PREŽNETJE BoLNIl(oV Z RAI(oM V SLoVENUI 1983-1997 VERA POMPE - KIRN BRANKO ZAKOTNIK VESNA ZADNII( ł Ż''' Y PREZIVTIIE, BOLNII(OV Z RAI(OM V SLOVE,NUI CANCER PATIENTS SURVIVAL IN SLOVENIA 1983-1997 Avtoľil/Authoľs Vera Pompe - Kirn Branko Zakotnik Vesna Zaclnik s soclelavci/ with contributors Uľeĺlnlki / Eĺlltors Vera Pompe - l(rn Branko Zakotnik Vesna Zaclnik Gregor Serša REGISTE,R RAI(A ZA SLOVENUO oNIoLoŠKI INŠTIruT LJUBLJANA 2003 PREŽIVETJE BoLNII(oV Z RAKoM V sLoVENUl198T1997 CANCER PATIENTS SURVIVAL IN SLOVE,NIA 1983-1997 s sodelovanjem with contľibutions of pĺof. dľ. Veľa Pompe - Kiĺn, doc, dľ. Bľanko Zakotnik Vesna Zadnik pľim. JoŽica Anžič, prof. dr. Maľrja Aueĺspeĺg, pľof. dr, MaĄan Budihna, o1ga Ceĺar' pľď dľ' Tanja Cufeĺ, pĺof. dľ. Andrej Debeljak, as. mag,JanezEľŽen, doc. dľ. Peteľ Fľas, doc' dľ' Marko Hočevaľ, dr.BaharaJezeĺšek - Novakovič, mag' BoľisJančaĺ, doc. dľ. Andĺej Kmetec, dľ. Borut Kľagelj, pĺof. dr. Juľij Lindtneq Elga Majdič, pĺoĹ dľ. Saša Maľkovič, pľim. France Maĺolt, dľ. Janja ocviĺk, pľim. JoŽe Pretnar, pľof. dr. Stane Repše, prof. dr. Zvonimiĺ RudolĹ prim. Boľis Sedmak' doc. dľ. Miha Sok, Maqeta Stanovnik, pľof. dľ. Lojze Smíd, prof. dľ' Boruľ Stabuc, mag. Radka Tomšič, mag. Maqeta Vovk, doc' dĺ. Maĺjetka Uľšič - Vľščaj, doc' dľ. MaÍjaž'ZvĺiÍteÍ in pľim. MiĄanaZumeĺ - Pľegelj' pľof. dĺ. Veĺa Pompe - Kiľn doc. dr. Branko Zakotnik Vesna Zadnik pľof. dľ. Gĺegoľ Seľša pľof. dľ. Maľija Auerspeľg, višja svetnica dr. Cvetka Jakopin - Bilban pľof. dr. Maja Pľimic - Żakelj doc' dr' Pľimož Strojan Monika Fink - Seľša uĺedniki editors recenzenti ľeviewers avtoĺji authoľs oblikovanje clesign fotogľafija photogĺaplry računalniška obdelava EDP analysĺs lektoĺica za slovenščino reader ĺor Slovene pĺevod v angleščino english veľsion pĺlpľava zatisk typesetting izdal published by tisk pľinteclby vse pĺavice pľidĺŽane allĺights ĺeservec1 Samo Rovan JurijModic ZlataPavlič onkološki inštitut Ljubljana Institute of Oncology Ljubljana Syncomp d. o. o. Mojca Čakš Syncomp d, o, o CIP - Kataloški zapis o publikaciji Naľodna in univeľzitetna knjiŽnica, Ljubljana 616-006-036.8(497 4) PoMPE-Kiĺn, Veľa Preživetje bolnikov z rakom v Sloveniji = Canceľ patients suľival in Slovenia :1983-1997 / avtoĺji, authoľs Veľa Pompe-Kiľn, Bľanko Zakotnik, Vesna Zadniks sodelavci, with contľibutors ;uredniki, edirors Vera Pompe _ Kiľn.'. et al.l ; [pľevod v angleščino Mojca Cakš] _ tjubljana : onkološki inštitut, 2003 ISBN 9ó1-6071-33-5 1. Zakotnik, Bľanko 2. Zadnik, Vesna - I. Kírn, Veĺa Pompe - glej Pompe-Kirn, Vera 123642624 zAt Tek vseh ACt This have Slov ha Ía v sPoMlN / IN MEMORY Prof, dr. Božena Raunihar 191+2002 ZAHVALA Te knjige ne bi bilo bľez vseh, ki so vestno pri1av\jalirukave bolezni od leta 1950 da\leinbrezvztrajnega in natančnega dela vseh dosedanjih sodelavk Registľa nka za Slovenijo. ACKNOWLEDGME,M This book would neveľ have been published, had not it been for the perseveľing and conscientious work of all those who have been accuľately ľepoľting Canceľ cases in Slovenia since 1950, as well as of the whole staff of the Cancer Registry in Slovenia. Izbor J Modo Kostni Ne- Ustna Żrelo Grlo,. Pljuča Dojka Jetra.. Sečni KAZALO PREDGOVOR UVOD PODATKI IN METODE Registĺacija ľaka v Slovenui'...............''''''..... Šifľiranje podatkov...... Kakovost podatkov in popolnost ľegistľacije Izbor bolnikov ................... Spĺemljanje bolnikov Metode NAđN PREDSTAVITVE PoDATKoV Pľostata Modo Maligni melanom ..... Saľkomi mehkih tkiv Kostni sarkomi ......... Ne-Hodgkinovi limfomi....... Hodgkinov limfom.......... Akutna limfoblastna levkemija Akutne nelimfoblastne levkemije Kľonična limfocitna levkemija'.'' CONTE.NTS FoRĽWoRD INTRODUCTION DATA AND METHODS.. Canceľ Registľation '" 'b;.;; .. . Data Coding Data Quality and Completeness of Registration. Patients Selection .... Follow-up of Patients .... Methodology ............. DATA PRESEMATION RESUnS AND DTSCUSSTON.. oľal Cavity.... Pharynx Larynx Thyľoid lung....,...,..,.. Pľostate Testis ........... Malignant Meianoma....,,..,.,,, Soft Tissue Sarcomas............. Bone Sarcomas,,,,,,.,............. Non-Hodgkin Lymphoma..... ...... Hodgkin Lymphoma ...,,, Acute Lymphoblastic Leukemia ....., ...... Acute NonJymphoblastic Leukemia ...... Chronic Lymphocytic Leukemia ...... 7 B c) c) c) 10 11 11 1,2 100 103 rc6 109 13 15 T6 19 22 1< 30 35 40 43 47 52 57 6t 66 70 73 /o BO 84 87 91 94 97 5 ľnrŽľĺĺ.;r BoLNlKoV z RAKoM V sLoVENUl 19Í3T1997 Kĺonična mieloična levkemija Multipli mielom Vsi ľaki, vključno s kožnim ZAKLJuČEK SKLEPNE MISLI Chľonic Myeloid Leukemia ........., Multiple Myeloma ....,... ,.....,... All Sites, Including Skin coNclusroN ........ CLOSING REMARKS .......... r21 ,,.,,,...127 6 CANCER PATIEMS SURVIVAL IN SLOVENIA 1983-1997 -- PREDGOVOR ...r1,2 ,..1r5 .. 118 PREDGOVOR Slovenci večkratne znamo dovolj ceniti svojih doseŽkov. Tuj- ci pogosto bolje vľednotijo naše delo in obstoj nekateĺih naših ustanov. Mislim, da je tak pĺimeľ tudi Registeľ ľaka za Slove- nijo in vse pub1ikacije, ki jih skupina stľokovnjakov te sluŽ- be ľedno izdaja, Redno objavijanje podatkov o incidenci različnih vľst ľaka in o pľeživetju bolnikov so dĺagoceno oĺodje nam, zdĺavnikom onkologom, za ocenjevanje uspešnosti našega zdravljenja v pľeteklosti iĺ za načrtovanje zdrav\jenja v pľihodnosti' Moralo pa bi biti nenehen viľ podatkov tudi vsem tistim, ki načľtujejo in odločajo o vseh ukľepih boja pĺoti ľaku' od pĺe- ventivnih in pľesejalnih dejavnosti, do uvajanja novih nači- nov zdľavljen ja z dľagimi zdravili, Nenazadnje bi moĺali biti podatki Registľa tudi osnova zanačľtovaĺje kadrovske poli- tike na področju onkologije. Podatki v tej knjigi odslikavajo pozoľnemu bralcu najĺazlič- nejše vplive narezu\Íate zdrav|jenja. Če jih pľavilno ľazume- mo, bomo v pľihodnje v boju z rakom 1ahko uspešnejši. Podatki kaŽejo, da smo pĺi pĺeŽivetju bolnikov s tistimi ĺaki, ki se večinoma zdĺavijo na onkološkem inštitutu ali specia- liziľanihoddelkih in klinikah Kliničnega centra (npĺ. ĺak ščit- nice, maligni limfomi, sarkomi, geľminalni tumoľji) pĺimeĺljivi zľazvitimidrźavami Evrope. Slabši pa smo pľi preživetju bol- nikov s tistimi vľstami ĺaka, ki se zdľavijo v vseh bolnicah Slo- venije. Ti reztitatikażejo, da je zdravljeĺje uspešnejše, če ga načrtuje in vodi specializirana multidisciplinaľna skupina. Ena- ko se je pokaza\ov tuiih šrudijah. Se veliko bomo morali posto- ĺitizaizobraźevan1ezdravnikovinzatesne jšopovezanostmed onkološkim inštitutom, Kliničnim centľom in ostalimi bolni- šnicami, za tesnejše sode1ovanje med ľazšiľjenim stľokovnim kolegijem za onkologijo in kolegiji drugih stľok in za pľimeĺ- no ozaveščanje javnosti s pomočjo civilne dĺuŽbe. onkologi smo ponosni na naš Registeĺ in smo veseli, da ga imamo. Bľez podatkov, ki so nam jih sodelavci te službe ved- no Spľoti pľipľavljeni posĺedovati, si našega dela sploh ne zna- mo več pľedstavljati. Ponosni smo tudizato,ker ga imamo Že od davnega lela1950 in ker pokriva celotno območje Repub- like Slovenije. Registľi mnogih večjih in bogatejših držav polai- vajo le 2_500/o območja. Samo 9 od20 drtav, ki sodelujejo v študiji EUROCARE-3 se ponaša s 100% zajetjemsvojih stal- nih pľebivalcev z ľegistľom raka. Ponosni smo lahko, da je med njimi ĺ"ldi Slovenija. Hvaležnismo vsem sodelavcem Regi- stľa, ki maľljivo, natančno, a skoraj anonimno opravljajo svoje delo in so nam vedno pĺipravljeni pomagati s podatki in svojim znan1em, Njihovo delo je tako vpeto v vse klinične študiie in objave' FOREWORD Slovenians usually tend to undeľestimate ouľ national achieve- ments. People fľom abĺoad oĺten have higher appreciation foĺ ouĺ woľk as we1l as foľ the activiĘ of our national institutions. I dare say this also holds true foľ the Canceľ Registry of Slovenia and foľ the publications that aľe ľegularly issued by the gĺoup of experts woľking at the Registry. Regu1aĺ publication of the data on the incidence of dífferent CanCeľS and on suĺvival is of supľeme impoĺtance foĺ us, the oncologists; it is a feedback that serues as a tool to assess the efficiency of tľeatment in the past and to foĺmulate future tľeatment plans. These publications are intended to be ľenew- able resouľces oĺ data ĺoľ all who aĺe involved in tľeatment planning and decision-making in fighting cancer, uiz.frompre- vention and scľeening pľograms to initiating new treatment modalities with expensive drugs. The data published by the Registry should eventually selve aS the basis foľ human resource management in oncology. Foľ a caľeful readeľ, the data gatheľed in this book aĺe a ľeflec- tion of diveľse factoľs influencing the tľeatment outcome' If we dľaw sensible conclusions fĺom them, our ĺight against Cancer willbe moľe successftllin the future' These data show that the survival of ouĺ patients with the canceľS (e. g. thyľoid canceĺ' maiignant lymphomas, saľComas' germ cel1tumoľs) that are pre- dominantly treated at health CenteľS specialized in canceľ tľeatment, such as the Institute oĺoncology in Ljubljana oľ some of the depaĺ1ments and clinics oĺthe Univeĺsity Medical Centre of L1ubljana, are compaľable with the survival in the developed countľies in Euľope. on the otheľ hand, the suruival of the patients affected with the canceľs that are treated also 1n otheĺ hospitals thľoughout Slovenia is loweľ than that in Euľopean countľies. These ľesults indicate that cancer treatment can be more efĺective if it is planned and carľied out by a specialized multidisciplinary team, The studies performed in otheľ coun- tries have reached the same conclusion. \ře still need to con- centĺate our effofis in furtheĺ training of ouľ physicians in oncology, in establishing constant cooperation of the Institute of oncology of Ljubljana with the UniveľsiĘ Medical Centĺe of Ljubljana, and the ĺemaining hospitals in Slovenia, in fosteĺing closeľ coopeĺation beMeen Slovenian Board on oncology and otheľ medícal expefts boaľds, and in ľaising public awaľeness thľough non-governmental oľganizations. Slovenian oncologists are Very pľoud of our Registry and extĺemely happy that we have it. Can we imagine how ouľ woľk would go on without the data concuľrently available from the Registry? Moreoveľ, we Can be also pľoud of oilľ Registry because we have it since the distant 1950s and because it cov- eľs the entiĺe ľegion of the Republic of Slovenia. It is woĺth men- tioning that the registries of otheľ biggeľ and moľe pľospelous countĺies than Slovenia coveľ no moľe than 2-50%o of the coun- try region. Only 9 of 20 countries included in the EUROCARE-3 study have canceľ registries that cover 100% ofthe population and it is our gľeat honor to be one of these 9 countľies, We aľe gratefulto the assiduous and caľeful employees at the Registry who are at any time ready to provide us with data and help us with their knowledge. Theiľ share of woľk is thus automatically interwoven with each clinical study or publication. Prof' Marija Atłersperg, Senior Aduiser 1,21, 127 7 >1997 ľnľŽvĺqĺ BoLNIKoV z RAKoM V sLoVĹNul 1 983-1 997 ľoREWoRD UVOD Podatki o pľeživetju bolnikov so kompleksna ocena brene- na ľakav opazovani populaciji. Zrcalijo uspešnost vseh pĺo- gľamov onkološkega Vafstva, od množičnega presejanja in zgodnjega odkľivanja' do zcIravljenja' rehabilitacije in dolgo- letnega spľemljanja zdľavstvenega stanjabolnikov. Na pľika- zano preŹivetje bolnikov z ľakom so vplivali številni dejavniki, ki so povezanitako z boiniki samimi: Staľost, spol, telesna zmogljivost in spľemljajoče bolezni, kot z ĺakom: lokacija in ľazšiľjenost bolezni ob cliagnozi, histološka vľsta, način zdtav- 1jenja. Slednji pa je močno odvisen tudi od oľganizacijeinľaz- poloŽljivosti celotne zdĺavstvene s1užbe. Dobľa oskrba in zdĺavljen1e v eni bo1nišnici sta lahko izbolj- šala pľeživetje tan zdľavljenih bolnikov. Na pomembne1še izbo1jšanje populacijskegapteŹivetjapa sta vp1tvala le, če sta bila dosegljiva večini bolnikov v Sloveniji. Pľičujoča knjiga je drugo obsežnejše poĺočilo o pľeživetju vseh ĺegistĺiľanih bolnikov z ľakom v Sloveniji. V njej so podatki o pľeživetju bolnikov, ki so zbole1i za ľakom v 1et1hl983_97 . Pruo obsežnejše poľočilo smo izdalileta1995 s podatki zazbo- le1e v letih 1963-90 (1). Tako kot v prui, tudi v tej o podatkih ľ azpľ avljajo zdĺ av n1ki, ki zdľ av ijo bol nike z ľakom, T i zďr av - niki so kiľuľgi, ľadioteĺapevti-onkologi' inteľnisti-onkologi in pec1iatrinja. Službujejo na onkološkem inštitutu a1i na klinič- nih oc1delkih Kliničnega Centfa V tjubljani (KC). V tej knjigi jih je več kot v plvi, keľ smo uredniki Želeli, da bi o prikaza- nih podatkih ľazmišlja1ipovsod, kjeľ se prične specifično zdľav- ljenje bolnikov, Namen kn1ige je soočiti se z izsledkl uspehov zďravl1enja v desetletnenr obdobju 1988_97 , jilr pľiĺneľjati z źe chjavlje- nimi izsledkiv prvi knjigi in predvsem z izsledki evlopske ľazi- skave EUROCARE-3, ki obravnava bolnike izlet 1990-94, Y njei je sodelovalo ó6 populacijskih ĺegistľov rakalz20 drźav;ned njimi tudi Slovenija. Naše dejansko mesto v Evĺopi nas včasih opogunri, včasih stľezni, skoľaj veclno panannakate pot, po kateri lahko kon- čen izid zdľavljenja bolnikov z rakom v Slovenrji še izboljša- mo neglede na sicer stalno prisotne izboljšave zdravljenja únov a zdr av ila, ve č j e nro žnosti po m trela, r patients :ific treat- )t in 51% :eatment received ) sufgery 'therapy. rncology ltoľhino- bljana in rin 10%. :ĺ in the The suľ- liguľe 2). )% lower patients ypopha- he peľi- VIRA 1. Šnlicl L, Lešničaľ H' Zakotnik B et al. Radiotheĺapy, combined with simul- tirneus chemotherapy vĺith mitomycin C and bleomycin foľ inoperable head ancl neck canceĺ: pľeliminary repoĺt' IntJ Radiat oncol Biol Phys 1995; 32: 769-75. 