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Gultekin, Dundar, Kucukyildiz, Karaca, Boztas, Turan, Hacikamiloglu, and Keskinkilic: Survival of gynecological cancers in Turkey: where are we at?
Original Article

J Gynecol Oncol 2017;28(6):e85.

Published online: 4 November 2017

DOI: https://doi.org/10.3802/jgo.2017.28.e85

Survival of gynecological cancers in Turkey: where are we at?

Murat Gultekin1, , Selin Dundar2, Irem Kucukyildiz2, Mujdegul Zayifoglu Karaca2, Guledal Boztas2, Semra Hatice Turan2, Ezgi Hacikamiloglu2, Bekir Keskinkilic2

1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey

2Department of Cancer Control, Public Health Institute, Turkish Ministry of Health, Ankara, Turkey

Correspondence to Murat Gultekin Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara 06230, Turkey. E-mail: mrtgultekin@yhooo.com

Received 8 June 2017       Revised 25 July 2017       Accepted 19 August 2017

Copyright © 2017 Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To investigate the 5-year relative survival rates in gynecological cancers diagnosed and treated in Turkey by year 2009 and to compare the results with developed countries.

Methods

Data of patients diagnosed for ovarian, corpus uteri or cervix uteri cancer at year 2009 are collected from 9 national cancer registry centers. Date of deaths are retracted from governmental Identity Information Sharing System (KPS). In order to calculate relative survival rates, national general population mortality tables are obtained from Turkish Statistical Institute (TurkStat). Hakulinen method is used for computing curves by R program. Data for European, Asian and some developed countries were obtained from official web pages.

Results

A total of 1,553 patients are evaluated. Among these, 713 (45.9%) are corpus uteri cancers, while remaining 489 (31.5%) are ovarian and 351 (22.6%) are cervix uteri. Five-year overall relative survival rates are 85%, 50%, and 62% for corpus uteri, ovarian, and cervix uteri, respectively. These figures are between 73%–87% for corpus uteri, 31%–62% for ovarian and 61%–80% for cervix uteri in developed countries. Stage is the most important factor for survival in all cancers. Five-year relative survival rates in corpus uteri cancers are 92%, 66%, and 38% for localized, regional, and distant metastatic disease, respectively. These figures are 77%, 57%, and 29% for ovarian; 80%, 50%, and 22% for cervix uteri.

Conclusion

This is the first report from Turkey giving national overall relative survival for gynecological cancers from a population based cancer registry system.

Keywords: Turkey, Relative Survival, Gynecologic Neoplasms, Ovarian Diseases, Cervix Uteri, Corpus Uteri Cancers

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Fig. 1.
Five-year relative survival curves.
SEER, Surveillance, Epidemiology, and End Results.
jgo-28-e85f1.tif
Table 1.
Clinico-pathological characteristics and relative survival
Characteristics No. (%) 5-year relative survival SE p-value
Corpus uteri Overall 713 0.85 0.01  
SEER stage Localized 424 (59.5) 0.92 0.02 <0.05
Regional 115 (16.1) 0.66 0.05
Distant 27 (3.8) 0.38 0.09
Unknown 147 (20.6) 0.87 0.03
Differentiation 1 246 (34.5) 0.95 0.02 <0.05
2 204 (28.6) 0.91 0.02
3 73 (10.2) 0.57 0.06
Unknown 190 (26.6) 0.76 0.03
Histology Endometrioid 472 (66.2) 0.91 0.02 <0.05
Others 241 (33.8) 0.73 0.03
Age group <40 33 (4.6) 0.94 0.04 <0.05
40–49 138 (19.4) 0.94 0.02
50–59 307 (43.1) 0.86 0.02
60–69 235 (33.0) 0.77 0.03
Ovary Overall 489 0.50 0.02  
SEER stage Localized 116 (23.7) 0.77 0.04 <0.05
Regional 70 (14.3) 0.57 0.06
Distant 191 (39.1) 0.29 0.03
Unknown 112 (22.9) 0.55 0.05
Differentiation 1 25 (5.1) – – –
2 67 (13.7) – –
3 96 (19.6) – –
Unknown 301 (61.6) – –
Histology Serous 224 (45.8) 0.41 0.03 <0.05
Others 265 (54.2) 0.58 0.03
Age group <30 43 (8.8) 0.86 0.05 <0.05
30–39 39 (8.0) 0.67 0.07
40–49 124 (25.4) 0.63 0.04
50–59 156 (31.9) 0.40 0.04
60–69 127 (26.0) 0.29 0.04
Cervix uteri Overall 351 0.62 0.03  
SEER stage Localized 132 (37.6) 0.80 0.04 <0.05
Regional 94 (26.8) 0.50 0.05
Distant 23 (6.6) 0.22 0.08
Unknown 102 (29.1) 0.57 0.05
Differentiation 1 21 (6.0) – – –
2 52 (14.8) – –
3 31 (8.8) – –
Unknown 247 (70.4) – –
Histology Squamous 265 (75.5) 0.64 0.33 0.44
Adenocarcinoma 66 (18.8) 0.56 0.06
Others 20 (5.7) 0.56 0.11
Age group <40 66 (18.8) 0.70 0.06 0.11
40–49 104 (29.6) 0.67 0.05
50–59 96 (27.4) 0.52 0.05
60–69 85 (24.2) 0.60 0.06

