Munich Cancer Registry

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1 Munich Cancer Registry Incidence and Mortality Selection Matrix Homepage Deutsch ICD-1 C25: Pancreas cancer Survival Year of diagnosis Patients ,778 Diseases ,779 Cases evaluated 774 6,847 Creation date 9/22/216 Export date 8/17/216 Population 4.69 m BERLIN GERMANY BAVARIA MUNICH Munich Cancer Registry at Munich Cancer Center Marchioninistr. 15 Munich, Germany E-ICD-1-C25-Pancreas-cancersurvival.pdf

2 GENERAL ICD-1 C25: Pancreas cancer Page 2 of 14 ICD-1 C25: Malignant neoplasm of pancreas Period of diagnosis % Relative survival N=7, Figure 1a. Relative survival of patients with pancreas cancer by period of diagnosis. Included in the evaluation are 7,524 cases diagnosed between 1988 and 214. The survival results of the SEER program (Surveillance, Epidemiology, and End Results) of the American National Cancer Institute (NCI) are summarized as the period of diagnosis from 1998 to 211, and are represented by gray diamonds in order to facilitate comparisons between MCR and SEER. The presented survival curves are derived from clinical records with valid follow-up informations, which means that death certificate cases (DCO) cases are omitted from the analysis. With this one restriction, the MCR has provided populationbased statistics since 1998, collecting data on all cancer cases in the region of southern Bavaria. Historical data of previous time periods can be heavily selected, therefore, univariate survival comparisons of the presented time periods must be carefully considered. Nonetheless, all calculable survival curves are depicted to facilitate the comparison of long time follow-up analyses of relative survival between particular cancers. Period of diagnosis n=77 n=2,687 n=4,67 obs. % rel. % obs. % rel. % obs. % rel. % Table 1b. Observed (obs.) and relative (rel.) survival of patients with pancreas cancer by period of diagnosis for period (N=7,524). Period of diagnosis n=77 1.2% n=2, % 27+ n=4, % SEER n=78,225

3 GENERAL ICD-1 C25: Pancreas cancer Page 3 of 14 ICD-1 C25: Malignant neoplasm of pancreas Gender % Survival N=7,524 N= Gender 9 8 Male n=3, % Female n=3, % Observed Expected Relative Figure 2a. Survival of patients with pancreas cancer by gender. Included in the evaluation are 7,524 cases diagnosed between 1988 and 214. Gender Male Female n=3,888 n=3,636 obs. % rel. % obs. % rel. % Table 2b. Observed (obs.) and relative (rel.) survival of patients with pancreas cancer by gender for period (N=7,524).

4 GENERAL ICD-1 C25: Pancreas cancer Page 4 of 14 ICD-1 C25: Malignant neoplasm of pancreas Age category % Observed survival N=7, Figure 3a. Observed survival of patients with pancreas cancer by age category. Included in the evaluation are 7,524 cases diagnosed between 1988 and 214. Age category -49 yrs n= % 5-59 yrs n=1, % 6-69 yrs n=2,3.6% 7-79 yrs n=2, % 8+ yrs n=1, % ICD-1 C25: Malignant neoplasm of pancreas Age category % Relative survival N=7, Figure 3b. Relative survival of patients with pancreas cancer by age category. Included in the evaluation are 7,524 cases diagnosed between 1988 and 214. Age category -49 yrs n= % 5-59 yrs n=1, % 6-69 yrs n=2,3.6% 7-79 yrs n=2, % 8+ yrs n=1, %

5 GENERAL ICD-1 C25: Pancreas cancer Page 5 of 14 Age category -49 yrs 5-59 yrs 6-69 yrs 7-79 yrs 8+ yrs n=463 n=1,157 n=2,3 n=2,515 n=1,86 obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % Table 3c. Observed (obs.) and relative (rel.) survival of patients with pancreas cancer by age category for period (N=7,524).

6 GENERAL ICD-1 C25: Pancreas cancer Page 6 of 14 ICD-1 C25: Malignant neoplasm of pancreas % Relative survival N=6, T1 n= % T2 n= % T3 n=2, % T4 n= % N n=1, % N+ n=2, % M n=1, % M1 n=3, % NA/NOS n=1, % Figure 4a. Relative survival of patients with pancreas cancer by. For 6,383 of 7,524 cases diagnosed between 1988 and 214 valid data could be obtained for this item. For a total of 6,363 cases an evaluable classification was established. The accumulated percentage exceeds the 1% value because patients are potientially considered in more than one subgroup. The grey line represents the subgroup of 1,161 patients with missing values regarding (15.4 % of 7,524 patients, the percent values of all other categories are related to n=6,363). T1 T2 T3 T4 N N+ M n=245 n=668 n=2,217 n=758 n=1,66 n=2,431 n=1,734 obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % cont'd M1 NA/NOS n=3,58 n=1,161 obs. % rel. % obs. % rel. % Table 4b. Observed (obs.) and relative (rel.) survival of patients with pancreas cancer by TNM staging for period (N=6,363).