2. Zakotnik B, Šnĺd Ĺ, Budihna M et al. Concomitant ľadiotheľapy with mitomy- cin C and bleomycin compared with radiotheĺapy alone in inopeľable heacl anĺl neck canceĺ: final ľeport. IntJ Radíat oncol Biol Phys 1998;41:1121_7 . Lojze šnlid, Marjan Bud.ihna, Branko Zakotnik , Lĺniuersi4l Department of otorhinolałyngologł ancĺ Ceruicofacial Surgety, LIMC, Ljubljana, and Institute of oncologl LjLłbUana Despite a significant impľovement of the suruival of patients with pharyngeal canceľ, the tfeatment outcome has not yet ĺeached a satisfactory level. In contľast to the observed pľogĺess of stage distľibution of the disease in oľal cavity' no impľovement was observed in the pharyngeai canceĺ stage distľibution' Better surviva1is therefoľe pľimaľily due to bet- tel tleatment fegimes. The tľeatment outcome in localized dis- ease did not improve, but an impĺovement was obserued in the patients with regional disease. The ľeason foĺ this impĺove- ment may simply lie in new tĺeatment appľoaches, such as concomitant ĺadio- and chemotheľapy (1,2). I>_Ą4 4>->+ ))-04 ot-/4 75+ 198T1997 PRI'żVET;E BoLNIKoV Z RAKoM V sLoVENUI 1gBT1997 21, LARYNX GRtO LARYNX MKB 8/ICD 8: 1ó1 V obdobju 1983-97 je zbo1e1o za Íakom grla I47 4 moških in 72J źeĺsk, od tega v \etlh1993_97 478 moških in 48 Žensk' Y analizo ni bi1o vključen1h 42 (3%) bolnikov, keľ je bil pľi njih ĺak ugotov1ien šele ob smrti' Med vključenimi je bilo v letih 1 983-87 37 0/o ĺaka glasilk, v letih 1993_97 pa 41 0Á' V opazovanem 15łetnem obdobju se incidenca ĺaka grla ni pomembno spremeni1a' V letih 198H7 jebtla gľobaincidenč- na stopnja 10,2/100.000 moških in 0,7/100.000 žensk, v leÍih 1993_97 pa 9,9 / 1,00'000 moških in 0, 9/ 1 00. 000 žensk. odstotek mikľoskopsko potľjenih pľimeĺov se je povečal s 97 0/o v letih 1983-87 na 990/o v Ierlh 1993_97. Med mikľo- skopsko potĺjenimi je bilo v letih 1993_97 97 0/o pIoščatoce- ličnih kaĺcinomov, 2 0/o neopĺedeljenih karcinomov, 3 pĺimeľi veruko zne ga kaľcinoma, 2 pr imeĺ a źlezne ga kar cinoma in p o en pľimer ne-Hodgkinovega limfoma in leiomiosarkoma. Staľostna poĺazdelitev v ana\izo zajetih bolnikov se je spľe- menila (tabela 1)' V letih 1993_97 se je povečalo število bo1' nikov, starih 65 1et ĺn več. Razšiĺjenost bolezni ob diagnozi se je spremenilra.Y zadnjemobdobju je bilo ugotovljeno več bolezni z ľegionaIno ruzšĺrĺwijo (tabela2). V 1etih 1993-97 jebi\o specifično zdravljenih96% bolnikov. Prvo zdravljenje je bilo v 530/o obseva\no,v 350/o kiruľško in obsevalno, v 10% samo kirurško, v 20/oobsevalno in citostat- TABELA l: Grlo. Bolniki vključeni v aĺalLzo po spolu, starosti in obdobju opazovanja, TABIE l: Larynx. Patients included in the anďysis by sex, age and peľiod of obseľvation. staros( ob djagnozi/Ágť at diagnosĺs Obdoble/ Skupaj/ Period All -14 83-87 8Ug2 - 93_97 012345 Ieta/years S[ll(A l: Relatlvno petletno prežlvetje bolĺrikov z rakom gľla, zbolelfü v letlh l983-L997 po obdobju điagtrcŻe, ľ|GURĽ l l Relatlve five-yeaľ suľvival of laryngeal cancer patients diagnosed in the period 198}1997 by period of diagnosĺs. In the peľiod 1983_97 , a total of 7,474 male and I23 ĺemale patients weĺe diagnosed with laryngeal canceĺ; of these patients, 478 males and 48 females weĺe diagnosed with this Canceľ in the ĺive-yeaľ peĺiod 1993-97. In 42 patients (30/o), this cancer was diagnosed at death; these patients weľe therefoľe not included in the analysis. In the peľiods 1983_87 and 1993_97 ,the glottic canceĺ Was diagnosed in ľespectively 370/o and 4I0/o of the patients inc1uded ínto the analysis. In the observed 15-yeaľ peĺiod, the incidence of laryngeal can- cer did not significantly change. In 1983-87, the crucle inci- dence ĺate was 10.2/100,000 in males and 0.7/100,000 in females, wheľeas 1nI993_97, it was 9.9/100,000 in males and 0.9/i00,000 in ĺemales. In comparison to 198}€7, the incľease of microscopically con- fiĺmed cases in the peĺiod 1993_97 was20/o, i. e. fĺom 970/oto 990Á.In the yeaĺs 1993_97 , the peľcentage of squamous cell and non-diffeĺentiated ce11 caĺcinomas in the micľoscopical- ly confiľmed 1aryngeal CanCerS w as 97 0/o and 20/o, ľespective- 1y; in addition, 3 cases weľe vemlcous carcinoma, 2 cases weľe adenocarcinoma, 1 non-Hodgkin lymphoma and 1 leiomiosaľ- coma. The age distĺibution of the patients included into the ana1y- sis has changed (Table 1). In the period 7993-97, the num- TABELA 2: Grlo. Bolnlki vključeni v anal1zo po spolu, stadiju bolezni in obdobju opazovanja. TABIE 2: Iaryĺx. Patients included ln the analysis by sex' stage aĺrd peľiod of obseľvation. Stad!/Stagc obdobje/ Skupaj/ omejen/ Razśirjen/ Rauejanl Neznan/ Period All Lĺlcalized 9t, Rľgional lb Dislanĺ !i, Unknuwn 9'o 100 80 GRtO TABELA 3t TABIE 3: Obdobte/ Peĺiod 'É .Ł äeo 'Đ o ;Ň 40 o. 20 198J-87 1988-92 199y91 Obdobje/ Period 1981-87 1988-92 199T91 80 G .Ł 56o .F o .t ,ľi 40 tr o. 20 100 STIKA zbolellh RGURT, nosed sko in ljenje nl, v V letih je kot staľejši źĺvetje (slika 1544 45_54 55_ó4 65-14 75+ Moški Nĺnles 198I87 198&92 1993-97 Ą61 508 4ó5 30 43 44 124 111 93 56,6 48,0 54,6 0,7 L,2 1,1 1,0 2,0 0,0 179 202 17t, 84 104 121 44 48 32 Ą61 508 4b) Moški Males 198H7 i988-92 199T97 183 39,7 2Ą8 48'8 206 4Ą,3 Ż61 244 254 14 10 0 3 () 5 Izsledlĺ pľečno )e za rt 56,30/o' in pľi ž kih je t Zenevt pĺovin Ženske I'cnialcs 1983-87 198&92 1993-97 33 42 46 0,0 0,0 2,2 0 0 1 18 20 28 33 42 46 1 1 4 4 7 14 16 17 ú Ženske 198}87 Feĺirles 198&92 1993-97 54,5 47,6 ó0'9 15 45,5 0 0,0 22 52,4 0 0,0 17 37,0 0 0,0 22 cANcER PATIĽNTS SuRVIVAL lN SLoVENIA 1983-1997 LARYNX 6Rto TABELA 3: Gľlo. opazovano in ľelativno petletno prežlvetje po spolu in obdobju opazovanJas 95olo lnteľvalomzaupaĺja(tZ). TABĹE 3: Larynx. obseľved and relative five_yeaľ suľvlval by sex and peľiod ofobseľvation wlth 950/o confidence intefvď (CI). obĺlobje/ Periocl M.ški Leta/Yeaľs letal\tars 1 vlct 3 tzlct 5 tzlct 1, TZI] 3 IZII 5 TZICI 1981-87 198&92 199y97 (73-81) (7Ŕ4) (7&8ó) (4&58) $Á4) 6947) 0HĐ (45-53) (4G56) (77-99) $543) (7Ł96) $149) (41-77) $Ŕ4) (5]-8t (40-70) (4Ł74) 43 49 51 53 60 63 71 80 82 88 69 85 73 62 70 69 55 59 Relativno / Relative (9/o) Moški/Males Leta / \'ears Ženske/Females Leta/\tars Obdobie/ Peĺiod I lzlc\ 3 Izlü 5 |zlc| 1 ruICI 3 TZICI 5 TZICI Dm gfla, patients iis. 1t83-87 1988-92 199Ť97 51 57 ó0 59 66 69 80 83 84 0Ŕ4) (79-8Đ (80-88) $Á4) (ó1-71) 6Ł74) (40-)()) 6242) 6Á6) (7&100) (t5-8t (7G96) 69-9r) (49-8Đ (t9-87) $7-91) (43-77) (49-81) 89 70 8ó 15 ś5 73 74 ó0 65 100 1973-77 197H2 100 i female rf these vith this rs (3%), ts were 1983ą7 ectively sis. iealcan- de incĹ ),000 in łles and rlly con- l 970/o Ío ous cell :opical- rective- ;eS weÍe rmiosar- 3 analy- re num- , stadlju tage and eznan/ rknoĺvn ľo BO .Ł ä0o 'Đ I 'S 40 o. 20 80 .: ;b0 's o ;Ň 40 o. 20 1983-87 obdobje/peĺiod 198U92 1993-97 0 3 4 5 14 10 0 3,0 2,0 0,0 SIIKA 2l Relativno petletno pľeživetje bolnikov z takom grla, zbolelih v letih 197T1997 po stadiju in obdobfu dlagnoze. tlGURE 2: Relative fľe_year suĺvivďof laryngeal canceľ patients dĘ- nosed in the period 197Tt997 by stage and peľiod of dlagnosls. sko in v 17o kiruľško, obsevalno in citostatsko . Prvo zdtav- Ijenje se je pričelo v 55o/ona onkološkem inštitutu v Ljublja- ni,v 300/o na Kliniki za otorinolaringologijo KC, v 14% v SB Maľiboľ. V 1etih 1993_97 1e bilo ľelativno petletno preživetie za7 o/oveč- je kot v letih 1983-87 (slika 1)' Pľeživetje se je povečalo pľi omejeni in ľazšiľjeni bolezni (slika 2),Preźivetje je bilo pľi naj- staľejši skupini 2_kra[ manjše kot pĺi najmlajših. Majhno pľe- Živetje v starosti 45_54let je najveľjetneje posledica slučaja (slika 3). Izsledkištudije EURoCARE-3 kaźejo,da je bilo v EvÍopi pov- prečno StaÍostno stan dardlzirano ľelativno petletno pľeživet- je za raka grla pri moških 59,4Vo (57,2-ó1,6) in pľi ženskah 56,30/o (5I,841, 1), v Sloveniji pa pľi moških 55,1'0/o (46,345,5) in pri ženskah 78,4%(54,+1'12,ý). Največje pľeŽívetje pĺi moš- kih je bilo 72,)o/ov Švici(samo v območjih ľegistľoV Basla in Zeneve ) in pri ženskah 84,3o/o v Španiji (samo povprečje za pľovince: Baskija, Mallorca, Navaĺľa iĺTarragoĺa). ob tem letalyeaĺs SIIKA 3: Relativno petletno pľeživet|e bolnlkov z ľakom grla, zbolelihv letih t993-|997 po staľostl. ľ|GURE 3: Relatlve five_year suľvival of laryngeal canceľ patients dlagnosed in the peľiod 1993-1997 by age. beľ of patients aged over 65 was higheľ. The stage distribu- tion at diagnosis a1so changed. In the last obseruation peľi- od, a higheľ peľCentage of patients with regional disease was observed (Table 2). In the peľiod 1993-97,)60/oof paĺienlsunderwent specific treat- ment. Radiotheĺapy was applied as pľimary tĺeatment in 530/o of patients, in another 350/o of patients, the pľimary tľeat- ment was surgery combined with ĺadiotherapy,1'00/o under- Went sufgery alone' 20/o received ľadio- and chemotheľapy, andI0/o sufgery, radio- and chemotheĺapy. oĺthese patients, 550/o recęived primary tľeatment at the Institute of oncology Ljubljana, 300/o atthe Depaítment of otoĺhinolaryngology and Cervicofacial Surgery, UMC, Ljublj an a, 270/o aÍ" the Depafi ment of Maxillofacial Surgery, UMC, Ljubljana, and 140/o in the Geneľal Hospital in Maribor. The relative five-yeaĺ suľival was 7% higheĺ in the years 1993_97 than in the yeaľs 1983_87 (Figuľe 1)' The suruival increased in the patients with localized and regional disease (Figure 2). 0,0 0,0 1 2,2 omejeďlocalized ĺazšiĺ1en/ĺegional - vsi/alj Moški - 1544 45-54 ))-04 65-14 75+ Moški- )83-lcĐ7 PREŽNET'JE BoLNlKoV z RAKoM V SLoVENĺI lg8T1g97 23 LARYNX moľamo upoštevati dejstvo, da je v Sloveniji odstotek pľog- nostičĺro ugoclne1šega ľaka glasilk v pľitneljavi z ostalinr gľbm manjši kot v zahodĺrih in seveľnih delih Evľope. Lojze Šmkt in Marjan Bu,clihncł, Brcłnko Zcłkohlik , Kliłlikcł za ĺltoľinolaringologijĺl in ceruikclfacialno kinłrgijo KC iłl, on kĺioški inštittlł Ij ublj alla Razpoĺeclitev bolnikov glede na stadi1 ob cliagnozi Se V opJ- Zovanem obdobjtr ni pomembno spľemenila' Toĺej lahko lzboljšanje pľeživetja pľipišemo pľeclvsem boljšemu zdľav' ljenju. Zanjmiv ĺl je, da se je izid zdľa.vljenja najbolj izbo1jša1 pĺi bol- nikih z omejeno lloleznijo. Način kiľuľškega zdravljenja lĺar' cinoma gľ1a se v opazovanem obdobju pľaktično ni spľemenil, spľemenil pa se 1e ĺežirn obsevanja bolnikov z zgodnjirn kaĺ- cinomom glasilk (1'l. Spľemenilo se je tudiľazmeĺje: kaľcinom glasi1ke naspľoti kaľcinomu ostalih poclklkacij gľla v pĺid pľog_ nostično ugodnejšemu kaľcinomu glasilk (2). In the oldest group oťpatients, a two-folcl 1oweľ survival was obseryed than in youngeľ patients' A poor suruival in the age gľoup of 45_54 years lnay be a sheeľ cĺlinciclence ' (Figtrľe 3l Accoľding to the EIIROCARE-3 study ľestllts ťoľ the peľi- od 1990_94,in Euľope' the age-stanclarc1ized ľelatlve suruival ľate of the patients With laryngealcancerwas 59.49ó (57 'Ż4L6) in nrale pafients anclin ťenrale patients 56.39ó (51.Bł1.1), while in Slovenia, itwas 55.19ó ('í6.