)
Table 1 Distribution of ovarian cancer by age group, comorbidity and cancer stage (1995-2012) Abbreviations: CCI, Charlson Comorbidity Index, FIGO, International Federation of Gynecology and Obstetrics Total period N 1995-2012 Calendar period of ovarian cancer diagnosis N 1995-1999 2000-2004 2005-2009 2010-2012 Total 9972 2678 2906 2779 1609 Median age (min-max years) 64 (16-103) 62 (16-94) 62 (16-103) 64 (17-94) 66 (16-99) Age group <45 years 886 285 270 211 120 45-54 years 1851 598 572 443 238 55-64 years 2605 624 788 794 399 65-74 years 2733 694 738 799 502 75 years 1897 477 538 532 350 Comorbidity Index CCI = 0 (None) 7669 2229 2226 2050 1164 CCI = 1 (Low) 869 184 259 297 129 CCI = 2 (Medium) 1025 217 301 300 207 CCI 3 (High) 409 48 120 132 109 FIGO cancer stage I 2183 632 576 656 319 II 755 217 201 215 122 III 3906 896 1136 1186 688 IV 1570 354 426 473 317 Unknown 1558 579 567 249 163
Table 2 1-year and 5-year age-adjusted mortality rate for ovarian cancer. Overall estimates and stratified by age group, comorbidity and cancer stage (1995-2012) Mortality rate, per 100 patient year () Calendar period of ovarian cancer diagnosis 1995-1999 2000-2004 2005-2009 2010-2012 Year Rate 95% CI Rate 95% CI Rate Rate Total 0-1 year 0-5 year 42.84 40.29 45.55 37.97 35.72 40.38 31.91 29.89 34.07 28.26 25.88 30.87 28.24 27.03 29.51 27.95 26.82 29.12 23.94 22.95 24.97...
Table 2 1-year and 5-year age-adjusted mortality rate for ovarian cancer. Overall estimates and stratified by age group, comorbidity and cancer stage (1995-2012) Mortality rate, per 100 patient year () Calendar period of ovarian cancer diagnosis 1995-1999 2000-2004 2005-2009 2010-2012 Year Rate Rate Rate Rate Age group <45 years 0-1 year 15.15 13.19 17.40 14.86 12.87 17.17 8.41 6.80 10.40 7.76 5.79 10.39 0-5 year 9.15 8.39 9.98 8.27 7.53 9.08 6.06 5.38 6.83... 45-54 years 0-1 year 13.99 12.67 15.45 17.26 15.74 18.92 11.56 10.19 13.12 10.22 8.51 12.27 0-5 year 14.25 13.54 15.00 14.51 13.78 15.28 11.97 11.25 12.74... 55-64 years 0-1 year 25.69 23.86 27.66 20.53 19.09 22.09 20.77 19.33 22.32 18.09 16.24 20.15 0-5 year 20.62 19.72 21.57 19.41 18.64 20.21 18.53 17.80 19.30... 65-74 years 0-1 year 41.05 38.75 43.48 35.41 33.35 37.60 28.93 27.17 30.80 26.49 24.42 28.73 0-5 year 27.07 26.01 28.18 27.14 26.12 28.21 22.63 21.77 23.52... 75 years 0-1 year 82.18 77.82 86.79 73.65 69.83 77.69 58.82 55.49 62.35 46.76 43.26 50.54 0-5 year 47.85 45.78 50.02 47.26 45.35 49.26 38.14 36.55 39.80...