7 GENERAL ICD-1 C25: Pancreas cancer Page 7 of 14 ICD-1 C25: Malignant neoplasm of pancreas % Relative survival N=5, T1 n= % T2 n=342 6.% T3 n=2, % T4 n= % N n= % N+ n=2, % M n=1, % M1 n=3, % NA/NOS n=1, % Figure 4c. Relative survival of patients with pancreas cancer by. For 5,738 of 6,754 cases diagnosed between 1998 and 214 valid data could be obtained for this item. For a total of 5,721 cases an evaluable classification was established. The accumulated percentage exceeds the 1% value because patients are potientially considered in more than one subgroup. The grey line represents the subgroup of 1,33 patients with missing values regarding (15.3 % of 6,754 patients, the percent values of all other categories are related to n=5,721). T1 T2 T3 T4 N N+ M n=147 n=342 n=2,138 n=751 n=911 n=2,153 n=1,466 obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % cont'd M1 NA/NOS n=3,231 n=1,33 obs. % rel. % obs. % rel. % Table 4d. Observed (obs.) and relative (rel.) survival of patients with pancreas cancer by TNM staging for period (N=5,721).

8 GENERAL ICD-1 C25: Pancreas cancer Page 8 of 14 ICD-1 C25: Malignant neoplasm of pancreas Extent of disease % Conditional relative 2 year survival N=6, Time since diagnosis (years) Extent of disease Local n=1, % Regional n=1, % Distant n=3, % NA/NOS n=1, % Figure 4e. Conditional relative 2-year survival of patients with pancreas cancer by extent of disease. For 6,383 of 7,524 cases diagnosed between 1988 and 214 valid data could be obtained for this item. For a total of 6,3 cases an evaluable classification was established. The grey line represents the subgroup of 1,194 patients with missing values regarding extent of disease (15.9% of 7,524 patients, the percent values of all other categories are related to n=6,3). Extent of disease Local Regional Distant NA/NOS Cond. Cond. Cond. Cond. surv. % surv. % surv. % surv. % n 2 yrs n 2 yrs n 2 yrs n 2 yrs 1, , , , Table 4f. Conditional relative 2-year survival of patients with pancreas cancer by extent of disease for period (N=6,3). Conditional relative survival rates refer to the relative survival probability, in this case for 2 years after cancer diagnosis, compared to the age- and sex-matched population (=1%) under the condition of being alive for a certain time period (x-axis in Figure 4c). The results illustrate to what extent the cancer induced mortality of particular subgroups declines in the subsequent years after detection of the malignancy. For instance, according to the presented survival statistics, patients in the subgroup extent of disease= Local, who are alive at least 3 years after cancer diagnosis, the conditional relative 2-year survival rate is 75.6% (n=29).

9 PROGRESSION ICD-1 C25: Pancreas cancer Page 9 of 14 % Time to first progression (TTP) N=3, Type of progression Any type (CI) Events=2,757 Any type (1-KM) Events=2,757 Distant metastasis (CI) Events=1,678 Distant metast. (1-KM) Events=1,678 Locoreg. relapse (CI) Events=316 Locoreg. rel. (1-KM) Events=316 NOS (CI) Events=278 NOS (1-KM) Events= Figure 5a. Time to first progression of 3,572 patients with pancreas cancer diagnosed between 1998 and 214 (M only in solid cancers) estimated by cumulative incidence function (CI, solid line) accounting for death as competing risk and by inverse Kaplan-Meier estimate (1-KM, dashed line). The frequency of events may be underestimated due to underreporting. Any type (CI) Any type (1-KM) Type of progression Distant metast. (1- KM) Distant metastasis (CI) Locoreg. relapse (CI) Locoreg. rel. (1-KM) NOS (CI) n=3,572 n=3,572 n=3,572 n=3,572 n=3,572 n=3,572 n=3,572 % % % % % % %

10 PROGRESSION ICD-1 C25: Pancreas cancer Page 1 of 14 Type of progression cont'd NOS (1-KM) n=3,572 % Table 5b. Time to first progression of patients with pancreas cancer for period (N=3,572).