Á5'5) iĺl ĺnale patients and78.40l, Ő4'+112.6) in femalc petients, The highest lates of 72.99io ancl of 84,30Á weľe observecl in ĺna1e patients in Switzeľland (on1y registľies ln Basel and Geneva) and in female patients in Spain (only in pĺovinces: Basquc Countľy, Malloľcll, Navaľra ancl Taľľagona). At this point, it shoulcl be taken into account that the pelcentxge of the gkĺtic canceľ in ľelation to the supľaglottic canceľ is loweľ in Slovenia t1ran in Westeľn and Noľthcĺn Euľopean Countľies. Ĺqze šnful, MaĘan Blłĺlillll,cł, Brĺłllko Zakotllik, (hiltlers iÜl Dep(łrtlnent ĺf otorhinolcłryngolo5!1l ĺłnd CeruicofaciaL Surgełry, tĺMC, Ĺjuĺ:ljaľlcl, ancl lĺlstittłte of oł'Lcologl ljubLjana Thc distľibutiĺln of the patients by the stage of clisease et diag- nĺxis did not cliange significantly in the observeclpeľlod. Thus, the iĺnpĺoved survival ľates coulcl then be well attľibuted tĺl the accottnt of betteľ treatment results. It is interesting that the tľeatment outcome impľovec1 the most in the patients with localized disease . In the observed peri' oĺ1, no innovatiĺlns oÍ suľgical tĺeatment of the laryngeal can- CeI Weľe introcluced, wheľeas the tľeatment regime in ľac1icĺherapy ĺoľ the patients with eaľly glottic canceľ was changed (1). Moľcover, the ľatio of glottic canceľ vs. otheľ laryngcal caľcinomas alsĺl changed in favclr of progrrostical- ly lnĺ,rľ fuvorlblt' glottii' t'lrt'inoml (2l. šČrĺľ.lIcł SCIT THY B MI(B VIRA 1. Lesničaĺ H' Šmicl L, Zakotnilĺ B. Eally glottic canceľ: the infhrerrce clf pri- nielY tleatltlent on v()ice pĺeseffetion. IntJ Raĺliat oncol Biĺĺ Phys' 199ó; 36:1025_3Ż' 2' Porltpe - KiIrr V' Epidetliological f'eatures of laryngeal canccľ in Slclvenia' Zclĺav VestIr 20()2;7I: Suppl. III: 59'ó3. V ĺĺxlc inbŻ}: V rrnali njih ľaJ V ĺlpal l.licc v( r,.1/10 l,()/10r otlstoĺ s 95%, slĺlps! cittĺllĺ1 lilľcin nih lĺa lN o o. -- 40 100 80 20 20 nĺl L0wn 1973:77 t97WZ 1983-87 obdobje 198U92 r99J-97 SLIKA 2: Relatlvno petletno pľeŽlvetie bolnlkov z rakom pliuč' zbolellhv letih 1973-1997 po stadiju ln obdobiu dtagnoze. odstotku (47 Vo) samo obsevalno, v 220/o samokirurško, 12 % samo citostatsko, v 1.1% obsevalno in citostatsko, v 60/0 kiruľško in citostatsko. Y 590/oso pĺičeli s pľvim zdravljenjem na onkološkem inštitutu v Ljubljani, v 220/o na Kliničnem oddelku zatoÍakaIno kiruľgijo KC,v I20/o v Bolnišnici Gol- Lik, v 60/0 v SB Maĺibor inv 1'0/o na Kliničnem oddelku za nevľokiruĺgijo KC. V letih 199}97 je bilo ľelativno petletno pĺeŽivetie za3i/oveč- je kot v letih 19B3-B7 (slika 1). Pľeživetje se je povečalo pľi bolnikih z omejeno boleznijo. Pľeživetje je bilo največje pľi bolnikih in bolnicah, mlajših od 45Iet (slika 3)' Izsledki študije EUROCARE -3kaŹejo, da je bilo v Evľopi pov- pľečno staľostno Standaľdiziľano ľelativno petletno pÍeživet- jezarakapljučpľimoških9,B0/o(9,Ę10,1)npľiźenskah9,90/o (9,ŁIO,4),v Sloveniji pa pľi moških 8,4 0/o(7,2_9,7) in pľi žen- skah9,5o/o (7,Ł12,I), Največje preživetje pľi moških je bilo 74,Io/o na Tiľolskem v Avstľiii in pľi ženskah 1'6,4o/o v Švici (samo območji ľegistľov Basla in Żeneve). 197T77 197H2 1983-87 period 198U92 1993-97 I|GURL 2: Relatlve five_year suľvlvď of lung canceľ patlents dtag- nosed ln the pedodl97T1997 by stage and pertod of dtagnosis. In the period L99T97 ,950/o oť patiens underwent speciÍic treat- ment, The highest percentage of tľeated patients had micľo- cellulaľ cafcinoma (79o/o) and the lowest peÍcentage (66w adenocarcinoma. Radiotherapy alone was applied as pľimary treatment in the highest percentage of patients(47w, in anoth- er 22o/o of patients, the primary treatment was suľgery alone' 12% ľeceived chemotherapy alone, 11% ĺadio- and chemotheľ- apy, and 67o undeľwent Suľgery and chemotheľapy. Pľimary tľeatment was staľted at the Institute of oncology Ljub\1ana in 590/o of patients, in 220/o at the Department of Thoracic Surgery, UMC Ljubljana, I20/o in the University Clinic of Respiratory and Alleľgic Diseases, Golnik, 6% in the Geneľal Hospital in Maľiboq and 10/o at the Depaĺtment of Neuľosuľgery, UMC tjubljana. The ľelative five-year survival ľate was 3% higheľ in the years 1993_97 than in the yeaĺs 19B3_B7 (Figure 1), The sur- vival increased in patients with localized diseases. The high- est survival was observed in male and female patients undeľ 45 years (Figuľe 3). i9 )0 Vo ;2 3,9 4,7 4,6 9,2 6,2 5,5 Moški _ Males omelen razšiĺjen razsejan vsi localized - 1ęgi6n2[ - distant - all Ženske - Females ŕ.1997 PREŽNE'IIE BoLNIKoV z RAKoM V sLoVENUl 1g83-'lgg7 3t LUNG Nklšlĺi _ N'ĺlrles r5-44 +t-t4 -*** 55-64 -6574 _ 15+ 100 tt0 Đ b() .Ż )N o- . +(l 100 ĺ]0 o0 40 20 = Žerrske _ Fenlales PLJuČA vselll III vrli ttrcli 7;1i'11o11 sv()ic 1la bĺllcztri. kĺltnllini stltilĺĺlv 20 .funcz E V nĺlce1ičnim ĺalĺĺlm III. in IV. steclija c1ĺlbiva kelnoteľapijĺl z nĺlvejšimi in clľaž;imicitĺlstatilĺi (10, 11)' I(ruńko zdĺav1jenje se Y o1nenienern olxlollju ni bistveno sple- menilo. Nelĺoliko večje ľelativno pĺežlvet1e v zaclnjeln petlet' nem obclobju bi silahlĺo ľlzlaga\is lĺonbinilaniln zclľavljenjem mlajših llĺl]n1lĺov z neclľĺtlllrĺlceličnitrr ľlkĺtm pljuč, pľecl- ycllrs ľIGURE 3: Relative five_yeaľ suĺvival of lung canceľ patients diag- nosed in the period 1993-1997 by age. Accĺlľcling to the EURoCARE-3 stucly resu1ts fbr the peri- ocl 1990-94, in Ettĺope' the age-standaľclizecl ľelative suruivll ľate of the patients with lLlng Canceľ WllS 9.89ó (9.Ł10.1) in male patients anclin felnale patients 9.1)l/ro,4-10,4), while in Slovenia, it was i1.49ó (1,2-9,7) in male patients ancl 9.5 (l .4-f2.1) in fcmalc pxtients. The highest rates of 14,19d ancl ĺlf 16.49lu wcrc ĺlłlselvec1 ľespectively in male patients in Tyľol in Austľil ancl in felnele petients in Sr'vitzeľlancl tĺlnly ľegistt'ies fľom Basel ancl Geneva). Aĺlclrej Debeljak, The [ĺłliueĺ'siĺ.y Clinic oJ'Respirator'y ĺuuĺ Alleľgic f)isea ses, (}ohlik Lung canceľ incideĺlce trencl depencls ĺln stnoking habits pľe- vlliJing in tllę l'lltst tlľt'lttlęs ĺ l. 2)' Thc incľcasccl peICťntegc ĺlf tniclĺlscĺlpicelly cĺxrtiľmecl lung canccI Cases cĺlrrelates with the intľocluctiĺln of the impľovecl biĺlpsy methocls in peľiplreľal tLuIoľS that can only be seen ĺln X-ray 1lut ĺrĺtt by flexible bľĺlnchoscope. in tlrcse patients, we usually peľfĺlľlrr bľĺnchĺlscclpic nccclle espiretitln biopsy ĺlf peľipheľal tunroľ ancl of mecliastinal 1ymph nodes (3). In s()lrre fale cases, bľonchĺlalveĺllaľ lavage of tlre bľonchi, cĺlnclucting kl thc periphelal tunrĺlľ, tnay lle helpftrl (4). Whcn brĺlnchĺlscĺlpy firils in cliagnĺlstics, we Can use transthĺlľacic nccdJc lrspiľlrtit ln llit lpsy (5 )' The cletcctĺln of eaľly stages ĺlf lung cancer has nctt been suc- cessfill so far. This ĺnly exphin tlre ľelsĺln wlry lr_rng Canceľ is mĺll'c ĺlftcn clctcctcd in aclvancecl stages. In ĺlĺcleľ tĺl iltlprĺlvc thę detectiĺln adju- e used ostop- to the rd with eľ inci- I wish ;m, but e judg- ics and icance d diffi- rowing y think e diag- rľefully :ussed; ,ects of :ryout- :eľwil1 majoľ- rcľtive rctully, ratients ĺaging s, com- ĺeleton hy and l. \íith )st sen- y treat- y. The ,e local nt plan stoper- Jly any ĺoľable r classi- ąl. And eľation ention, DOJKA BREAST MKB 8/lCD 8:174 V obdobju 1983_97 je zbolelo za ľakom dojk 96 moških in 70,324źensk,od tega v letih 1993_97 46moških in 4041 žensk' Y analizo ni bilo vključenih263 Q,5W bolnic, keĺ je bil pĺi njih ľak ugotovljen še]e ob smľti. Y opazovanem 15łetnem obdobju se je incidencaľakadojk večala. V letih I9B3_B7 je bila groba incidenčna stopnja 0,4/100.000 moških in 57,9/100'000 žensk, v letih 1993-1997 pa 1/100.000 moških in 791100.000 Žensk, odstotek mikľoskopsko potĺjenih pľimeľov je bil v letih 198}€7 97 0/o, v \etih 1993_97 pa 96 0/o. Med mikroskopsko potľjenimi je bilo v letih 1993_97 99'/okarcinomov, ! primeľov ne-Hodg- kinovih limfomov in 4 primeri fiioidnih cistosarkomov. Staĺostna poľazdelitev v analizo zajetih bolnic se je spľeme- nila, v letih 1993_97 je bilo zajetih več staĺejših bolnic (tabe- la 1). RazšĘenost bolezni ob diagnozi se je Ie malo spľemenila, V zadnjem obdobju je bilo v omejenem stadiju bolezni odkľi- tih samo za 3 0/o v eč primerov bolezni kot v pľve m (tabela 2), Y |erĺhl993_97 je bilo specifično zdrav\jenih97 7o bolnic' Prvo zdravljen|e ie bilo v 17 % kiruľško in citostatsko, v 1'60/0 samo kirurško, v 15 7o kirurško in hoĺmonsko, v 10% kirurško, obse- valno in citostatsko, v 9 % kiruĺško in obsevalno, v 9o/o samo hoľmonsko, v ó7o kiruľško, obsevalno in hormonsko, v 6% kiruľško, citostatsko in hoľmonsko, v 4% kiruľško, obsevalno, TABELA ll Doika. Botntkt vključenl v analizo po spolu, staľostl in obđobju opazovanja. TABLE 1 l Breast. Patients included ln the anďysls by sex , age aĺd peľiod of obseľvatíon. Staroĺ ob diagnozi/ Age at diagnosis Obdobje/ Skupaj/ Period All -14 8H7 8&-92 - 93_97 012345 leta/yearc StlKA l: Relativno petletno prežlvetje bolnlkov z ľakom dojke, zbolellh v letlh 1973-1997 po obdobiu diagĺoze. ľlGURf, l: Relative five_yeaľ suľvlvď ofbľeast cancer patients diag- nosed in the peĺoďt97T|997 by pertod of diagnosis. In the peĺiod 1983_97 , a total of 96 male and 1'0,324 fema\e patients weľe diagnosedwith breast canceĺ; of these, 46ma\es and 4,041' females were diagnosed in the peľiod 1993_97 .In 263 patlents (2.5w, bľeast canceľ was diagnose d at death; these patients were theľefore not included in the analysis. In the obseĺved 15-year peĺiod, the incidence of this canceĺ was incľeasing. In I9B3_87, the crude incidence rate was 0.4/100,000 in males and 57.9/100,000 in females, whereas in 1993-97, it was 1/100,000 in males and 791100,000 in females. The peľcentage of the micľoscopically confirmed cases in 1983-87 was 970/o, wheľeas in the observation perĹ od1993_97 ,itwas960/o' In the years 1993_97 , the peľcentage oľcarcinomas in the micľoscopically coďiľmed cases was 99%; 9 cases weľe non-Hodgkin lymphomas and 4were phylloid Cytosaľcomas. The age distribution of patients included into the analysis has changed. In the peľiod 1993_97,the numbeľ of elderly patients included in the analysis was higher (Table 1). The stage dis- tribution at diagnosis slightly changed. In the last observation peĺiod only a 3% higher peľCentage of patients with localized disease was observed in compaľison to the first obseruation peľiod (Table 2). TABEtA 2l DoJka. Bolniki vključeni v ana|izo po spolu, stadiju bolezni in obd obJl opazov anja, TABIĽ 2: Bľeast. Patlents lncluded ln the anďysis by sex, stage and peľiod ofobseľvation. Sudij/Stage i00 80 .Ł Ł a60 'Ě o .e ,ti 40 o. s 20 1544 45-54 5544 65-14 15+ Obdobje/ Skupaj/ Omejen/ Ra*iĺjen/ Razsejan/ Neznan/ Peĺiod All Localized 0k Regional % Distánt % Unknown 7o Males Moški 198!87 1988-92 r99T97 Moški Females 198fr7 198U92 199T97 19,0 17,2 21, 'Ô 45 4 6 18 8 10 13 2 2 7 0 3 4 Males 6 11 14 21. 29 45 10 T3 25 28,6 37,9 31,1 4,8 0,0 Ą/,0 44,8 55,6 Females 1983-87 2762 1988-92 3342 1993-97 3958 1310 1539 1798 117 8ó1 945 432 531 565 660 716 843 40,4 42,2 43,5 388 ą)) 594 505 712 1011 198347 2762 198U92 3342 't99T97 3958 111ó 1410 1121. 47 '4 Ż95 10,7 41 1'5 46,1 339 10,1 54 1,() 45,4 397 10,0 42 1,1 ľnľŽvryr' BoLNlKoV z RAKoM V sLoVENuI 1983-1997 35 ,83-1997 BREAST TABELA 3: Dojka. opazovano in relativno petletno pľeživetje po spolu in obdobju opazovaĺja s 95olo inteľvalomzallpaĺja(IZ). TABLE 3l Bľeast' obseľved and relative five-yeaľ suľvival by sex and peľiod of obseľvation with 950/o confidence inteľval (CI)' Opnzovanĺl/()hscľeĺl (! ll) DOIKA Za r3lirl cl 04,Ť75l skrh o5,t 86,Ą'I',lv Navllľľlt Moški/ 1\ĺlllts Leta/\t,rľs Ženske / }'tnlaLcs Ĺt'ta/\'elľs 0bcIĺlllje/ Pcľiĺlil 1 Vli 3 rzl(:t 5 rzl("r 1 lzl(.t 3 tzl(') I IZI(,1 1981-87 1t8ti 92 1991,97 íl ó0 64 70 13 15 ĺJ8 90 90 33 55 48 67 8(j 89 (,1Ĺtr8) (71-99) (80-9ri) (21is) (55-ĺr9) (41-71) (t2-54) (3F74) (]3 ó3) (87,89) (ll9-91) (89- l) (i8,72) (71-7t (1Ą T6) (5Ł58) (58{2) (tl,O 4J '1) 56 Tanlĺĺ (, Rclativno/ltclatiľc (li) ]\'ĺoški / i\ĺlrlcs Leta/\'errrs Žcnske / ]lelllllcs Lcĺa/\'trn Obclobje / Peľiĺxl 1. Vl ('t 3 rzl (,1 5 IZI(:| L VIC.I I IZIC <, lZl{'I 198j-ri7 1988-92 1993,97 (50 94) (80-100) (80-1 l:)rt (2(Ftl0) (jĺ]_100) (4Ĺ78] (1&7ô) {41,95) (40 7(i) (s9-91) (et-93) (91-9]) (/4 /h) (77-79) (79-81) (i1-63) (j7 ó9) 0o-74) 62 ó8 f) 15 78 81 90 9Ż 92 Ą7 71 58 53 84 (;Ż 12 90 9Ż 100 i(x) 1.544 45-54 55-64 65,74 75+ Pľi žctrsl nc ill 1Jz ľej(le nis Žeĺlsk (tl jlttclrl s ohcl, rhiu bĺllczni, gľlĺ.s1ĺih Glcclc n, stikĺ: ľal 1 0'ĺ iclstĺ llĺllnic,; Celllí' ZC Zllllnjša ljcnr let zclľlvljel ltbsĺl1lttl ka í-leti pĺĺĺlrŽe' ljcrrjl nĺ votcm št'cvilne sistelns: l]ť1]JJ sŕ iz1loljša: iltltľaci} lctr 199 1)ľeg1ec gl z,tIra 7, ľllzšil1l nijo Ve 7, nęgat ni surist hĺlľlnol' ]lĺlľmol lĺĺl jc bi lrilnimt l'u plve ()hľabr scjano ce sice Z LIVCd} ĺ]i, takĺ clrevite ()lneieÍ' ]iĺlvitih z (nlej l)ĺeŽivt mlajših ĺJ0 E ? a60 'Đ o o. 20 ti0 F .a a Ź ô() 'F a 'Đ 40 o. 'Ż() Ženske - Fenleles 19t]3_ĺ]7 ĺlbclobjt'/pc'ĺiĺxl SIIKA 2: Relativno petletno preživetje bolnĺc z rakom dojk, zbolelih v letih L973-1997 po stadiju in obdobju diagnoze. ÍlGtlRE 2: Relative five-yeaľ suľvival ofbľeast canceľ patients diag- nosed in the period 1973-1997 by stage and period of diagnosis. Citostatsko in horĺnonsko ,v 20/o salno Citostatsko, v 2 % obse- Valno, citostatsko ilr hoĺmonsko, v 2 9ó citostatsko iĺr obsevalno tn v 10Á citostatsko in hoľmonslĺo. y íIVoSo pľiče1i s prvim zdravljenjeĺn na onkološkem inšti- tutl"r v Ljubl1arrt, v 17 0/o v SB Maľiboľ, po 7 0/o v SB v Sempetru pľi Novi Goľici in v Ce1ju, v 4o/ov SB v Novem mestu, v 2% v SB v S1ovenj Gľadcu in v dobľem oc1stotku v Bolnišnici za Ženske bĺl1ezni ln poľoclnišfvo V Postoini. PosameZne bolnice So pličele s pffim zclľavljenjem še na Kl1ničnern ocldelku za nevľokiľtlľgiio KC, Kliničnem oddelku za abc1ominalnĺl kiľuľ- gijo KC in v clrugih splošnih bo1nišnicah S1ovenije { l %)' V letili 19%-97 je bilo ĺe1ativno petletno pľeŽivetje za 100/o večje kot v letih 19B3-B7, razlike v 1-3 letneĺn pĺeživetju pa so bile maĺrjše (slika 1). Pležrvetje se je povečalo pľi vseh sta_ clijlh boleznl(slika 2)' Pr'eživetje je bib pĺi staľih 75 1et in več za l5%l1naniše kot pľi mlajših (slika 3). Izs1cc1kištlldije EUROCARE-3 liaŽejo, da je bilo v Evľclpipov- plečno stŹlľostno stanclaľcliziľano l'elatlvno petletno pľeživetje leta/yeurs SL|KA 3l Relativno petletno preźivetje bolnic z ľakom dojk, zbolelih v letih L993-1997 po starosti. ľIGURE 3: Relative five-yeaľ suľvíval ofbreast canceľ patients diag- nosed in the period 1993-1997 by age. Females In t1rc peľiccl 19%-97,979ĺ of patients unĹ1efwent specific tftjet- ment. SurgeÍy encl chenclthelapy Wcrc epplied xs pnlmry tľeatlnent in I70/o, in 1'60,/ĺl of petients Suľgery only, in 159'o of paticnts the pľimary tľcatment WaS suryery ancl hoľtłrĺlnal thcľ- epy, 109ĺ ľeceivecl sllrgcly' fecli()- ancl chcmrltheľapy, 99ó Llnc1elwent su ľge1y anc1 ĺacliotheľ lpy, 90io l eceiveĹl hoľllĺln- al theľapy aklnc' 6% undel'wcnt Sllĺgery' rac1io- and hoľmonal theľapy, ó1{ unclelwcnt sul€eľy, chemotherapy end h()l' 1n()nal theľapy, 49{l ĺeceivec1 Sulgery' ľacli()', chcm()- encl hoľ- tnĺlnal thelapy, 2-0'1' clrenrĺltheľapy <'lnlly, Ż|\/l ľacliĺl- ancl chctlrothcľapy , 2|:'ia reclĺĺl-, chenĺltherapy encl hoľmonal theľ- apy, ancl 19ó chemĺr ancl hĺlľll-lonal tlrerapy. Primary tľęetmęnt was startecl at the Instittlte oť oncolĺlgy LjLrbljana in 61% of paticnts, it l7o/o in the General Hospital in Maľihĺlr, in 70łl ĺnthe Genęral Hĺlspitals Šempeteľ pľi Ńovi Gĺlľici encl in Cclje, iri 4jĺ in thc Gcneľal ľIĺlspital ĺlf Nĺlvĺl tl]ťst()' ill 2l1, in thc Genęral Hĺlspital ĺlf Slĺlvenj Graclec ancl iĺl 19í, itl thc LIĺlspital ĺlf Pĺlstĺljna. A few patients {all ĺlgctlr- 1973-77 1978-82 7988 92 1993-91 0 'Ż 4 ĺĺrlejen/lĺ lcelizccl ĺazšiĺjen/ľegiĺlnlrl ĺurzsejan/clistlrnt **-- vsi/ell Ženske - Fenl:rles 36 CANCER PATIENTS SURVIVAL IN SLOVE,NIA 1983-1997 PREZlVľ BREAST ). Za nliJ (l()jk pľi moških 74,40/o(68,5Ą0,9) npriżenskah74,80/o fr [+l s.ll,, sloven1i pa pri moških 57, 4Vo (37,5Ą8) npľi Žen- )i..