Table 2 1-year and 5-year age-adjusted mortality rate for ovarian cancer. Overall estimates and stratified by age group, comorbidity and cancer stage (1995-2012) Mortality rate, per 100 patient year () Calendar period of ovarian cancer diagnosis 1995-1999 2000-2004 2005-2009 2010-2012 Year Rate Rate Rate Rate FIGO cancer stage I 0-1 year 9.49 7.32 12.36 10.58 8.30 13.60 8.53 6.69 10.96 8.45 5.89 12.25 0-5 year 7.79 6.73 9.01 7.97 6.88 9.23 5.89 5.08 6.83... II 0-1 year 26.93 20.78 35.14 14.20 9.99 20.45 14.34 10.41 20.06 17.16 11.61 25.61 0-5 year 20.45 17.14 24.40 13.70 11.28 16.66 13.35 11.13 16.03... III 0-1 year 39.10 35.09 43.59 36.54 33.19 40.25 31.30 28.43 34.50 22.90 19.86 26.45 0-5 year 38.54 35.95 41.32 35.85 33.76 38.07 31.73 29.97 33.59... IV 0-1 year 91.26 80.78 103.19 70.13 61.94 79.47 57.69 50.96 65.37 41.87 35.53 49.46 0-5 year 69.42 62.86 76.67 51.90 47.29 56.97 45.95 42.12 50.14... Unknown 0-1 year 67.56 60.68 75.25 60.19 53.56 67.68 91.80 78.52 107.41 97.60 82.05 116.25 0-5 year 33.04 30.29 36.03 34.13 31.19 37.35 41.10 35.87 47.11...
Table 3a 1-year and 5-year age-adjusted absolute survival for ovarian cancer. Overall estimates and stratified by age group, comorbidity and cancer stage (2001-2012) Absolute survival % () Year Calendar period of ovarian cancer diagnosis 1995-1999 2000-2004 2005-2009 2010-2012 Surviva l % Surviva l % Surviva l % Surviva l % Total 1 year 68 66 69 71 69 72 74 73 76 76 74 78 5 year 33 32 35 33 31 34 36 34 38...
Dansk Gynækologisk Cancer Gruppe (DGCG) Table 3a 1-year and 5-year age-adjusted absolute survival for ovarian cancer. Overall estimates and stratified by age group, comorbidity and cancer stage (2001-2012) Absolute survival % () Year Calendar period of ovarian cancer diagnosis 1995-1999 2000-2004 2005-2009 2010-2012 Surviva l % Surviva l % Surviva l % Surviva l % Age group <45 years 1 year 86 81 90 86 82 90 92 87 95 93 86 96 5 year 64 58 69 67 61 73 74 68 80... 45-54 years 1 year 87 84 89 84 81 87 89 86 92 90 86 93 5 year 51 47 55 50 46 54 55 50 60... 55-64 years 1 year 77 74 80 82 79 84 81 78 84 83 79 87 5 year 39 35 43 40 37 43 41 37 44... 65-74 years 1 year 67 63 70 71 68 74 76 72 78 77 73 80 5 year 31 27 34 30 26 33 35 32 39... 75 years 1 year 46 41 50 50 46 54 58 53 62 64 58 69 5 year 18 15 21 17 14 20 21 17 24...
Dansk Gynækologisk Cancer Gruppe (DGCG) Table 3a 1-year and 5-year age-adjusted absolute survival for ovarian cancer. Overall estimates and stratified by age group, comorbidity and cancer stage (2001-2012) Absolute survival % () Year Calendar period of ovarian cancer diagnosis 1995-1999 2000-2004 2005-2009 2010-2012 Surviva l % Surviva l % Surviva l % Surviva l % FIGO cancer stage I 1 year 91 88 93 90 87 93 92 90 94 92 88 95 5 year 70 66 74 70 66 74 76 73 80... II 1 year 79 72 84 88 82 92 87 82 91 85 77 90 5 year 46 39 52 54 47 61 57 49 63... III 1 year 69 66 72 71 68 74 75 72 77 80 76 83 5 year 20 17 22 22 19 24 23 20 25... IV 1 year 45 39 50 57 52 61 60 55 64 68 63 73 5 year 11 08 15 14 11 18 14 11 18... Unknown 1 year 55 50 59 58 54 62 48 42 55 44 36 52 5 year 31 27 34 30 26 34......
