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International variation in oesophageal and gastric cancer survival 2012–2014: differences by histological subtype and stage at diagnosis (an ICBP SURVMARK-2 population-based study)
  1. Melina Arnold1,
  2. Eileen Morgan1,
  3. Aude Bardot1,
  4. Mark J Rutherford1,2,
  5. Jacques Ferlay1,
  6. Alana Little3,
  7. Bjorn Møller4,
  8. Oliver Bucher5,
  9. Prithwish De6,
  10. Ryan R Woods7,
  11. Nathalie Saint-Jacques8,
  12. Anna T Gavin9,
  13. Gerda Engholm10,
  14. Michael P Achiam11,
  15. Geoff Porter12,
  16. Paul M Walsh13,
  17. Sally Vernon14,
  18. Serena Kozie15,
  19. Agnihotram V Ramanakumar16,
  20. Charlotte Lynch17,
  21. Samantha Harrison17,
  22. Neil Merrett18,
  23. Dianne L O’Connell19,
  24. Tom Mala20,
  25. Mark Elwood21,
  26. John Zalcberg22,
  27. Dyfed W Huws23,24,
  28. David Ransom25,
  29. Freddie Bray1,
  30. Isabelle Soerjomataram1
  1. 1 Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
  2. 2 Department of Health Sciences, University of Leicester, Leicester, UK
  3. 3 Cancer Institute New South Wales, Alexandria, New South Wales, Australia
  4. 4 Cancer Registry of Norway, Oslo, Norway
  5. 5 CancerCare Manitoba, Winnipeg, Manitoba, Canada
  6. 6 Surveillance and Cancer Registry, Cancer Care Ontario, Toronto, Ontario, Canada
  7. 7 BC Cancer, Vancouver, British Columbia, Canada
  8. 8 Registry & Analytics, Nova Scotia Health Authority Cancer Care Program, Halifax, Nova Scotia, Canada
  9. 9 Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
  10. 10 Cancer Prevention & Documentation, Danish Cancer Society, Copenhagen, Denmark
  11. 11 Danish EsophagoGastric Cancer group, Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark
  12. 12 Canadian Partnership Against Cancer, Toronto, Ontario, Canada
  13. 13 National Cancer Registry Ireland, Cork, Ireland
  14. 14 Public Health England, London, UK
  15. 15 Saskatchewan Cancer Agency, Regina, Saskatchewan, Canada
  16. 16 McGill University Health Centre Research Institute, Montreal, Québec, Canada
  17. 17 International Cancer Benchmarking Partnership (ICBP), Policy & Information, Cancer Research UK, London, UK
  18. 18 Department of Upper Gastrointestinal Surgery, Bankstown‐Lidcombe Hospital and School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
  19. 19 The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
  20. 20 Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
  21. 21 School of Population Health, The University of Auckland, Auckland, New Zealand
  22. 22 School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  23. 23 Swansea University, Swansea, Wales, UK
  24. 24 Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, Wales, UK
  25. 25 WA Cancer and Palliative Care Network Policy Unit, Health Networks Branch, Department of Health, Perth, WA, Australia
  1. Correspondence to Dr Melina Arnold, Cancer Surveillance Branch, International Agency for Research on Cancer, 69008 Lyon, Rhône-Alpes, France; arnoldm{at}


Objective To provide the first international comparison of oesophageal and gastric cancer survival by stage at diagnosis and histological subtype across high-income countries with similar access to healthcare.

Methods As part of the ICBP SURVMARK-2 project, data from 28 923 patients with oesophageal cancer and 25 946 patients with gastric cancer diagnosed during 2012–2014 from 14 cancer registries in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK) were included. 1-year and 3-year age-standardised net survival were estimated by stage at diagnosis, histological subtype (oesophageal adenocarcinoma (OAC) and oesophageal squamous cell carcinoma (OSCC)) and country.

Results Oesophageal cancer survival was highest in Ireland and lowest in Canada at 1 (50.3% vs 41.3%, respectively) and 3 years (27.0% vs 19.2%) postdiagnosis. Survival from gastric cancer was highest in Australia and lowest in the UK, for both 1-year (55.2% vs 44.8%, respectively) and 3-year survival (33.7% vs 22.3%). Most patients with oesophageal and gastric cancer had regional or distant disease, with proportions ranging between 56% and 90% across countries. Stage-specific analyses showed that variation between countries was greatest for localised disease, where survival ranged between 66.6% in Australia and 83.2% in the UK for oesophageal cancer and between 75.5% in Australia and 94.3% in New Zealand for gastric cancer at 1-year postdiagnosis. While survival for OAC was generally higher than that for OSCC, disparities across countries were similar for both histological subtypes.

Conclusion Survival from oesophageal and gastric cancer varies across high-income countries including within stage groups, particularly for localised disease. Disparities can partly be explained by earlier diagnosis resulting in more favourable stage distributions, and distributions of histological subtypes of oesophageal cancer across countries. Yet, differences in treatment, and also in cancer registration practice and the use of different staging methods and systems, across countries may have impacted the comparisons. While primary prevention remains key, advancements in early detection research are promising and will likely allow for additional risk stratification and survival improvements in the future.

  • epidemiology
  • oesophageal cancer
  • surveillance

Data availability statement

No data are available.

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  • Contributors Study concept and design: MA and IS. Data analysis: MA, AB and MJR. Data collection and interpretation: EM, JF, AL, BM, OB, PD, RW, NS-J, ATG, GE, MPA, GP, PMW, SV, SK, AVR, CL, SH, NM, DOC, TM, ME, JZ, DWH, DR and FB. Drafting the manuscript: MA, EM and IS. Critical revision of the manuscript for important intellectual content: all authors. MA is the guarantor of the study and accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The ICBP is funded by the Canadian Partnership Against Cancer; Cancer Council Victoria; Cancer Institute New South Wales; Cancer Research UK; Danish Cancer Society; National Cancer Registry Ireland; The Cancer Society of New Zealand; NHS England; Norwegian Cancer Society; Public Health Agency Northern Ireland, on behalf of the Northern Ireland Cancer Registry; The Scottish Government; Western Australia Department of Health; Wales Cancer Network.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.