ň oĺ'ĺ,rĺ ĺ63,I48,il' Največje pľeŽivetje pľi moških je bilo ä,ĺ]:, u Špeniji (samo na območju provinc: Baskr1a, Mallorca, Ňu*n, in Taľľagona), pľiŽenskah pa8l,60/o na Svedskeln. Tania Cĺłfer, oll.kološki inštitut Ljubaana Pľi Žtnslĺah in pri moških se ľazĺneľje med deležem omeje- ne in ľazširiene bolezni v 15Jetnem opazovanem obdobju sko- iaicl,r ni splelnenilo' Śe vedno je pľi več kot polovici slovenskih iensL ĺtábela 2) bolezen odkĺita šele v ĺazšiĺjenem ali ĺazse- ianent stadiju bolezni' Zaskĺbljujoče je, da v opazovanem äh.l,']''1u ni bilo večjih pĺemikov k zgodnejšemu odkĺivanju bolczni, keľ se 1e prav v letih 1993-97 povečalo število mamo- gľafslĺih centĺov v drźavi. Glecle na nespremenjeno stanje na podľočju zgodn1e diagno- stilĺe ľa1ĺa dojk so razlike v preživetju ogledalo zdravljenja. 10_odstotno izboljšanje 5Jetnega ľelativnega preživetja vseh bolrric, zdľavljenih v obdobju 1993_97, v pľimeľjavi z bolnĹ cemi, zdrav\jenimi v letih 1983-87, pomeni za okoli četľtino zmanjšano umĺijivost zaradl raka do1k. Meta_analiza, objav- liena leta 1992, je jasno pokazala, da dopolnilno sistemsko źdrav|jenjeza okoli ĺetjino zmanjša umľljivost zaÍadi Íaka dojk, absolutna dobľobit pa je odvisna od stadija bolezni(1, 2). Sli- ka 5-letnih pľeŽivetij po stadiju glede na obdobje diagnoze pĺlkeŹe,da so bile dobľobiti dopolnilnega sistemskega zdĺav- ljenja naše bolnice deležne Že v letih I98u92, še pred obja- VO te lneta-analize'To je posledica dejstva, da so bile takĺat številne bolnice vk1jučene v klinične raziskave dopoln1lnega sistemskega zdravljenja in so bile deležne koristi tega zdľav- ljenja še pľeden je bilo uvedeno v rutinsko prakso. Nadaljnje izboljšanje preźlvetja v letih 1993_97 je posledica uvedbe antľacildinov, ki, kot je dokazano v meta-analizi, objavljeni leta 1998, še za I20/o zmanjšajo umrljivost za ľakom dojk (3). Pľcgled po stadijih pa pove, da smo dobľobiti dopolnilne- gzt zdľavljenja povsem zadovoljivo izkoristili pĺi bolnicah z nzšĘeno bo\eznjo,pľemalo pa pľi bolnicah z omejeno bolez- nr1ĺl. Veľjetno je pľedolgo veljala dogma, da imajo vse bolnice z negativnimi pazdušnimi bezgavkamidobĺo pĺognozo in jih ni snriselno izpostavljati neŽelenim učinkom kemoterapije in hĺlľlnonske teľapije. To poľjuje tudi število s kemoteľapijo in hĺlľtnonsko teľapijo zdľavljenih bolnic. V obdobju 1993_97, ko 1e bilo povsem 1asno (1 , 2), da ima1o vse bolnice z opeÍa- hilnun rakom dojk korist od dopolnilnega zdrĄenja,je v okvi- ľLl pruega zdĺav\jen1apĺejelo kemoteĺapijo samo 44\/obolnic. ohľabrujoče je povečanje 5łetnega preźivetjaboLnic z raz- se j ano bolezn ijo v zadnjem opazov arem obdobju. Te bolni- cę siceľ niso ozdľavljene, podatki pa potľjuieio' da imajo z uvedbo učinkovitejšega sistemskega zdĺav\jenja (antracik1i- ni, taksani) sedaj veliko večje možností dolgotľajnejšĺh zaz- clľĺtvitev (4). Večje izboljšanje preźivetja pri razsejani kot pri olnejeni bolezni je veľjetno posledica dejstva, da novih učin- lĺoy1111 zdravil nismo v zadostni meľi upoľabili pľi bolnicah Ż onleieno boleznijo. lłcżivetje bolnic, staľejšIh oď75IeÍ", je za 15% manjše kot pĺi mlajših. To kaŽe, da te bolnice niso deležne pľimeľnega prve- er 7o/o) staľted pľimary treatment at the Depaĺtments of Neuĺosuĺgery ańd of Abclominal Sutgery, UMC in Ljubljana and in otheĺ general hospitals of Slovenia, The relative five-yeaľ sulvival Íate was 10% higheľ in the years 7993_97 than in the years 1983-87 ' The diffeľences in 1-J-yeaĺ sulvivals weľe loweľ (Figuľe 1). The suruival incĺeased in patients with the diseases at all stages (Figuľe 2). The suľ- vival in the patients over 75 yeaľS WaS 15% loweľ than that in youngeľ patients (Figuľe 3). According to the EUROCARE-3 study ľesults foľ the peri- od1990-94, in Europe , the age-standardizedrelative suruival ĺate oĺ the patients with bľeast Canceľ Was 7 4'40/o (68.5_80.9) in male patients anclin female patients 74'80Á(74,3-75.3), while in Slovenia, it was 57.40/o (37.5-88) in male patients and 65.6(63.l4s.3) in female patients. The highest ľates oĺ86.4% and of 81.6% weĺe observed ľespective1y in male patients in Spain (only regions: Basque Country, Graĺada,Ma1loĺca, Muľ- cia, Navaľľa and Taľľagona) and in female patients in Sweden' Tałl1a Čĺłfer, Iłlstitĺłte of oł'lcologl Ljubljana Both in female and male patients, the ľatio between localized ancl ľegional disease has not significantly changed in the 75-year obseĺvation peľiocl' In more than half of ĺemale patients in Slovenia, bĺeast cancer is detected in its ľegional oľ advanced stage (Table 2). Moľeover, what is woľrying is the fact that, in the last obseruation peľiod' no significant pľogĺess was observed m eaĄ detection of the disease' thouglr the numbeĺ of mammogĺaphic health Centeĺs in the country incĺeased just in the years 1'993_97 ' Consideľing the unchanged situation in the eaĺly detection of breast canceľ, the diffeĺences in survival aĺe a true ĺeflection of tľeatment impact. In cclmpaĺison to the survival of patients tĺeated for bľeast canceľ in the peĺiod 198ffi7, a 10% impľove- ment of ľelative ĺive-yeaĺ sulvival of the patients tľeated in the years 7993_97 is, in fact, the moľtality rate ĺeduced by almost 25o/o. Meta-analysis published in 1992 cleaĄ demonstľated that the adjuvant systemic tľeatment reduces bľeast canceľ moftality ĺate by about one third, whereas the absolute benefit ľemains dependent upon the stage of the disesase (I,2). A closer look at five-year suruival by stage of the disease indicates that the patients in Slovenla benef1ted fĺom acljuvant systemic treatnrent already in the yeaĺs 1988_92, i' e. long befoľe the pub1ication of the above meta-analysis. This may be due to the fact that, at that time, a 1ot oĺ patients weĺe included in clinical studies on adjuvant systemic treatment; hence, they had benefitecl from that tľeatment modality before it was intľoduced aS a ĺou- tine in everyday pĺactice . Fuĺtheĺ impľovements of surviva1s in the yeaľs 1993_97 aľe attributable to the application of anthľacyclines; this clľug, as it was proved in the meta-analy- sis published in7998, recluces additiona11y the bľeast Canceľ moĺtality ĺate by ITVo3), The ana1ysis by stage confiĺms that we have satisťactoľily exp1oitecl the benefits oĺ acljuvant sys- temic treatment in the patients with ľegioĺra1 disease, bu 1ess sufĺiciently in the patients with localized disease. It seems that the guidelines aclvocating that the patients with negative axil- lary lymph nodes have ľavorable prognosis anc1 theľefoľe should not be unnecessarily exposed to sicle-effects of IZICI (5Ł5ď) 6842) (6246i) IZICI (61-óĐ (67-ó9) (10-74) rm dojk, :nts diag- ific tĺeat- pĺimary t l5o/o of nal theľ- apy,9o/o loľmon- oľmonal ncl hor- rnd hoľ- lio- ancl nal ther- ncology Hospital priNovi of Novo clec and Itogeth- 5 198T1997 ľRrŽtvr'r;r. BoLNlKoV Z RAKoM V sLoVĹNlJI 1983-1997 37 BREAST DoĺKA VIRI ga zdľavljenja. Razklg laliko iščerno v pľeĺnajhniupoľabi lroľ- monslĺe teľapije in v pĺedsodku, cla kemoterapija ni pľimeľno zc1ĺavljenje Ze Staľe bolnice' Na pĺobleln nezadostnega zdľav- ljenja in slabega pľeživetja staľih bĺllnic so opozorilitucli drug- je po svetu (5). Izoblikovali so žc pĺlsebne pilmemejše smemice zdrevljenja staĺih bolnic. Preživetje bolnic v Slovenijije odvi- sno od tega, lĺoliko bomo te smeľnice spľejeli in jim sledili. PĺeŽivet1e bo1nic z ľa1ĺom c1ĺljk je mĺlgoče izboljšati z zgocl- nejšim oc1kľivanjenr bolezni in s spľotnim uvajanjem novih načinov sistemskega zdravljenja, V Sloveniji lahko še izbo1j- šarno zgodnje odlĺľivanje ľalĺa do11ĺ. Novi načinisistemskega zdravljenja so se uvajali Sproti. optimalnega tľetjinskega zmanjšanja urnľljtvosti pa nismo dosegli pľi bolnicah z ome- jeno boleznijĺl in pri staĺih bo1nicah. Te bolnice veľjetno niso bile v zaclostni neri cle1ežne dopo1nilnega zclľavljenjl' Jurĺj Lindhler, onkološki iłlšilnu Ljĺłbljana Povečano 5łetno pľeživetje pĺipistrjem pľedvsem modeľnim, agľesivnejšim načinom zdravljenja in manj le zaJ\/ovečjemu številu bolnic v omejenem stadiju bolezni. PľeŽivetje pľi sta- lih bolnicah, pli kateľih je opisano zdravljenjeteźjeizvedljlvo, potľjuje to soclbo' Ugotovitev, da spada Slovenija na podlagi izs1edkov ĺaziska- ve EUROCARE-3 še vedno med deŽele s podpovpĺečnim ĺela- tivnim starostno standaľdiziranim pľeŽivetjeln, 1e ob premajhnem odstotku bolnic, odkľitih z omejeno bĺlleznijo, morcla moč razlożlti tudi z dejstvom, da načini ravnanja z bolnicami, lĺi se po pĺejšnjem odstavku kažejo kot trčinko- vitejši, ne doseŽejo vseh bo1nic. Elga Maj cłič, otl.koklški in štittłt Ij ublj ancł V obclobju 1983_97 je pĺlšlo tudi do sprcmemb v načinu lokal- nega zdravljenja opeľabilnega ĺalĺa dojk, ZeIo se je zmanjša- b število ľaclilĺalnih mastektomij in pĺlveča1o število delnih resekcij clojk s poopeĺativnim ĺlbsevanjem. Na ta način smo dosegli boljšo kakovost življenja, po meta-analizl radĺotera- pevtsliih štucllj leta 2000 (6,7) papoopeĺativno obsevanje pozi- tivno vpliva tucli na pĺeživetje. Tako kĺlt sisternskega je bila tudi obsevalnega zdľav11enja v manjši meri cleležna starejša populacija. chemotherapy ancl hoľnonll tlrclapy was faľ tĺn klng in pľat'_ tice. The same issue wes sllpportccl alsĺl by tĺÍll number ĺif patierrts whrl were tľeated with chemcltheľlpy encl hoľmĺll-l- al theľapy; in the peľioĺ1 l'L)93_97, when it was alĺeacly evi_ c1ent ( 1, 2 ) that all patients with ĺlpeľable bľeast canceľ ma1' beneflt fĺĺlm adjuvant tlcetmcnt, only 440/o ĺlf łlĺcast cancťľ petients ĺeceived chelnĺltheľapy as pľinrary tfcetment' Tlre impľovement of ĺive-yeaľ sulvival oť the patients with mctastatic c]isease in the latest obseľvation perioc1 is enctlttľ- aging. These patients aľe not consiclet'ecl as cuľecl; hence, lľĺxrl these data, it may be cĺlncluclecl that theiľ prospects Íilľ long{eľm ľenrissiĺln aľe muclr gr'cateľ (4)with thc applicatrĺlrl oĺ moľe ef1'ective systemic treatncnt (anthľacyclines, taxanes ). Gľeateľ impľovement in suruival ĺlf the patients witlr metasta_ tic clisease than of those witli lĺlcalized disease nly bc cltle tĺl the fact that, in the tl'eetlTlent of patients with loca1ized clis- ease' We clicl not apply the latest most efÍěctive cltugs as muclr as we shoulcl. The survival ĺlť patients ĺlveľ 75 yeaľs is klweľ lly 159ó in com- paľison to y()ungeĺ pxtients. This may be tlrc inc1icatiĺln tlrat these patients hed not ľeceivccl a pĺopeĺ primary tľeetnent. Mĺlľeĺlveľ, the ľeasons foľ theiľ lower suruivel mey lie silnply in the ľestľictiĺlns ĺlf application of hoľmclnal tlreľapy and in the prcjuclicc t1rat cheĺnotheľapy is n()t an appľopľiate tfeat- ment moclality ťoľ clcledy patients. This problem of inaclequate tľeattnent and poĺlľ sl.ltvival of elclcrly bľeast canceľ patients has lten ollseruecl a1scl e1sewheĺe in t1re worlcl ( 5)' Thcĺefoĺe, special guiclelines, moľe eppľopl'iate for the treatmcnt of c1d- crly patients, have alľeady been designecl. The suryival of these patients in Slovenia clepcncls ĺln kl what extent We shall adopt and follow these guidelines. The survival ĺlf breast Canceľ patients may be inproved by earlier cletection of the cliseasc anc] concuĺľent intľoduction of trpclated ľegimes ĺlf systenric tĺeatment. In Slĺlvenia, early cletectiĺln of bĺeast canceľ can be fuĺtheľ ilnprĺlvec1. As tĺl thc new rcgimes ĺ;f systemic tľeatment, We Weľe intľoclucing t1rem into pľactice as they were appcaľing. The optimal, one{hiľcl decľease in moĺtality rate ĺlf the patients witlr lĺlcalizecl dis' ease and of elclelly patients Was not achievecl. Appaĺcntly, these paticnts dicl nĺÍ ľeceive aĺlequate adjuvant treatment' .