Dansk Gynækologisk Cancer Gruppe (DGCG) Table 4 1-year and 5-year age-adjusted relative survival for ovarian cancer. Overall estimates and stratified by age group, comorbidity and cancer stage (1995-2012) Relative survival % () Calendar period of ovarian cancer diagnosis 1995-1999 2000-2004 2005-2009 2010-2012 Year Relative survival Relative survival Relative survival Relative survival Total 1 year 69 67 71 72 70 74 76 74 78 78 76 80 5 year 34 32 36 33 32 35 37 35 38...
Dansk Gynækologisk Cancer Gruppe (DGCG) Table 4 1-year and 5-year age-adjusted relative survival for ovarian cancer. Overall estimates and stratified by age group, comorbidity and cancer stage (1995-2012) Relative survival % () Calendar period of ovarian cancer diagnosis 1995-1999 2000-2004 2005-2009 2010-2012 Relative survival Relative survival Relative survival Relative survival Year Age group <45 years 1 year 86 81 90 86 82 90 92 87 95 93 86 96 5 year 64 58 70 67 62 73 74 68 80... 45-54 years 1 year 87 84 90 84 81 87 89 86 92 91 86 94 5 year 51 47 55 50 46 54 55 51 60... 55-64 years 1 year 78 75 81 82 79 85 82 79 85 84 80 87 5 year 40 36 43 40 37 44 41 38 44... 65-74 years 1 year 68 65 72 73 69 76 77 74 80 78 74 82 5 year 32 28 35 30 27 34 36 33 39... 75 years 1 year 49 44 54 53 49 58 61 57 66 68 62 73 5 year 19 16 23 18 14 21 22 18 26...
Table 4 1-year and 5-year age-adjusted relative survival for ovarian cancer. Overall estimates and stratified by age group, comorbidity and cancer stage (1995-2012) Relative survival % () Year Calendar period of ovarian cancer diagnosis 1995-1999 2000-2004 2005-2009 2010-2012 Relative survival Relative survival Relative survival Relative survival FIGO cancer stage I 1 year 93 90 95 92 89 94 94 91 96 94 90 96 5 year 72 67 75 71 67 75 77 74 81... II 1 year 81 74 86 89 84 93 89 83 93 87 79 93 5 year 47 39 53 55 48 62 58 51 65... III 1 year 71 67 74 72 70 75 76 73 79 81 78 84 5 year 20 17 23 22 20 25 23 21 26... IV 1 year 46 40 51 58 53 63 61 56 65 70 64 75 5 year 12 08 15 14 11 18 14 11 18... Unknown 1 year 56 52 60 60 55 64 49 43 56 45 37 53 5 year 31 27 35 30 26 34...... FIGO cancer stage
Fjernelse af lymfeknuder sker sent I 2005 fik kun 25% og i 2011 kun 55% af kirurgisk stadium I foretaget lymfeknuderesektion i Danmark* Mulig terapeutisk effekt St. I misklassifikation Stage gliding I III * Svolgaard O, Lidegaard O, Nielsen ML et al. Lymphadenectomy in surgical stage I epithelial ovarian cancer. Acta Obstet Gynecol Scand 2014;93(3):256-60. /Berit Mosgaard, Gyn RH
Dansk Gynækologisk Cancer Gruppe (DGCG) Figure 5 Age-standardized relative 1-year and 5-year survival
Konklusioner Overlevelsen er steget gennem perioden. Fremgangen betyder, at overlevelsen nu er på højde med nogle af de lande, vi traditionelt sammenligner os med, men fortsat også på nogle punkter lavere end de bedste lande. De største ændringer er gradvis sket inden for de sidste perioder, hvor specielt 5 års overlevelsen ikke har kunnet opgøres. Stigningen i 1 års overlevelsen ses som et indicium for yderligere forbedrede resultater i de fremtidige rapporter. DGCG s strategi har båret frugt men der er stadig plads for forædling og forbedring.