11 PROGRESSION ICD-1 C25: Pancreas cancer Page 11 of 14 ICD-1 C25: Malignant neoplasm of pancreas Progression type % Observed post-progression survival N=4, Type of progression Any type n=4,257 1.% Distant metastasis n=3, % Locoregional relapse n=383 9.% 6 NOS n= % Figure 5c. Observed post-progression survival of 4,257 patients with pancreas cancer diagnosed between 1998 and 214. These 4,257 patients with documented progression events during their course of disease represent 63.2 % of the totally 6,732 evaluated cases (incl. M1, n=3,16, 46.9 %). Patients with cancer relapse documented via death certificates only were excluded (n=1,66, 24.7 %). Multiple progression types on different sites are included in the evaluation even when not occuring synchronously. The NOS (not otherwise specified) class is included under the condition, that it is the one and only progression type during the course of disease. Medical record documentation often lacks the linguistic severity to distinguish between local relapse, regional lymph node metastasis and distant spread in solid cancers. Frequently, the statement not specified is the only information in registries regarding relapse of the disease. The category Any type denotes all cases who suffered from at least one relapse during the course of disease (incl. primary M1-status). Although, the real number of relapsed patients is likely to be much higher. The accumulated percentage of patients with local relapse or distant metastasis exceeds the 1% value because patients are potientially considered in more than one subgroup. Type of progression Any type Distant metastasis Locoregional relapse NOS n=4,257 n=3,938 n=383 n=278 % % % % Table 5d. Observed post-progression survival of patients with pancreas cancer for period (N=4,257).

12 PROGRESSION ICD-1 C25: Pancreas cancer Page 12 of 14 ICD-1 C25: Malignant neoplasm of pancreas Type of Progression: Distant metastasis % Observed post-progression survival by period of progression date N=4, Figure 5e. Observed post-progression (distant metastasis) survival of 4,291 patients with pancreas cancer diagnosed between 1988 and 214 by period of progression. Period of progression n=323 n=1,466 n=2,52 % % % Table 5f. Observed post-progression (distant metastasis) survival of patients with pancreas cancer for period by period of progression (N=4,291). Period of progression n= % n=1, % 27+ n=2, %

13 USAGE ICD-1 C25: Pancreas cancer Page 13 of 14 Shortcuts MCR Munich Cancer Registry, Germany NCI National Cancer Institute, USA SEER Surveillance, Epidemiology, and End Results, USA UICC Union for International Cancer Control, Geneva DCO Death certificate only NA Not available NOS Not otherwise specified Death certificate provides the only notification to the registry. OS Overall/Observed survival Overall/Observed survival (Kaplan-Meier estimate) Date of entry: diagnosis Event: death from any cause RS Relative survival Survival compared to general population, ratio of observed to expected survival (Ederer II method), reflecting cancer specific survival AS Assembled survival Assembled chart of observed, expected, relative survival CS Conditional survival Survival probability under the condition of surviving a given period of time TTP Time to progression Time to first progression / relapse Date of entry: diagnosis Event: (progression/ relapse): first local-, lymph node recurrence, distant metastasis or unspecified progression 1-KM CI 1 minus Kaplan-Meier estimator ( inverse Kaplan-Meier estimator) Cumulative incidence Death as competing risk (according to Kalbfleisch und Prentice) PPS Post-progression survival Survival since first progression / relapse (Kaplan-Meier estimate) Date of entry (progression / relapse): first local-, lymph node recurrence, distant metastasis or unspecified progression Event: death from any cause Recommended Citation Munich Cancer Registry. Survival ICD-1 C25: Pancreas cancer [Internet]. 216 [updated 216 Sep 22; cited 216 Nov 1]. Available from: E-ICD-1- C25-Pancreas-cancer-survival.pdf Copyright The content of the public web site provided by the Munich Cancer Registry is available worldwide and free of charge. All documents are free to download, utilize, copy, print-out and distribute, providing that the MCR is referenced. Disclaimer The Munich Cancer Registry reserves the right to not be responsible for the topicality, correctness, completeness or quality of the information provided. Liability claims regarding damage caused by the use of any information provided, including any kind of information which is incomplete or incorrect, will therefore be rejected.

14 INDEX ICD-1 C25: Pancreas cancer Page 14 of 14 Fig./Tbl. Index of figures and tables Page 1a Relative survival by period of diagnosis (chart) 2 1b Survival by period of diagnosis (table) 2 2a Survival by gender (chart) 3 2b Survival by gender (table) 3 3a Observed survival by age category (chart) 4 3b Relative survival by age category (chart) 4 3c Survival by age category (table) 5 4a Relative survival by (chart) 6 4b Survival by (table) 6 4c Relative survival by (chart) 7 4d Survival by (table) 7 4e Conditional survival by extent of disease (chart) 8 4f Conditional survival by extent of disease (table) 8 5a Time to first progression (chart) 9 5b Time to first progression (table) 9 5c Observed post-progression survival (chart) 11 5d Observed post-progression survival (table) 11 5e Observed post-progression survival by period of progression (chart) 12 5f Observed post-progression survival by period of progression (table) 12