|lłĘ Ĺinĺĺtner' Illstiĺtłte tf oncoklgy Ljtłbliĺ.łna In my view, the incĺeasc of fivc-yeaľ sulvival is attĺibutable to up-to-date, aggressive tľeatment mĺlclalities and to a less- cI extent kl only 3% incĺease of patients with localizccl clis- ease. 'I'he suruival ratcs oť clclcĺly patients who can lraĺdly bc tĺcatccl with thcse mĺlclalitięs supp()l'ts this view. Tlre obseruatiĺln that, accoľcling kl the EURoCARE-3 study results for thc pcrkxl 1990-94, Slovenia ranks arnong the coun- tĺies ancl ľcgiĺlns with the age-stanclaľdizec1 ľelative surulva1 rete that is bclrlw the averlge ľetť, Can lrc explainecl by the fact that not all of the bľeast cancer patients with the clisease clctecteĺ1 in lĺlcalizecl stage, clespite lĺlw percentage of thcm, wcrc eligiblc fĺlr tlrc tľeatlllcnt mĺlclalities thet aľe clescľibed in the abĺlve paragraph aS m()Ie effectivc. 1' Eaľly I} e;rr1Y b clĺlntise 75,0ĺ)0 2' EłĺlyB l]Iť'lst ( 3. E;rĺly B elĺly bĺ t130 ,iŻ 4. Esto'lt ccL: wľ 5. lvtLrss I: Llrpy' Á ó' |1ldy ts r'ĺlLlrab cťl': ln 7. KurlzJl \riťĺr ()] 38 CANCER PATIENTS SURVIVAL IN SLOVE,NIA 1983-1997 nnrŽvrĺ1 BREAST :r prac- Lber of rfmOn- ly evi ]ľ may cancer :s with ncouľ- :, fľom cts for ication ranes). etasta- re due ed dis- imuch n com- )n that tment. simply and in ? tÍeat- equate atients |refoľe, of eld- f these I adopt ved by luction t, eaľly i to the gthem e-third ed dis- Lľently, tment. rutable a less- ed dis- rdlybe } ĺudy 3 COUn- urvival by the Jisease f them, ;cribed 1 Eally BÍeast Cancer Trialists' Collaborative Gľoup. Systemic treatment of _ earlv breast cancer by hormonal, cytotoxic, or immune therapy: 133 ľan_ dońised ľials involving 31,000 recurľences and 24,000 deaths among 75,000 women. lancer1992; )j): 1-5, and71-85. r Eailv Breast canceľ Trialists' Collaborative Gľoup. ovaľian ablation in earý _'Ĺr.írt.un..',overviewoftheľandomisedtĺials.Laĺcet1996;348l1189-96' 4 EaÍlv Breast Cancer Tľialists' Collaborative Gľoup. Polychemotheľapy for ' earlý bľeast canceľ: an oveľView of the ľandomised tĺia\s. Laĺcet 7998; 35Żl 9304Ż. 4. Esteva FJ, Valero V, PusŻtai L et al. Chemotherapy of metastatic breast can- - cer, whát to expect in 2001 and beyond. oncologist 2001; 6:1'3346. 5. Muss HB' Bfeast cancer in the eldeĄ: the role of systemic adjuvant the- raov. ASCo Educational book Ż001;106_23' ó' Eáľĺy Bĺeast Cancer Trialists' Collaborative Group. Favouľable and unfa- vouĺable effects on long-teľm survival of radiotherapy foĺ early bĺeast can- ceĺ: an oveľiew ofthe randomised trials. Lancet. Ż000;355:1757ł0. 7. KuľtzJM. Radiotheľapy foĺ early breast cancer: was a compĺehensive oveľ_ view of trials needed? Lancet 2000;355: 173940. VIRI Elga Majdič, Institute of oncolog1t Ljubĺ;jana In the years 1983_97, Several changes weĺe introduced into the localtĺeatment of operable breast canceľ. The numbeľ of ľadicaI mastectomies dĺopped consideľably, whereas the number of paľtial ľesections followed by postoperative ĺadio- therapy incĺeased. That way, the quality of life of patients impľoved significantly; moľeoveľ' accoĺding to th e meta-analy- sis_of ľadiotheľapy studies fľom the yeaĺ 2000 (6, 7), postop- eľative ľadiotheĺapy has a favoĺable effect on the survival. EldeĄ patients, though to a smalleľ extent' were also ľeceiv- ing systemic tľeatment as wellas postopeľative radiotheľapy. a3ĄĐ7 nnľŽvr1r BoLNlKoV z RAKoM V sLoVENul l 983-1 997 39 ESOPHAGUS POZIRALNII( ESOPHAGUS MKB B/ ICD 8: 150 TABEIA l: Požiľalnik. Bolniki vkliučeni v analŁo po spolu, starosti in obdobiu opazovaĺja. TABIE t: Esophagus. Patients included in the analysis by sex, age and period of obseľvation. \t.lli^t ĺl|ltli,r;'{n,'zi Ą1r'.ll,li.rgn'*i' Skuprj/ All V obclobju 1983-97 jezbo1e1o za raliom poŽiľalnilĺa 11Bó rnoš- kih in 210 žensk, ocl tega v letih 7993_C)7 3B7 mošlĺih in 66 ženslĺ. Y an.llizo ni bi1ĺl v1ĺljučenili 165 (8,5 %) bolĺlikov' 1ĺeľ je bi1 pĺi njih ľak trgotovljcn šele ob smľti. V ĺlpazĺlvatrelłr 15-letnenr obdob1u je bi1a inciclencx faka poži- ľalnika ustaljena. V 1etih I9B3_87 je bi1a gľoba inciclenc*na stĺlp_ nja 8,6/100'000 mĺlšlĺih in 1,3/100.000 ženslĺ, v leti1r 1993_97 pa 8/100.000 mošlĺih in 1,3/100'000 žens1ĺ. oclstĺÍelĺ nrikrĺls1ĺopslĺĺ) potĺienih pľitneľov se 1e povečal s 83 % v letih 19B3_i]7 nĺl B90/o v letih 1993_97. Mec1 milĺro- skopsko potľjerrimi je bilĺl v letih 1'993-97 81% ploščaĺlce_ ličnih' 89ó Źlęznlh in 8% neopľecleljenih kzrľcinĺllnĺlv' V zaclrrjerrr ĺlbdobju 1993-97 je bilĺl v anllizc, zajetrh več sta- ľe1ših bolnikĺlv (tabela 1) in več zŹe ľmšiľjenĺl boleznijo ĺlb cliagnozi(tabela 2). V 1etili 7()93_()7 1e bi1o speciťic'nĺl zdĺavljenih le 60 7o bolnĹ kĺlv. Pľvo zclľavljenje je bilo najvec*lĺrat samo obsevalno (389/o) ali samo kiľuľško G60/ĺl) a1i lĺombinacija obojega. opeĺiľaniso bi1i na Kliničnem oclclelku Za toľaka1no lĺiľuľgijĺ; I(C teĺ v splĺlšnlh bolnišnicah Maľiboľ irr Celje, cÍlsevani pa na onlĺološkem inštitutu v LjLrbljani. V 1etih 1993-97 je bilo t'elativno pet1etncl pľeživetje etrako kot v 1etih 1983-ĺ]7, le enoletno se je povečalo za 59ó (slika 1). lll-87 8tt-92 .- 9a_97 01)347 lcta/ycaĺs slll(A l: Relativno petletno preŽivetje bolĺrikov z rakom požiľďnika, zbolelih v letih I983-t997 po obdobju diagnoze. ľ|GURE l : Relative five-year suľvival of esophageal canceľ patients diagnosed in the peľiod 1983-1997 by peľiod of diagnosis. In the peľiod l9B3_97, a klta1 of 1,186 lnale anc1 210 fernale patients weľe cliagnosed with esophageal Cancef; of these, 387 males and 66 females were c1iagnosec1 with this canceľ in tlre periĺlcl 1993_9].In 1(ĺ5 patients (8.59lo), esophagealcan- cef was cliagnĺlsed at cleath; these patients were therefore not incluclecl in the analysis. In thc ollseryecl 15-yeaľ peĺiod, the irrcidence of esophageal Canceĺ was stab1e' In 1983_87, the crude inciclence rate was 8.6/100,000 in tnales and 1 3/100,000 in ĺenrales' whereas in 1993-91, it was 8/100,000 in males ancl 1.3/100,000 in females. In cĺlmpaľison to 198}-97, the incľease ĺlf micľoscclpically con- finned cases in the observation pericld 1993_97 wls í-'!'o, i' e' fľorn 83% to t]97o. In the yeaľs 1993_97,the percentage clf sql-ra- trrous cell caľcinĺlmas, ac1enocarcinomas, ancl non-cliffeľen- tiatcc1 cell caľcinomas in the micľĺlscclpically confiľmec1 esophageal CanCeĺS was 819/o, 89ó, and tl7o, ľespectively. In the 1ast ĺlbseĺvation peľiocl 1993-97, a higher peľCentage of elc1crly patients (Table 1) weĺe inclucled into the analy- sis ancl moľe patients with ĺegional clisease at cliagnosis (Table 2). In the periocl 19()3-97,ó0%lof patients tlndelwent specific trcat- lnent. In most cases, primary tľeetment was racliotheľapy aklne IABEIA 2: Požiralnik. BoĹnfüvključeniv analŁo po spolu, stadiju bolezni in obdobju opazovaĺja. TABIE 2: Esophagus. Patients included in the analysis by sex, stage and períod of obseĺvation' Starlil/Srrgr íJhĺlĺĺlje/ SliLlprj/ olllejtn/ Rĺrzii|cn/ lłlzscjrn/ Nt'zn:tn/ Ptrĺĺxl ^lL Locrlized !i Rcgiĺlnlrl !i ])istant |í llnknorvn |il 10() ĺi0 PoŽlRALNi TABilA ' TABLĽ 3: Obĺltĺlj,'' Pe ritrl l98l-5' l 9Bs'']Ż l99ř'1 a i ĺ,rl .E :S +0 o. 20 Olilĺ'lli,''' Periĺxl l9H1-ri l9rtB-!l 19!)J-tl llJl) Nklški j\hki Žen.kc lturults 19l.13'ĺt7 3ú 19riB-92 3(r9 1993_!' 3ĺĺ) 19lr3 ĺ]7 54 1!)B8 9Ż ú 19t)3-t)T íí li( ) tt)7 SIIKA 2: zbolelll l)ľcživĺ njih pa lzslecll 1lľct*tlc' z'rl rĺlk, l l ')íl (! 1lr'i žcr itl pľi l}lrskijĺ Miln, lłalĺ pĺ cije pc ĺaj veĺ ĺ)ĺlgleĺ nilĺĺlv slabo r (ĺ .i{ .) ą )l ()hĺlĺlbje / I)eliĺxl 1Ą 154Ą 45-54 55f;1 (l5 74 1\+ Nlĺlški 19ił.1'i]7 l9ii8-92 1993,f)7 4h 'ilt 45 (ŕ 59 5,1 9(' ĺl(l ŕjt l 3Ĺí ł;9 łjl] trhlL s l(i 1() 17 l7 1l 111 144 160 t) l9 102 61 í;J 27 115 113 9lł 31,5 30,ń Ż1'2 14{l 153 lĹjĺl 3ĺł'5 41,5 r7,1 th {t 1s,8 Żĺ, 1,9 Ż,5 8,s 5,6 Žcnske l9ll3-ĺl7 l9Ell-9Ż 19e3-97 I cln.llľs T7 ŻŻ 1Ą ir 0 0 54 ô4 5Ĺ; Ż l(r 3 1(i t5 9 1lJ 15 19 Iri 23 Ż.] 31,s 34,i 25,0 T7 25 19 ł5 39,Ĺl 3l,e 10 1 l) 18,5 10,9 1b, I 14 25,ir 40 cANcER PATIENTS SURV|VAL lN SLoVE'NĺA 1983-1997 PRTZMI )PHAGUS TABELA 3: Požiľatnik. opazovano in ľelatlvno petletno prežívetje po spolu tn obdobju opazovanjas 95 o/o inteľvalomzalpafiia(lz). TABLI 3l Esophagus. obseľved and ľelative five-yeaľ sufvlvď by sex and peľiod of obseľvatíon with 95olo confidence inteľvď (CI). Observed (ľo) Moški/Males leta / Years /Females leta /Years Obdobje/ Peĺiod I IZICI 3 IZICI IZICI 1 Iz/q 3 IZlü 5 wC| 198347 198V92 1993-97 (15-23) (20-28) (19-27) (24) 6-11) (1-t (1-t 3-1) (1-t (10Ą2) (12-32) (15-39) (2-18) (2-16) (Ł22) (0-1Đ (1-9) (Lzz) 8 3 19 24 23 6 5 13 10 9 13 21. 2Ż 27 Relativno/ Relative (70) Moški/Males kta/Years Ženske/Females LetalYears obdobje/ Peĺiod 1 IZII 3 IZICI 5 V/CI 1' IZlCl 3 IZlÜ 5 lzlcl 5 ÍalÍ'llkĄ patients ts. r98l-87 l988-9Ż 1993-97 (15ą3) (20-30) (19-29) (G12) (11-35) (IŻ-34) (1u2) 0-21) (3-1Đ (Ł26) (1-1t (0-12) 6-29) 19 25 Ż4 5 9 4 Q-8) 8 6 17 11 11 15 23 23 lo 4 6 3 (24) 0-9) (M) (24) female t these, Canceľ )aIcan- ore not rhageal rte was 'hereas ,000 in lly con- io/0, i. e. rf squa- 'ffeľen- firmed ,ly, tgnosls ic tĺeat- y alone , stadiju x, stage znan/ knoĺvn % 100 Moški - Males ome,en - p2ji|ęn - Íazsejan - vsi 1973-77 197U82 1983Ą7 obdobje 198U92 1993-97 S[ll(A 2: Relatfuno petletno prdivetie bolnlkov z ľakom požiĺahrką zbolelih v letlh l973-t997 po stadlju ln obdobju dĘnoze' Pľeživetje je bi1o večje pĺi ženskah kot pri moških, pľi sled- njih pa največje v staľosti 45_54let, Izsledki študije EUROCARE-3kaźejo, da je bi1o v Evľopi pov- pľečno Staĺostno stafidaÍdiziÍano ĺelativno petletno pĺeživetje zaÍakapoŹiľa]lnika pri moških 8,60/o(-7,7_9,-7) in pľi ženskah 770/o(9,7_12,4), v Sloveniji pa pľi moških 5,50/o(2,8_10,7)in pľi Ženskah I0,20/o ( 4,G22,8). Naivečie preživetje prí moških in pľi Ženskah je bilo v Spaniji (samo na območju pľovinc: Baskija, Mallorca, Navaľĺa inTarragona): I2,9 0/o oziľoma 230/o. Miha Sok, Klinični oddelek za' torakalno kirurgijo KC Rak poŽiľalnik a je teżko ozďavljiva bolezen. Zaľadi obstruk- cije požiľalnika s tumoľjem in težav s poŽiĺanjem bolnik sko- ĺajvedno išče pomoč pri kiruľgu. Pogled iz klinične prakse pot{uie zbrane podatke:večina bol- nikov ima ob diagnoziŹe ÍazšiÍjeno bolezen oziÍoma njihovo s1abo splošno stanje in pridružene socialne bolezni pľepľečujejo 198U92 1993-97 tlGURL 2: Relatlve five_yeaľ suľvlval ofesophageal cancef patients diagnosed ln the period 1973-1997 by stage and peľlod ofdiag- nosls. (380/o) or sufgery a\oĺe (360/o) oľ combination of both. The patients were opefated on at the Depaľtment of Thoracic Surgery, UMC in tjubljana and in the Geneľal Hospitals in Maľiboľ and in Celje, and they ľeceived radiotheĺapy at the Institute of Oncology in Ljubljana. The ĺelative five-year suruival ľate in the years 1993_97 was the same as in the yeaÍs1983_87, except that one-year suĺ- vival incľeasedt:y 5oń (Figuľe 1). The suľvivalwas betteľ in female patients than in male patients; in the latteľ, the high- est suľVivalwas in the age gľoup oť 45_54yearc. Accoľding to the EUROCARE-3 study results foľ the peri- od 1990_94, in Euľope, the age-standardized relative survival rate of the patients with esophageal canceľ was 8'60/0 0.7_9'7) ín male patients and in female patients 11% O.7-I2,4), while in Slovenia, itwas5.50/o(2.8-1.0.7) in male parients and70.20/o(4.6-22.8) in female patients, The high- est ľates of I2.90/oandof 230/owere observed ľespectively in both sexes in Spain (only ľegions: Basque Country, Malloľca, Navaľľa and T arr agona)' 80 100 80 860 't s40 'ď oU )N o o. -- 40 20 z0 1973:77 1978Ą2 1983-87 period entage analy- 12,6 11.,9 12,5 46 44 45 10 i8,5 10 15,ś 14 25,0 localized --- 1ęgi6n2| - distant - all Ženske _ Females 8T1c)97 PREŽIVE'TJE BoLNlKoV Z RAKoM V sLoVENUl ĺ983-1997 41 ESOPHAGUS 4!-!4 - 55-{14 - 75+ Nĺoški _ Nĺales leta/ye:rĺs SIIKA 3: Relativno p€tletno pľeživ€tje bolnikov z ľakom požiľalniĘ zbolelih v letih 1993-1997 po starosti. ľ|GURE 3: Relative five-year suĺvival ofesophageal canceľ patients diagnosed in the peľiod 1993-1997 by age. aktivnejše zdľav|jenje' Polovico vseh bo1nikov z novo odkľitim fakom na požiľalniku zdĺavimo simptomatsko ali naľediĺno olnejen paliativni poseg' Cla omogočimo zadovoljivo pľehľa- nievan1e. Drugo polovico poskušamo ľadilĺalno opeľiľati. Med njiĺni pa je Ie 200Á s patološkim stadijem I in II, lĺjeľ je racli- kalno (lĺuľativno) zdĺavljenje možno. Zeto ne pľeseneča majlrno petletno pr'eživetje vselr bolnikov z rakoĺn poŽiľalnika. Zgodn1adiagnostika je že obrabljena fľaza,IJł+ 45-54 tt-54 o>- /4 75+ IMACH -17) -21) -22) 100 80 100 BO d ot, t s40 .