The incidence of childhood leukaemia in The Netherlands in the period 1973-1986 was studied by means of the DCLSG nationwide register, which lists all patients according to bone marrow slides ...classified in the DCLSG central laboratory. Acute lymphocytic leukaemia (ALL) accounted for 81% of cases, acute non-lymphocytic leukaemia (ANLL) for 13%, chronic myelocytic leukaemia (CML) for 2.5%, and acute unclassifiable leukaemia (AUL) for 3%. The peak incidence of ALL was at age 3, common-ALL and pre B-ALL comprising about 95% of the immunophenotypes at this age. Incidence rates for ALL remained stable between 1973 and 1978 at 2.85 cases per 10(5) children per year, exhibited a temporary increase between 1979 and 1984 to 3.60 and dropped back to the lower, previous level in 1985 and 1986. This rise was seen mainly among children in the 1-4 year age group, especially at age 3, and those with common-ALL and an initial WBC less than 5.0 x 10(9) l-1. Cumulative incidence rates per year of birth were fairly homogeneous up to age 6, except for the 1978 birth cohort which exhibited higher rates. Incidence rates for ANLL, CML and AUL remained stable over time. Changes in ascertainment, declining birth rates and a 50% decrease in childhood mortality, e.g. from infectious diseases, could not explain this temporary variation. Moreover, incidence rates in this survey appeared to be similar to those reported in various developed countries for the same period. As far as the aetiology of childhood common-ALL is concerned, therefore, the Dutch data appear to support the hypothesis of 'random mutation' as well as that of a limited role of environmental factors.
Data on 73,070 patients for seven major haematological malignancies diagnosed in Europe between 1985 and 1989 from 39 population-based cancer registries in 17 countries are included in the EUROCARE ...database. Relative survival was analysed by country and age between 1985 and 1989 and time trends were analysed from 1978-1989 for 13 countries which collaborated in EUROCARE for this entire period. The European weighted age-standardised 5-year relative survival rate was 72% for patients with Hodgkin's disease (HD, ranging from 45 to 76% in 13 countries), 63% for chronic lymphocytic leukaemia (CLL, range 51-79%, 14 countries), 46% for patients with non-Hodgkin's lymphoma (NHL, range 25-63%, 17 countries), 31% for patients with chronic myelocytic leukaemia (CML, range 8-40%, 13 countries), 28% for patients with multiple myeloma (MM, range 18-36%, 14 countries), 25% for patients with acute lymphoblastic leukaemia (ALL, range 19-33%, 7 countries) and 10% for patients with acute myeloblastic leukaemia (AML, range 4-15%, 11 countries). In all countries, relative survival declined with age, most markedly for patients with acute leukaemias. Patients in Northern and Western Europe had better survival rates, particularly in younger patients (15-45 years of age), whilst those in Eastern European countries tended to have poorer rates. Compared with 1978-1979, relative 5-year survival improved in 1987-1989 for most haematological malignancies (relative risk (RR) of death for CLL 0.65, AML 0.75, HD 0.76, ALL 0.79, NHL 0.82), with only CML (RR 0.95) and MM (RR 1.00) showing little or no change. These results suggest that generally and particularly in Eastern Europe there is room for improvement in the diagnosis and treatment of haematological malignancies. The intercountry differences also highlight the importance of socio-economic conditions to health status.
We used data supplied by population-based cancer registries, collected and quality controlled using a common protocol, to analyse survival from acute non-lymphocytic leukaemia (ANLL) and chronic ...myeloid leukaemia (CML) among children in 17 European countries. Variations in survival in relation to age, country, histologic subtype and period of diagnosis (1978–1992) were examined. These are rare malignancies and survival can be studied reliably only by examination of data from a very large population (in this case EUROCARE). 5 years after diagnosis, overall survival was 44% (95% CI 33–55) for CML and 37% (95% CI 32–43) for ANLL. For both types of leukaemia, survival was slightly better for girls and worse in children under 5 years of age. Consistent with clinical literature, the ANLL subtypes with poorer prognosis were monocytic, megakaryocytic and erythroleukaemia. For ANLL, 5-year survival was better in Finland, the UK, The Netherlands and Germany (⩾40%); for CML, 5-year survival was highest in Italy, although the 95% CI were wide. The risk of death from ANLL and CML fell by 7% per year and 5% per year, respectively, after adjustment for age, gender and country. Since these rare childhood malignancies were virtually untreatable until 1970, these are very welcome trends.
The standard technique for the detection of lymph node metastases (LNM) underdiagnosis a large proportion of the cases. The more intensive the search for LNM, the larger the number of LNM detected. ...Most of these newly detected LNM are of microscopic size ('micrometastases'). As a result of a more accurate lymph node staging, more patients have a higher stage of disease (stage migration). In addition to direct methods for revealing LNM microscopically, indirect molecular methods such as the polymerase chain reaction have become available. These methods are extremely sensitive but possibly have an unacceptable low specificity. Caution is needed when introducing techniques for molecular ultrastaging. The clinical significance of newly detected LNM is yet ill understood. Owing to the recent introduction of the sentinel node procedure lymph nodes are much more intensively examined. This may lead to stage migration for a substantial number of women and it is yet unclear whether this is to their benefit. The results of observational research to determine the clinical significance of (micro) metastases should not lag behind the ever increasing sensitivity of detection techniques.
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