SE, standard error; SEER, Surveillance, Epidemiology, and End Results.

Table 2.
Relative survival regression models
Characteristics Ovary Corpus uteri Cervix uteri
β SE Exp(β) p-value β SE Exp(β) p-value β SE Exp(β) p-value
Stage
    Reg./Loc. 0.70 0.27 2.01 <0.05 1.28 0.27 3.59 <0.05 1.20 0.26 3.32 <0.05
    Distant/Loc. 1.33 0.22 3.77 <0.05 1.70 0.34 5.49 <0.05 2.21 0.32 9.15 <0.05
    Unknown/Loc. 0.79 0.25 2.21 <0.05 0.15 0.32 1.16 0.63 1.00 0.26 2.71 <0.05
Histology
    Serous/others −0.02 0.14 0.98 0.91                
    Endometrioid/others         −0.41 0.25 0.66 0.09        
Age
    30–39/<30 0.66 0.51 1.93 0.20                
    40–49/<30 0.88 0.44 2.42 <0.05                
    50–59/<30 1.44 0.43 4.22 <0.05                
    60–69/<30 1.76 0.43 5.83 <0.05                
    40–49/<40         0.52 0.82 1.69 0.52        
    50–59/<40         1.18 0.76 3.27 0.11        
    60–69/<40         1.49 0.75 4.44 <0.05        
fu
    fu [0,1] −3.97 0.46 0.019 <0.05 −5.22 0.86 0.005 <0.05 −3.16 0.26 0.04 <0.05
    fu (1,2] −4.01 0.47 0.018 <0.05 −5.52 0.87 0.004 <0.05 −2.65 0.24 0.07 <0.05
    fu (2,3] −4.24 0.47 0.014 <0.05 −5.63 0.88 0.004 <0.05 −3.41 0.30 0.03 <0.05
    fu (3,4] −3.91 0.47 0.020 <0.05 −5.64 0.88 0.004 <0.05 −3.37 0.31 0.03 <0.05
    fu (4,5] −4.27 0.48 0.014 <0.05 −6.47 0.95 0.002 <0.05 −3.69 0.35 0.03 <0.05
Differ
    2/1         0.35 0.44 1.42 0.41        
    3/1         1.61 0.42 4.99 <0.05        
    Unknown/1         1.23 0.41 3.43 <0.05        

fu, follow-up interval covariates; Loc., localized; Reg., regional; SE, standard error.

Table 3.
Five-year relative survival rates (%) per country (year of diagnosis)
Country Corpus uteri Ovary Cervix uteri
Turkey 85 (2009) 50 (2009) 62 (2009)
USA [6] 82 (2006–2012) 46 (2006–2012) 68 (2006–2012)
UK [7,8] 77 (2000–2007) 31 (2000–2007) 59 (2005–2007)
Germany [7,9,10] 81 (2002–2006) 40 (2000–2007) 65 (1997–2006)
France [7] 73 (2000–2007) 40 (2000–2007) 61 (2000–2007)
EU [7] 76 (2000–2007) 38 (2000–2007) 62 (2000–2007)
Australia [11] 83 (2008–2012) 44 (2009–2013) 72 (2008–2012)
Canada [12] 84 (2006–2008) 44 (2006–2008) 73 (2006–2008)
Korea [13] 87 (2008–2012) 62 (2008–2009) 80 (2008–2012)
China [14,15] 76 (2000–2002) 55 (2005–2010) 74 (2005–2010)
Japan [16] 80 (2003–2005) 55 (2003–2005) 72 (2003–2005)
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