$ 60 Ś) ;Ň o Żąo tct /CI -23) -26) -zt) )93-97 r dJag- nosis. perl- rvival "21.9) while 119.1 with ,€ÍIlo- The of all '.380/0) ninal 'edat 20 20 0 Ż 4 0 3 2 4 5 Ieta SIIKA 3l Relatlvno petletno pľeživetie bolnlkov z želodčntm ľakom, zbolellh v letih 1993-1997 po starostl. yeafs tlGURL 3: Relative ftve_yeaľ suĺvivď of stomach cancer pattents diag- nosed in the perlod 1993-1997 by age. / was rvival 'le 3). :gion- high- prevzelavodilno vlogo ' Za predopeľativno zame1itev bolezni se 1e sredi80. let uveljavilklasični ultľazvok in sredi 90. endo- skopski ultĺazvok' Patologi so v B0. Ietih dodatno standaľdi- zira\i ana\ize resektatov u Laurenovo histološko klasifikacijo źelodčĺega ľaka, stopnjo malignosti (G) in UICC pTNM teľ v 90. še z R klasifikacijo. Do začetka 80, let je bilpľincip kiruľškega zdravljenja želodč- nega mka ľesekcija z omentektoĄo (distalna subtotalna resek- cija iz pľincipa,totalna gastľektomija iz nuje). V 1982. letu je bila uvedena nova stĺategija - načrtovanje opeĺacije v odvisno- sti od histološkegatipa (Lauĺen), od lokacije rakana želodcu (ľetjine) in od globine infiltľacije (T) teľ v 1986. letu sistema- tična limfadenektomija I. in II. skupine bezgavk_D2(1). Delež totalnih gastrektomij se je postopoma dvignil od 5-I0o/o na 30400/o(2). V prvi polovici 90. let ie multidisciplinaĺna skupina stľokov- njakov izdelala "Pľipoĺočila za celostno obravnavo bolnikov z rakom pľebavil". Sprejela so jih vsa stĺokovna telesa, potľ- di1jih je Zdĺavstveni SVet pfi MinistÍStvu za zdľavstvo Repub- like Slovenije. Izšla so v knjiŽni obliki in postala dostopna vsem zdravnikom v Sloveniji (3). v 1995,letu sta dve kiruľški delavnici in simpozija ter Zbor- nik "Kirurgija telodca" pľipomogli, da so to strategijo posto- poma pĺevzeli tudi drugi kiĺurškí oddelki (1). Čepĺav je ĺaďika\na opencijaedina metoda, ki nudi možnost ozdravitve, kaľ tľetjina novo odkľitih bolnikov z želodčnim ĺakom v tem obdobju sploh ni pľišla do kiruľškega oddelka. V 1eĺr 1993 ie bilo na vseh kirurških oddelkih zďzvljenih samo 72Vo (37 4/520) novo odkľitih pľimeľov v tem lefu in v len l 2000 samo 690/o (330/480) (1), Vzľoki za to niso pojasnjeni, goto- Vo pa to pľispeva k nizkemu 5łetnemu pľeživetju bolnikov z želodčnim rakom v dĺźavi' V opazovanem obdobju je bila popľečno vsa leta tĺetjina bolni- kov opeľimnih v KC v Ljubljani, tľetjina v dveh večjih regional- nih bolnišnicah in tľetjina v pľeostalih bolnišnicah. V začetku 90. let se je začelo močno poudaľjati, da je zdravljenje malig- nihbolezniv centľih, ki imajo kľitično število bolnikov (high (16'3_22.4) in female patients. The highest ľatesoť31''20/oand of 37 '50/o weľe obseĺved respectively in male patients in Iceland and in female patients in Tyrol in Austria, Stane Repše, Depa'rtnxent of Abdominal Surgery, UMC, Ijubljana Endoscopic examination and biopsy of suspicious changes of the mucous membrane took on the leading role in the diag- nostics of stomach canceĺ in eaľly i980s. In pľeoperative dis- ease staging, standard ultľasonographywas intĺoduced in the mid-1980s, wheľeas endoscopic ultľasonography came into use in the mid-1990s, In the 1980s, pathologists additionally standardized the analyses ofľesections by Lauren's histology classification foĺ stomach Cancer' malignancy stage (G) and UICC pTNM, and in the 1990s, also by R classification. Until the eaľly 1!80s, the pĺincipal suľgica1 tľeatment of stomach canceľ involved resection with omentectomy (in pĺin- cipie, distal subtotal ľesection, total gastľectomy when oth- erwise not possible). A new Stľategy was initiated inl91?that implied surgery planning depending upon the histology type (Lauľen), subsite (thiĺds of the stomach), and depth of infil- tĺation (Đ. In 1986, systemic lymphadenectomy of the gľoups of lymph nodes I and II - D2 was initiated (1). The pľopof- tion of total gastľectomies was gmdually increasing fľom 1-107o to3040o/o(2). In the first half of the 1990s, a multidisciplinary team of expeĺts elaboĺated,Recommendations foĺ a Compľehensive Approach to Patients with Digestive Canceĺ-. These recommendations were adopted by all professional boaľds and appľoved by the Health Council at the Ministry of Health of the Republic of Slovenia. They were published as a booklet and thus made available to all Slovenian physicians (J). In 1995, two workshops and symposia on suÍgery with the proceedings "Stomach Surgery" facilitated the implementation of this stĺategy also in the surgical departments of otheľ hos- pitals (1). Though ľadical suľgery is the sole tľeatment modal- It44 4>->4 - ))-04 - o>-/4 _ 75+ Ženske _ Females c I 11cĐ7 ľnrŽwľĺ;r loI-NIKoV Z RAKoM V SLoVENUI 1983-1997 45 STOMACH volume)' bistveno uspešnejše. V zadnjih letih 1e tudi pĺr nas vse večji delež bolnikov opeľiľan na večjih odclelkih. Manjši lĺiľuľški oddelki skclĺaj ne opeĺirajo več bolnikov z Želodčnim ľakorn (3'). P ľizadev enja zaclnjih 20. Iet za laŽjo dostopnost enc1oskopskih pĺeiskav, za spľeniljanje slĺupin bolnikov z visokim Neganjem, za mu1tidisciplinaľno obľavnavo bolnikov, za standardizirano kiľuĺško zdľavljenje na več1i1r kiruľških oddelkih teľ za speci- fično onko1oško zc1mvljenje se bodo pokazala z bo1jšimi ľezul- Í:,tÍizdrĄenjana nacionalnem nivoju v naslednjem obdobju (3). VIRI 1. Repše S, Juvan R. Kíluĺgija raka želodca v Sloveniji. In: RepŠe S ed' Kiruĺ- gijl Żeloclcr: kirtlľŚklr (ola' LjLlbljana: Kiĺ"rľške klinike KC, 1995;10I_12, Ż' RcpŚc S' Jt'lerlc F, Z:rkľlj B et al. Rak želoclca * spľeĺlentlle v naši patolĺl' gijí v dveh desetletjih' Zdĺav Vestn 199I;60:281_5. 3' Anon' Rak žebdcl, In: Repše S ecl, Priporočila za celostno obnvnavo bolni- liĺlv z ľrkonl prebavil' Ljtlbljana: Ministĺstvo z:r zclľavswĺl R Slovenije, 1997; 13-21. ity tlrat offeľs the possibility of cttľc, ebollt one thiľd ĺlť petients with newly cletcctecl St()mach Cancef have nevcľ enteľecl a suľgical unit itr this peľiocl. In 1993, only 729i' ę74/52(l) of patiellts witlr newly cletectec1 stomach CanccľWeľť treated at vaľiĺltts sulgical tlnits, Wheľees in 2000, only 69-li' (330/4t10) (1). No explanation has evel been given for suclr Ciľcumstences, though they definitely contlibtlte to a pooľ live-yeaľ sutvival of pltients with stomach cenceľ in Sklvenia. In the obseruecl periocl, on aveÍage one tlrilcl of patients was opeľated on in UMC in Ljubljana, the otlreľ thiľclin two maiol regional hĺlspitals anc1 thc last thiľcl in the ĺemaining gcner- al hĺlspita1s' In tlre caľly 1990s, it was oľten stĺessed that thc tľeetlnent ĺlf ĺnalignant cliseases in the centeľs that can aclmit a cľitical numbeľ of patients is significantly moľe effective. Iĺl ĺecent years' an increasing propoľtion of patients eľe opef- atec1 on at laľger clepaľtments of majoĺ hospitals in Slovenia' In ninoľ suľgical clcpaľtnclrts, they pĺactically do not opcl- ate any mĺlle the patients witlr stĺlmach canceľ (3). The beneťits tlf ouľ tweĺrty-year enĹleavĺlrs to facilitate the access t() encklscopic cxaminatiĺlns, follow-trp of high-ľislĺ patients, mrrlticlisciplinary appľoaclr tĺl patients, stanclaľclizecl sttľgical tfeatment at mejor suľgical units anc1 at specializecl Cancel'tÍeetment clepaľtments will staľt to have an itnpact ĺll-l the tľeatnent ľesltlts Relatirłĺl/ Rcllrtivc (']í) 20 tr1rlški / i\'ĺlrlts Ĺcta/\'e,rľs Żenslĺc / l'tnlllts J'ťtl/\'ťilľs {)biLobie/ Peľĺxl 1' IZ lC,I 3 IZ l(,I s Żl(,I 1 VlÜ 3 IZIC] 5 lzlcl t9tr.3'87 1988-e2 1993 97 (4Ĺ5Ó) (5Ł6Ż) (ńll(j(l) (3ĺ}'1ó) (]ĺľ14) (45-51) (t1-41) (11-3e) (]8-4Ó) (5ir-58) (54{i) (b3{i9) (]5ł]) (t9-47) (47-53) (i1-3e) (j(14) (4Ż'!ll) 35 4U 4s 39 43 50 54 58 66 3(í 35 Ą2 4\ 40 48 51 5ĺ'] Ó3 0 Mĺlślĺi _ ]Vĺales ()ĺl1clcn Lłzšiľjen lazscjan -.- vsi 100 ĺ'}0 1oLr 80 i ź j 4L) SLIKA 3r I črevesa' u '\ttlll.c ]łe kinlri4ijĺ Đ ()() .Ż I o, .e 4() Ženslĺc - F'enrl]cs 19ĺt3_t]7 pcriĺlil Pľcscjatr v Slĺlvcn ntclnb je clrt, r,etld lrJ nlrcic jĺl śc pĺl1 18r11, vse vcniji) ( ĺ lllclĺ ĺlju tlltľlzvo' slĺi l.rltľa lizc ľese 1ll'NM iĺ ncm onl ľilZiijk()\ z tlľugir l]ĺllnilĺe ĺ l1lcľirali 1litlliziľ: SX, VKC' vcčjih r, lih llĺlln l)ľirrcip l ĺllxlcÍ-ljt ti ľaclilĺa nc laĹlil 1igiľanjt tlchvni v letu L s() pľip, liiľtlľšk, MLrlticli: lĺl uvclj vilĺl. Kl šttlclije Żl) 20 1973-77 1978-82 1983_ĺ]7 ĺlllclĺlllje 19ĺj8-92 1993_97 197)-77 1978-82 19iJł.} 9Ż 1993_97 SIIKA 2: Relativno petletno pľeživetje bolnikov z rakom debelega črevesa, zbolelih vletth1973-I997 po stadiju in obdobju diagnoze. I|GURE 2: Relative five-year suľvival ofcolon canceľ patients diag- nosed in the peľiod 1973-|997 by stage and peľiod of diagnosis. ľiľani so bi1i ĺra vseh lĺiĺr-rĺških odclelkih sp1ošni1r bolnišnic v Sloveniji, v 1etih 1993_97 največ (41%) na l(liničnem oclclelku za abclĺlminalno kiľuľgijo KC v Ljubljani' 5 9ĺo bolni- kov pa je pľičeb zclravljenje na onlĺološlĺem inštitutll v Ljub- ljanl. V letih 199}97 je bib ĺelatiYno petletno pleživetje zzl)lÁvečje kcĺ v letilr 1'9B3_B7 (s1ilĺa 1), bo1j pľi moških kot pl'i ženskah (tabela 3). Pľeživetje se je povečalo pľi bolnikih Z olnejťno in ĺazšrľjeno boleznijo. Pľi moških, mlajših oc1 55 let 1e bilcl zzt 2Oo/o večje kot pľi staľih 65 let in Več, pľi Ženskah so bi1e ĺaz1i1ie po staľosti še večje (slika 3). izsleclklštuclije EURoCARE-3 1ĺažejo, da je bib v Evľopi pov- pľečnO Staľostno stanc1aľdiziľano felatlvno petlctno preŽivct- je z:"l ľilzirĺ>- n:J 60,70ł), Irr the periocl I()Bť92,770/u of ptĺÍienÍS undelwent speciłic tľeat- ment. Sulgery alone was peľf,ll'metl in ó9%' tlf pltients, in 120rí, ĺlť patients, postoperative chemotheĺapy was appliecl ,70/o of paticnts wcľe tľeated witlr clremĺĺherapy ancl immunotheĺ- 'Jpy, 4ÍY0 ľeceivec1 ľacliĺltheĺapy alone, whel'eas the treatment ĺnĺlc1a1ity applieĹl in 89ó of paticnts Was never ľepoľtecl to the Registľy (it is assumccĺ that they Were ()pelatcc1 ĺln). Suryical trcatlnent of these patients was Carľiecl ollt et the surgical depaľtments ĺlf a11 geneľal hospitals in Sklvcnia; in the peľi- odI9c)3_97, tlre rnajodty oťpatients (4i91l) was ĺlpeľatec1on et the Depaľtment of Allcklmlnll Sur'gery, UMC in Ljubljana; 59t ĺlf patients ľeceiveĹl pľinary tľeatment at the Instittrtc of oncĺllĺlgy, Ljubljena Tlre ľelativę five-yeaľ sltrvival fate Wes 99{, highcľ in the yeaľs IL)L)3_97 than in the years 19t]3_t]7 (Figuľe 1 ). The suľ- vival incľeasecl in lnales as well as in females (Teble 3), ancl in the patients witlr krcllizccl ancl ľegional clisease. In t1re males unĹlel thc agc ol55, the sutvival was 20jó liighel than in tlrose ()Vťf ó5 yeľs' In ĺ'emalcs, the ĺlifférenccs itl sttlvivlrl witlr regaĺcl t-Ą+ +>-)+ ))-{4 o)-/+ 75+ Moški - ia(|Ż). 1993-97 rts diag- rynosís. ic ľear in12o/o l,70/o oÍ nother- ratment J to the iuľgical ;uľgica1 le perĹ łted on rbljana; itute of in the 'he suľ- 3), and e males n those l ľegaĺd 80 100 20 100 80 860 t s40 .i 60 u 'Đ ś4U WCI ,5.31) 2y35) 3T39) IZICI 3149) 3H4) 42J8) 20 0 2 3 2 leta 4 0 4 5[lKA 3l Relativno petletno pľeživetje bolnikov z ľakom debelega čfevesa, zbolelih v letlh 1993-1997 po stafostl. years FIGURE 3: Relative five-year suľvival ofcolon canceľ patients diag- nosed in the pertod 1993-1997 by age, Stane Repše, Klinični oddelek za abdominalno kinłrgijo KC Pľesejanja pľebivalstva zar adi raka debe1ega čľevesa in danke v Sloveniji še ni. Kolonoskopija z biopsijami sumljivih spľe- memb je bila že sredi 80. let pľipoľočena diagnostična meto- da, vendaľ je blla, zaradi prenajhnih zmogljivosti endoskopije na naciona1nem nivojtt, rentgenska diagnostika z irigograťi- jo še pogosto pwa aIi celo edina pľeiskava (v letu 1995 še pĺi 18 %o vseh bolnikov z ľakom debelega čĺevesa in danke v Slo- veniji) (1). Za pĺedoperativno zamejitev bolezni So Se V tem obdobju uveljavile slikovne diagnostike; v 80. letih klasičen ultľazvok in ľačunalniškatomogĺaťija,v 90. letih pa endoskop- skiultľazvok in deloma MRI. Patologi so standaĺdizira\iana- lize ľesektatov z določanjem stopnje malignosti (G), UICC pTNM in R klasifikacijo, kaĺ je omogočilo odločanje o dodat- nem onkološkem zdľav1jenju, boljše napovedovanje pľognoze, ľaziskovalno delo in pľímeľjave lastnih ľezultatov zdravljenja z drugimi, Bolnike z rakom debelega črevesa so v obdobju I9B3_I997 opeľiľalina vseh kiruľških oddelkih v S1oveniji, kjeľ je bilo hos- pita1iziľanih 90_95 0/o vsehbolnikov z ľakom debelega čľeve- sa. V KC v Ljubljani je bilo zdrĄenih 4045 %o bolnikov, v dveh večjih ľegiona1nih bolnišnicah četľtina in tĺetjina v pĺeosta- lih bolnišnicah (1). Pľincip kiruľŠke ga zdrav\enja raka debelega črevesa je bil v tem obdobju radikalna resekcija. ob koncu 80. let se je začeIauvaja- ti ĺadika1nejša kirurgijaraka debelega črevesa; tipične standard- ne ľadikalne in razšiľjene ĺadika1ne ľesekcije z ľadikulaľnim ligiranjem podľočnih Źil z \imfadenektomijo. Dve kiruĺški delavnici in simpozija "Kirurgija šiľokega čľevesa in danke- v 1etu 1996 ter Zbornik "Kiruľgija šiľokega črevesa in danke" so pľipomogli k šiľjenju ľadikalnejše kiĺuľgije tudi na dĺuge kiľurške oddelke v Sloveniji ( 1). Multidisciplinaľno obravnavanje bolnikov se je v B0. Ietihzače- lo uveljavljati in v 90' letih postalo na večjih oddelkih tudi pra' vilo. K temu so pripomogli semlnarjiob začetku vseslovenske študije o ĺaku debelega črevesa in publikacija ''Adjuvantno Accoľding to the EURoCARE-3 study ľesults foľ the peľi- od 1990_9 4, in Euľope, the age-stand ardized reIative survival ľate of the patients with colon canceľ was 500/o (49.1_50,Đ in male patients and in female patients 5L90/o (5LF52.8), while in Slovenia, it was 36.30/o (32.540.) in male patiens and 39,80/o ę6243.8) in female patients. The highest rates oť 57 ,Z\/oand of 60.Io/o weľe obserued ĺespectively in both sexes in three regions in Fľance: Bas-Rhin, Calvados and Cote d'oľ. Stane Repše, Department of Abdominal Surgery, UMC, Ljubljana In Slovenia, no scľeeníng foľ coloľectal Cancer has been so faľ started. Since the 1980s, the methods ľecommended in the diagnostics of this cancer have been colonoscopy and biop- sy; howeveľ, due to the limited potentials of endoscopy at the national level, X-ray diagnostics with iĺĺigogĺaphy was often the method of choice oľ, in some cases, the on1y one (e' g. in 1995, in as much as IB0/o of patients with coloľecta| can- CeĐ (1). The preoperative staging of the disease was then based on imaging diagnostics, uiz, classicĺllüzsonogĺaphy and Computeľ tomogľaphy in the 1980s, and in the 1990s, endo- scopic ultrasonogľaphy and paĺtly also magnetic resonance imaging. Pathologists standardized the analyses of ĺesections by deteľmining the malignancy gĺade (G) accoľding to UICC pTNM and R classifications. Both classifications facilitated the decisíons with ľespect to the application of adjuvant cancer therapy' betteľ pĺognostication of the disease and ĺesearch together with the comparison of ouľ own tľeatment results with the ľesults of other studies. In the years r9$_I997, the patients with colon Cancer weľe surgically tľeated at suľgical departments oľ all geneľal hos- pitals in Slovenia. Of 90-950/0 of colon cancer patients who were hospitalizedat that period in Slovenia, 40450/owere admitted to tĺeatment at UMC in Ljubljana. one fouľth was tľeated at two maiof County hospitals and one thiĺd in the remaining Slovenian hospitais (1). I>44 Ą>_>4 --- ))-o4 Ženske - Females )83-t997 PREŽIVET1E BoLNIKoV z RAKoM V sLoVENUl 1g8Ttg97 49 coLON DEBTLO CR VIRI zdľavljenje bolnikov z opeľabilnim ľakom clebelega čľeve- sa" (2). Acljuvantno in palrativlio onkološko zdĺavljeqe, ki je bi1o v opazovanem obdobju na naciclnalnem nivoju spľve fakultativno, ie u 9o. letih postalo standaľcl(3). Za 9 o/oboliše relativno 5letno preživetje bolnikov na nacional- nem nivoju v ĺlbdob1Lr 1993-97 v prmerjavi z obdobjem 198}€7 je posleclica nekoliko hitľejše cliagnostike zaradilaŹje c1ostĺlp- ĺrosti endoskopskih pĺeislĺav, uvajanja sodobnih pľincipov ope- ľacijskega zdravljenja na večini kiruľških odc1e1lĺov, boljšega poopeľaci1slĺega in specifičnega onkološk ega zdravljenja. Zanimívo je, da je v tem obdobjLr kaľ za60/opadel delež loka- Lizitane boleznr na debeleĺn črevesu pľi moških inzaB0/opri ženskah in se za toliko dvignil clelež bolnikov z legionalno (bolj napľedovarro) boleznijo. Delež bolnilĺov z odda1jenimi zasevkije v tem obclobju poľasel za20/oprimošklh in pľi žen- skalr pade1 za I 0/o (tabela 2,)' T o Iłaźę na boljše zamejevanie bolezni pĺed opeľacijo zaľadi ľutinske ľabe natančnejših pľeiskova1nili metod (ultľazvok, ĺačunalniška tomogľafi1a), med operacijĺl (intĺaopeľativni ultĺazvok) in na stanclardizi- ľano definitivno patološko zamejitev bolezni naľeseciľanem pĺepeľatu. P ĺizadev anja zadnjih 15 let zzl multiclisciplinaľno obľavnavo bo1nilĺov, za\aźp clostopnost do encloskopskih pľeiskav, za pĺeventivne pľeglecle skupin z visokim tveganjem in endo- skopsko odstľanjevanje pľeneop1astičnih lezij, za standaľdi- ziľano kin'rĺško zdľav\jenje saĺno na večjih kirurških oddellĺih, za specifično onkološko zc1rav1jenje in sleclenje reseciľanr1r bol- nikov bodo pokazala boljše ľezu1tate zdrav|jenja na nacional- nem nivoju v naslednjem obdobju (2). Bonłt Štabĺĺc, Kliľlič'łli odcĺ'elek za 7asĺroenteľologijo KC Delež omejene bolezni je bil v zadnjem obclobju ĺnanjši zaľadi natančne jšega določanja stac1i j a' Več1 e pľeŽivet j e bol- nikov z oĺnejeno in ĺazšiľ1eno boleznijo je v prvivľsti posle' clica standarclizacije opeľacij teľ stanĺlaĺdne dopolnilne lĺemoteľapije po evľopskih irr ameľiških pľipoľočilih. Skup- no pľeživetje se je v ĺnanjšl meĺi povečalo tudi zaĺadi skľb- nejšega nadzora bolnikov po zaključenem zdľavljenju, zgodnjega odkľivanja ľesektabilnih zasevkov in metahľone- ga čľevesnega raka teĺ zaradi specifičnega onkološkega zdrevljenja bolnikov z ĺazšir)eno boleznijo. Petletno pretivet1e bolnikov z opeľabilnirn ľakotn clebelega črevesa je v pľimeľjavi z nekateilmi evľopskimi c1ľžavamimaĄ- še zaľacIi večje ga deleźa bo1nikov z večjirn pľimaĺnim tllmoľ- 1em in večjiĺn številom pozrtivnih bezgavk (4;. V Sloveniji smo po letu 19C)3 stan TABI'LA L Danka. Bolnfü vključeni v analino po spolu, stadiju bolezni in obdobju opazovaĺja. TABIE 2r Rectum. Patients included in the analysis by sex, stage and peľiod of obseľvatiorr. Staclij/5tagr Obclĺllljc/ Skuprj/ orllcjen/ lłĺzšiLjtn/ Rlzsejlrl/ Nt'znĺtn,/ I)t'ľĺĺI All I-ĺxrlizcd !ll lłcgiĺlnlrl ti' Distlnt lnl l]nknĺnvn !l 100 ĺ]0 F Ł 7 t'ĺl 'Đ s) ]ś 40 o. 20 DANKA ĺABttA 3 TABLE 3: l Ohllĺlj,''' PeľlĺlJ lgtll-81 l98rl-tl 1991-l)l 6|dr ńjc1 Pcriul _ iil1]łl 19H8'('rŻ 11)93 9r I0r) s0 'ä ĺ,' Ŕ r() )0 1974 Sĺ.IKA 2: zllolelih cijĺl, lĺe' ľlLpijo 3 nn vseh vcc'(36; 11ijĺl I(C ()rrlĺo1c \ĺ letih , 1c kot v llĺllniki. ttajvečj, ĺ'ih 75 1, Obĺlĺňjt/ skLrpaj/ lłr'iĺĺl All '14 Stllr)st ob dilgn()ŻilAgť lt 1544 4i_11 55rj4 65-7Ą 75+ trĺĺlški \ĺ.tlľl 1981-rJ7 19R8_91 1et3 97 802 91íj 1 l(ĺ) 123 12r'l 14ĺl 19ł) 31s 3(;l 2Ż8 24tlt 38rl 21(r zŻ3 23.9 45 4ĺl 41 0 il (.1 1Óó )|),7 73 9,I Ż2l) )3,3 qt 9,6 Ż3Ż 19'8 106 9'1 tio2 119 !ú(í lĹjil 1169 2()t) '\ĺrlts jlklški l98l 87 I 9r'lrl-92 ILĺ)3-97 Żľnskt 19l]] l]7 145 I](ĺ]],ll('s 198l] 9Ż ĺ]1] lgel-97 t)49 Ą'l '9 5()lŻ 53'Ż 21,0 lrl,5 lt),4 1(),8 ĺ'](i 11,5 1l],5 lłĺj ll),(j 1ĺ]'7 104 11'Ĺ| Ż2'3 3|] 1 1ĺí,t) 415 17,9 (t22 lzsleclk 1lľcčno je za ra, 50,20/o in pľi ž, lĺih jc 7'ęnev< in Cote Żľnskc Irľlllllrs 19lii3 ĺ']7 l9B8 92 1993-97 813 949 11 i) 9s 17r) 2|)Ż 21rl ŻŻ9 265 255 111) 15ll lr't4 355 ĄŻ1 484 125 150 171 43 3Ż 4ĺ] U (l ĺl 47 ,1 l2's 5l,ĺ l ś) 23Ż )42 341 cANcE'R PATIE'MS SuRVĺVAL IN SLoVENIA 1983-1997 PREZIVE'I TABEtA 3l Danka. opazovano ln ľelatlvno petletno pľežlvetje po spolu in obdobju opazovanj a s 95o/o lnteľvďom zaupaĺJa (V). TABIE 3: Rectum. obseĺved and relative Ílve_yeaľ suľvival by sex and peľiod of obseľvation with 95olo conÍidence inteĺvď (ü). LetalYears letalYears Obdobje/ Period 1 rzlct 3 tzlq 5 \zlcI 1 rzlu 3 tzlct 5 tzlcl 198147 198V92 199T97 59 64 67 $5-63) 6147) (6Ł70) (2u34) 3U0) 3945) (20-26) (2Ł30) (2ť34) $Á4) (ó0-óó) (6Ł10) 0147) ę541) (4147) (zĘ30) (25-31) 3Ż_38) 31 31 42 23 21 31 60 63 67 34 38 44 Ż7 28 35 Relativno / Relative (ľo) Moški/Males ktalYears Ženske/Females IÉtálYears Obdobje/ Period 1 rzlct 3 tzlct 5 tzlcl 1 tzlct 3 rzlu 5 tzlcl 1983Ą7 198U92 199T91 6846) 6Ł70) (6u74) 0ý1) 0947) (45-51) Q7-35) 31-39) 0u4) (58{6) (6149) (67-73) ęu2) $846) (4ý53) (29-31) 31-39) e947) 62 67 71 31 35 40 37 43 48 38 42 49 62 65 70 33 35 43 lÉcruM I 5 rlanke, s dtag- bmale lhese, is can- ]anceľ re not rl can- I, tOO. males it was I COm- / con- o/0, i, e, mlysis of eld- ). The too. In 'age oť c treat- s, 150/o 'ľadio- stadtju (, stage naĺl nown % 8ó 11,' 8ó 10,6 r04 11,0 8T1997 73 91. 106 9,1. 9,6 9,1 Moški - Males omeJen - fazšiĺjen - razsejan - vsi 100 80 $oo .Ł )N U o -- 40 sś ,. ź 100 80 60 40 20 z0 S[lt(A 2: Relatlvno petletno pľežlvetje bolnlkov z ľakom danke, zbolelih v letih 1973-1997 po stadiju in obdobiu diagnoze. cijo, kemo- in imunoterapijo J0/0, z obsevanjem in kemote- rapijo J\/o in zopeĺacijo in kemoteľapij o 20/o' operirani so bili na vseh kirurških oddelkih splošnih bolnišnic v Sloveniji' naj- več (360/o) pa na Kliničnem oddelku za abdominalno kiruf- gijo KC v tjubljani. 13% bolnikov je pľičelo zdravljenje na onkološkem inštítutu v Ljubljani. v letihL993_97 je bilo ĺelativno petletno pľeżivetje za)o/oveč- je kot v letih 1983-87 (slika 1). Preživetje se je povečalo pľi bolnikih z omejeno in ľazšiľjeno boleznijo. Pľeživetje je bilo največje pľi moških, starih55-ó4Iet(za300/ovečje kot pfi sta- ľih 75 let in več), pri ženskah pa V stafosti do 44\etGlika 3). Izsledki študije EUROCARE -3kaźejo, da je bilo v Evľopi pov- pľečno Starostno standardizirano ľelativno petletno pľeživet- je zankadanke pľi moških45,7 0/o(44,G46,B) in pľi ženskah 50,20Á (49,1'_51,4), v Sloveniji pa pľi moških 34Vo (30,3_38) in pľi Ženska h 35,2 Vo (ŕ1,7 49, 2). Največje pr eźiv etje pľi moš- kih je bilo 55,Bo/o v Švici na območju registľov izBasla in Zeneve in pľi Ženskah 63,40/ov Fľanciji (Bas-Rhin, Calvados in Cote d'oľ). 1973:77 197ffi2 1983-87 period 198u92 1993-97 tlGURL 2: Relatlve Ílve_yeaľ suĺvlvď ofľectal cancer patlents diag- nosed ln the pertod 197ř1997 by stage and pedod of diagnosis. 1973-77 197H2 1983ą7 obdobje r98U92 1993-97 therapy, Suľgery and chemotherapy,1'00/o were tľeated with radiotherapy and suľgery, B% ľeceived radiotherapy, Suľgery, chemo-andimmunotheÍapy,5'/oradiotherupyalone'31/oradio- and chemotherapy,31/o surgery, chemo- and immunotherapy, and 2o/o surgery and chemotheĺapy. Suľgical treatment oľthese patients was caľied out at the suĺgical departments of all gen- éralhospitals in Slovenia; the majoriĘ of patients (36Vo)was opeľated on at the Department of Abdominal Surgery of UMC in Ljubljana; I30/oof patients ĺeceived pľimary tfeatment at the Institute of Oncology, in Ljubljana. The relative five-yeaľ survival ľate was 97o higher in the years 1993_97 than in the yeaľs I9B3_B7 (Figuĺe 1). The suľ- vival incľeased in the patients with local and in those with regional disease and was the highest in the males aged between 5544years (30% higheľ than in the patients over 75 years), The suľvival of the female patients was the high- est in the age gľoup upto 44 years (Figuľe 3). According to the EURoCARE-3 study ľesults foľ the peri- od 1990_94, in Euľope, the age-stand arďized relative suľvival rate of the patients with ľectal cancer was 45Jvo G4.G46'8) Ženske - Females localized - fegional - distänt - all PREŽIVETJE BoLNIKoV Z RAKoM V sLoVENI|l 198T1997 53 RECTUM 15-í4 ' 45-5,4 - '_- 55_ó4 - a< 1/, DANKA 100 8() i00 ti() 1s44 Eó0 .a t s40 -$ ó0 iŇ u o. :+0 4s-54 ()r /4 nilĺi sĺ; juv.ttltr 9( ). lt't. Z1t 9')'o jrr tĹ)9: jenr I9b sor.lĺ lllr kih oĺlc lošlĺcgl Zenitlli Ziľlu]e' dvignil nijo:Pt z orlcla 1 qí, pľ bĺlljše ; ših pľe nišlĺa ' lt1tľllzv jitcv lx Pľizrclt in rlult clĺl ctrd z rrisok phstičĺ jill lĺiľl" ľcc1trĺl lťZtllta ĺlhclĺlb 20 20 55-64 75+ Ženske _ Fenlales 0 3 2 lete 4 5 0 3 + SL|KA 3: Relativno petletno pľeživetje bolnikov z rakom danke, zboleľh v letih 1993_1997 po stafosti. Stcłle Repše, Kliničn i oĺłcĺ,elek za ĺłbĺĺ.ołnin cl lłl.o kinłrgijo KC Pľesejanja plebivalstva zaradi raka debelega čľevesa in clalr- ke v Sklveniji še ni. Koloĺloskopija z biopsijamisum1jivi1r spre- menrb je bila Že sľec1i 80' let pľipoľočena diagnostična metocla, venclaľ je bila, zaracli pl'emajhnih zmog11ivosti na naciona1nem nivojtt, rentgenska diagnostika z iľigogľaťijo še pogosto prva ali ce1o edina diagnostična pľeiskava. Pľi ĺaktt danke je bila ľigidna ľelĺtoskopija v tem obclobju prua pĺei- skava (v letLr 1995 pri250/o bolnikov z ľakom c1anke v Slove- ĺriji), včasih so 1o lĺĺlmbrniľali z iľigogľaĺljo ali s lĺolonoskopijo pľeclopeĺacijo (1). Kot sem že ĺlmcni1 pľi ľaktr c1ebe1ega čľevesa, je bi1o na vseh klľuľških oc1del1ĺlh v 51oveniji hospitalizĺľanih 90_95 % bolni- lĺov z ľakom clebelega čľevesa in clanke. Trend k zc1rav1jenju bolnikov z ľakoĺn clanke saĺno na večjih lĺiľLlĺških oddelkih je vic1en v zacInjem c1eset1et1u pĺedvsem pri lolĺalizaclji ĺaka v spodnjih dveh tĺet1inah clanke (2). Princip kiruľškega zclravljenjaraka claĺrke je bi1v i]0. 1etih ľac1i- ka1na monołlblĺ ľesekcija (nizka spĺednja ľesekcija pľi ľaku zgc>ľnje in srednje tĺetiine danke, abdominopeľinealna eks' cizijapri ľalĺu spodnje tretjine in večjih tumoľjih sľedĺlje tľet- jine) z visoko ligatuľo arterije mezenterilĺe infeĺioľ (2). Avtĺlĺlutski spenjalniki in clvo1ne stapleľske anastomoze So postopoma zamenjale ľočno šivanje anastomoz pľi nizkih spľednjih ĺesekcijah Že v začetku B0. 1et in omogočile vse več raclikalnih kĺlntinentnih ĺlperacij. V 90. letih je postala kiľuľ- gija ĺaka danlĺe še ĺadilĺa1nejša. Serninaľjiob začetku vseslo- venslĺe šttrdije o ľalĺu c1ebelega čľevesa in c1anke , ptrb1ikacija o ľaku clanke ter cfue kiľurškiclelavĺrici in simpozija "KiľtrľgĹ ja širokega čľevesa in c1anke" v 1996' 1etu in Zboľnik "Kiľuĺ- gija širokega čľevesa in clanke" so pľipornogli 1ĺ šiľjenju te kir'uľgije na dľuge kiruľške oclclelke (1, 3)' Totalna mezolek- talna ekscizija pa se je začehuvajatikonec 90. let in še ni mog1a irneti vpliva na tu pľikazane ľezultate. Adjuvantno in paliativnĺl onkĺlloško zclľavljenjc se je nlt nlciĺl- nalnem nivoju V opaZovane1n obcklbju še1e trveljavljaio. Bol- yťaĺs tlGURE 3: Relative five-yeaľ suľvival ofľectal canceľ patients diag- nosed in the peľiod 1993_1997 by a$e. in lnale petients anclin tcnrale patients 50.20/o(4C).I-57'4)' whilę in Slovenia, it was 34% (30.3-38) in male patients end35.2l, (31.7-39'2) in female patients. The highest ľates of 55.B9ro ancl oÍ 63'40l: wcľc ĺýlseryed ľespectively in men in Switzeľlancl (ľegistries from Basel aĺrcl Geneve only) and in wcltnen in three ľegions in France: Bas-Rhin, Calvados and Cĺlte d'oĺ' Stane Repše, Depĺłrt'nent ĺý'Abdolninal Surgery, tĺMC, Liubliana In Sklvenia, no scĺeening fbľ coloľectal Canceľ has been sĺl faľ intľĺx1ucecl. Sincc the 19B0s' thc methods ĺecomlnendecl in the diagnostics of ľectal canccľ lrave been coklnoscclpy ancl bklpsy; howeveĺ, due tĺ'l the limited potentials of endoscopy at the nationa1 level, X-ľay cliagnostics with iľľigography was ĺ;ften the method of choice oľ, in sĺlme cases, the only one' In those yeaľs, the ťiĺst exanrination of a patient with ľęctal Canceľ was fectosc()py, peľfĺllmec1 by a ľigid endoscĺlpe ( e' g in 1995, it was peľfoľnred in as much n 250,/ĺt of patients with cĺllĺlrectal canceĺ), occasi le intprĺlvcs sLlľvival irr stagc II ancl III cĺ>lonic canccl, bl.tt lrot in rectal can- tr'|'' l)lrr ^\Co l()()()' lit: Żĺ'ĺ'lr' er with cat'lieľ c1iagĺlĺlsis ĺlĺ ľectal cenccf will lropefully lravc a favĺlľablc effěct ĺln the tľeatncnt ()utcone that can pľeclict better results only in the ncxt ĺlllseryation peliocl. \Wc expect that the latest cliagnĺlstic ĺlethĺlcls anc1 festcĺ cliag- nĺlstic pĺocecluľes will lle ľeecĺily accessible to all patients ln Slovenia. This is the only way that coulcl enhmce our chancei to cletect end also tľeat the clisease in its locally aclvancecl stagt in a lalgeľ nlllr.lbel ĺlť petients' '|ĺulja Ocuil'k, Illstitute of oncology Ĺjubljcun Vith r'cgaľcl tĺl the research ľesults of the 1990s, the adjuvant chemotlrerapy secms kl łle thc stanclaĺcl tĺeatment oť thc patients with the colĺln cenccL, stagc III (5). It is lnteľesting t() note tlrat the l'eseaÍch ľesults of the stuclies that incluclęcl the patients with the stage III cancer of the colon ancl re ctunl inc1icate tliat the ecliuvent tl'eetlrrent heĹl a favoľable effect only ĺln t1rc patients wit1r Col()n Cancef end none on the patients with ľectal cancer (6). It shĺlulcl be ľeasĺlnable t1rat the ad1Ll- vant therapy hacl the same effcct ĺln the tecta1 cancer as well es on Cololl canceľ' as they ale bĺlth parts ĺlť tlre Same ()rgell' one of the ľeasons lvhy the Sulvival oĺ the patie nts with t'e c- tal canceĺ is not impľoved as muclr as it is that of tlre patients with ccllon canceľ mey lie in the fact that most ĺlf the stuclies incluclecl the pltients that 1racl not been tľeated by TME but hacl unc1eĺgĺlne tlre classic sl.rľgica1 methocl. Systemic tľeatment was 1css cťfectivc because of numeľotls local ľecttĺľences thlt aľe ľcsistent t() systetnic thellrpy. A number ĺlťstudies eľe being caľľiecl ĺlut, c1ealing with tlrc cffect of acljuvlnt therapy on tlrc patients with thc rcctal ceľcinĺlĺla fĺĺlĺlwing an tlptimal suľ- gícal interuentiĺln ancl iľracliatiĺln. Wc expect that these stucl- ies will pľĺlvicle us with the ĺnĺlľc valrrablc c1ata ĺ;n tlre ľea1 usefullress of ac1juvant chcmotherapy ĺlf the paticnts wit1r rec- tal carcinorna. ]Ĺ1 LI\ MI(B V ĺlll 4t)ĺJ r lĺilt il nilĺĺr V ĺll-l grr jer nlt s l' lctĺ ĺ )tlst; v lcti jcnin r'ino ]ĺllľc hepe Stltľĺ lllCn Šjh o V let diju V let tlilĺc' sllllt( sitetS 'ľABt obdc TABT peľi lI,"ľi '\l.llťs Ž*'t lrľnlal, PREZ 5(r CANCER PATIENTS SURVIVAL IN SLOVENIA 1983_1997 RECruM y have lľedict r diag- :nts in tances I stage luvant of the 'esting :luded ectum ct only rtients : adju- rs well organ. th rec- atients tudies lĺE but rtment es that :being on the al suľ- : stud- le real th ľec- FTRA LNE,R 100 80 G t e60 'Đ o iŇ 40 o. s 20 83-87 -8u9Ż - 93-97 MKB 8/lCD 8: 155 V obdobju 1983-97 je zbolelo za primaĺnim jetrnim ľakom 498 moških in268źensk, od tega vletih1993_97 222moš- kihinl}3 žensk. V analizo ni bilo vključenih167 Qz\/o)l:ol- nikov' ker je bilpľi njih ľak ugotovljen šele ob smľti. Y opazovanem 15'letnem obdobju se je incidenca pĺimaľne- ga jetrnega ĺaka večala. V letih 198ffi 7 je bila groba incidenč- na stopnja 2,4/rc}.000 moških iĺ I,4/1'00.000 Žensk, v\erih1993_97 pa 4,6lloo.o00 moških in 2,4/100.000 Žensk. oclstotek mikoskopsko poĺjenih primeĺov s e je zmanjša| s 950/o v letih 198}€7 na890/ov1ethl993-97 . Med mikoskopsko poľ- jenimi tumoĺii je bi1o v letih 1993-97 í5vohepatocelulaľnih kaľ- cinomov' 26 0/o ho\angiokaĺcinomov, 8 7o neopĺedeljenih kaľcinomov in ŽIeznih kaĺcinomov ter posamezni primeľi hepatobiastoma, rabdoidnega in mešanoceličnega karcinoma. Staľostna poľazdelitev v analizo zajetíh bolnikov se je spre- meníla (tabela 1). V 1etih 1993_97 je zbolelo več bolnikov, mlaj- ših od 55 let. Razširjenost bolezni ob diagnozi se je spremenila. v leĺih1993_97 je bilo odkľite več bolezniv omejenem sta- diju (tabela 2), Y \etih 1993_97 je bilo specifično zdĺavljenih samo 27 o/obo!- nikov. Prvo zdravljenje je bilo v največjem odstotku (40%) samo kiľuľško,v 36,Jo/o citostatsko, v 10% kiľuĺško in cito- statsko, v 6% samo obsevalno in v 370 obsevalno in citostatsko, TABEIA l : Jetľa. Bolniki vključ eni v ana|,jao po spolu, staľostl ln obdobju opazovanja. TABLE ll Liveľ. Patients lncluded in the anďysis by sex, age aĺd peľlod ofobseľvatlon. Staľo$ ob diagnozi/ Age at diagnosis Obdobje/ Skupaj/ Period All -14 198H7 198U92 199T97 Females 1983-87 198U92 199Ť97 012345 letalyeaĺs SL|KA ll Relatlvno petletno pľežlvetje bolnikov z ľakom jeteľ, zbolelih v letih 1983-1997 po obdobju diagnoze, tlGURL t: Relatlve Íive-yeaľ suľvivď of liveľ cancer patients diag nosed in the pedod 198Tt997 by period of dlagnosis. In the period r9B3-97, a total of 498 male and 268 female patients weľe diagnosed with pľimary liveĺ canceĺ; oť these, 222ma\es and123 females weĺe diagnosed with this canceľ in the period 19%_97 .In 167 patient s (220/o),liveľ cancer was diagnosed at death; these patients Were theĺefore not includ- ed in the analysis. In the obserued l'5-year peĺiod, the incidence of this cancer was incľeasing. In 1983_87, the crude incidence Íate was 2'4/100,000 in males aĺd 7.4/1'00,000 in females, wheľeas in 1993-97, itwas 4.6/100,000 in males and 2.4/100,000 in females. In comparison to 198}87' a decľease of micľoscopically con- fiĺmed cases from 950/o to B90/o was obseľved in the peĺi- od 1'993_97. In the years 7993_97, the peľcentage of hepatocellulaľ caÍcinomas, cholangiocaľcinomaS' and non-specified carcinomas together with adenocaĺcinomas in the micľoscopically confiľmed pĺimary liv eĺ cancer was 650/o, 260/o,and}0/o,respectively; in addition, there were some indi- vidual cases of hepatoblastoma, ľhabdoid-cell and mixed-cell carcinomas, The age distľibution of the patients included into the analy- sis has changed (Table 1). In the peľiod 1'993-97, the num- beľ of patients younger than 55 yeaľs was higheľ. The stage TABELA 2lJetra Bolnikivključenlv analizo po spolu, stadiju boleznl in obdobju opazovanja, TABIÉ 2: Liveť. Patients tncluded in the analysis by sex' stag€ and period ofobseľvatlon. Stadij / Stage 1544 45-54 5544 65:/4 75+ obdobje/ Skupa1/ Omejen/ Razšiľjen/ Razse1aĺl Neznan/ Period Äll Incalized 0k Regional % Distánt % Unknown % ĺlosu, lnral 1 ą,z Males 198u92 129 67 51'9 24 18,6 28 Ż1,7 10 7,8 1993-97 180 87 48'3 28 15,6 54 30,0 11 ó,1 Females 198U92 66 25 )7,9 17 25,8 13 19,7 11 16,7 71 129 180 51, 66 102 Moški Males 2 8 13 4 2 9 1 3 1 1 2 1 9 17 18 z0 38 51 32 49 62 7 14 29 10 18 17 23 17 52 9 19 12 4 I 11 1993-97 102 31 29 24 23,5 18 17,6 lý1997 PREŽIVET|E BoLNlKoV z RAKoM V sLoVENuI 198T1997 57 LIVER FTRA TABEIA 3: Jetra' opazovano in ľelativno petletno pľeživetje po spolu in obdobju opazovanja s 95 0/o inteľvalom zalpanja (lZ)' TABIE 3: Liveľ' obseľved and relative five-year suľvival by sex and peľiod of obseľvation with 950lo corr-fidence inteľval (CI). Sašĺł xÍt ()b.eľecl (']i) Moški/ Nĺlrlts Lr1l/\t.rľs Itcllr:rlcs Obclobje/ Leta/\t.us ]ł'lirxl 1 VlC,t 3 lzlÜ 5 IZI(,r I Vl(] 3 rzl(,r 5 IZI(.| 19ĺr3'87 198l]-9Ż 1993-91 (0 8) (12-26) (18-30) (-.) (1-7) (5-1t (-) (H) 0,11) (ll-3iD (14-14) (14-30) Ż 5 (r 4 I I l9 24 2Ż 0 4 10 4 lg 24 (r-9) (1-1t (l-13) ()-5) (1-,9) (1-11) Relrtirłĺl/l(t'llrtĺt' (')l,) ]!klški /i\ĺr]ĺ's Leta /\'e:Ős Ohdĺlllje / Żenske/t'tllulcs Lete/\'ľrĺs Pľliĺxl 1 VIJ 3 rzl(,t 5 rul("l 1 Vlň 3 rzl.l 5 VlC.t 1981-87 1988-92 1991-97 08) (13-27) (1e-31) (-) (1-7) ((r1ó) (-) (1-t (3,13) (u-30) (15-lt (14-30) (Ll{)) (l-1t ()łj) (L10) Q-12) 19 Ż5 22 4 2n 25 0 4 11 (1-1t ĺ]0 F ť. ;60 'Đ o ;Ň 40 o- 20 100 ft0 F .? Ĺ' = íl{) .F o :Ň 4() o- ěę Ż0 100 leta /,ĺcllľs PovcčltI cinolllc blagĺlstĺ povťčxl titisĺltrr ĺ ciľ()Z(),, ]etľih' T pĹÍclixt ocllĺľiva Slovcns bolnilĺe kouccn g1eclĺĺll ocllĺitih ti lltcch- ciľ()Z() : nolll > I Cit( )l()šk Pľi llĺllr njť jťtrĺ Slllľt 1lr n() stop čct'l'"t pĺ tr"lrlĺlľjś cil'ično V letu gilstľ()e nice c1i lrlrciolli Pľi1ncrl sť ()cllc ni, Na r l]i po ( I{inlršl jih in p ĺl]xklb l)Iťop( potem ĺĺlv tĺl l 1)(nlter lĺi smc lipiĺxk nilĺilr z tifĺtkal Iüsnej ľe izid jcmo. lxĺnik planta Obseł lĺĺlvito čanju Na On ticlisci ljenisl 7973-77 1ľ17ĺ;9Ż 1983-r.i7 ohdĺlbje/periĺ ltl 19ĺ.}t]_92 1993_97 0 2 3 4 SIIKA 2: Relativno petletno pľeživetje bolnikov z rakom jeteľ, zbolelih v letih 1973-1997 po stadiju in obdobju diagnoze. tlGURE 2: Relative fiive-yeaľ suĺvival of liver canceľ patients diag- nosed in the peľiod 1973_ĺ997 by stage and peľiod of diagnosis' imunoterapijo so cloc1a1i v 20/o, v 20/o pa način zdľavljenja Regi- stru nibilspoľočen. Y 450/oso pľičelis plviĺn zdľavljenjem na onliološlĺem inštituttl v L1rrbljani, v 320/onaKliničnem ocldel- ku za abdominalno lĺill"ttgijo KC v Ljubljani ,Y 150/ov SB v Maľi- boLtt, v 5 %l na l(iničnern oc1cle1ku Ża gastľoenteľologijo KC in v Zn/o nll Pediatĺični klinilĺi I(C v Ljubljani. V letih 1993_971e bilo lelativno petletno pľeŽivetje za7 o/oveč- je kot v letih 1983*87 (slika 1). Preživetje se je povecYalĺ:l pri bolnikih z omejeno bĺllcznijo. Plibolnikih, mlajših ĺ>d75let, je bilo pľeŽivet1e večje kot pl'istaľejšlh (slika 3). Pľimcljava podatkov o pĺeživetju bĺllnikĺlv meci evľopslĺimi clľžavami ni tnoŽna z'arldj ľtlzličnega šiĺĺiĺanja plimar'nih tumo!ev, jetl'nih rnetastaz in neopredeljenih tumorjev. SIIKA 3: Relativno petletno pľeživetje bolnikov z ľakom jeteľ, zbolelih v letih 1993_|997 po staľosti. F|GURE 3: Relative five-yeaľ suľvival of liveľ canceľ patients diag- nosed in the peľiod t993-I997 by age. clistľilltrtiĺln at cliagnĺlsis has clrangccl, tĺlĺl. In tlre last o]lseľ_ vation periĺxl 7993-()] , a hlgheľ peľCentege of paticnts with lĺlcalizccl clisease lvas ĺýlscruecl (Telllc 2). In the pcľiĺrl IC)9T97,27')íl ĺlf paticnts llncletwent speciÍic ücat- mcnt. Sttlgeľy alĺlnc was appliecl as pľinrary tľeatnrent in 4091, ĺlf paticl-lts, 36'59íi ĺlf patients ľeccivccl ĺln1y c1rctnĺltltcľapy es pľimaľy treatment, i09.ó tlnclcnł,cnt sllllacly ancl chemothcr- apy, (l% were tľeatecl with recliĺltheľapy alĺlne , J)ll with ľacliĺl theľapy ancl chelrrĺltheĺlpy, anct 20/,, ĺlf pltients wcľc lrclclitiĺlnllly trclttecl rł,ith imnlllnĺlt1rcrapy, whcľees the tl.eltt- trlcnt ill()cla'lity lrppliccl in 21il ĺlf paticnts WeS n()t ľeP()ltcĹl t() thc ltegistry. I)ľiĺrraľy tľcetnlent wes startccl lLt the Institute ĺlf Oncĺl1ĺlgy Ljtrb1jlLna in ,i59L ĺl[ pltticnts, irr 329íl at thc Dcpaľttncnt ĺlf Allclĺlntinal SLrrycry' UMC in l'jullljana, 15().í, in Moški_ il4:rlcs ĺlmejeĺr/lĺlclrlizetl ' vsi/rrll 4)-)4 '- - 5t-()r+ _ 75+ Moški _ ]!llrlt's 5ŕJ cANcER PATIE'NTS SURV|VAL IN SLoVI'NĺA 1983-19C)7 PRTZIVI LIVER ZICI (0-t (1-Đ 1-11) Saša Markouič, Klinični oddelek za gastroenterologijo KC P ov ečanje incidenčne stopnje za pľlmaľne jetrnoceiične kaľ- cinome (HCC) so v zadnjih letih opazili v vseh drŹavah blagostan1a' V bodočnosti 1ahko pľičakujemo še nadaljnje oovečanje. Prvivzrokzato je velik odstotek okuženih s hepa_ iitisorn C. Dĺugi vzľok je daljše pĺeŽivetje bolnikov z jetrno ciĺ ozo, ki je prekanceľo za; HCC v 95 0/o vznikne v cirotičnih ietľih. Trerji vztok pa je, da je v obdobju od leta 1993 začela potekati med gastľoenteľologi usmeĺjena akcija zgodnjega ädkrivan1a HCC pľi bolnikih z jetĺno ciĺozo, ki jo je sprožilo Slovensko zdrużenjeua gastfoenteľologijo in hepatologijo. Vse bolnike z jetrno ciĺozo smo spremljali na pol1eta z meĺjenjem koncentľacije alfafetopľoteina V serumu in ultĺazvočnim pľe- gledom jeteĺ' Tumoĺje smo tako odkľili pĺej in starost novo óakľitin bonĺkov se je zniŽala.Istočasno je pľičela v svetu velja- ti mednaľodno Spfejeta doktľina, da je pľi bolniku z jetrno ciĺozo z ultľazvočno vidno fokalno \ezijo in alfafetoprotei nom > 400 dovolj dokazov, da gre zaHCC in da histološke in citološke potľditve niso potrebne. Pľi bolnikih s HCC je kľiterij za zdravljenje odvisen od stop- nje jetĺne ciľoze _ zaľadikateľe tudi večina bolnikov umľe' Smrt pľiHCC ni povezana s tumoľjem, pačpaznapredova- no Stopnjo jetľne ciĺoze. Napredovana stopnja kot je ozna- čena po Childu s stopnjo C onemogoča zdrĄeĺje jetľnih tLlmoĺjev' S tem si lahlkoruzl'oźimo tudi majhen odstotek spe- cifično zdravljenih bo1nikov v S1oveniji, Y letll 1'993 smo pľičeli prek S1ovenskega zdrlźen1a za gastľoenteĺologijo in hepatologjio izdelovati nacionalne smer- nice diagnostike in zdľavljenja, Zdľavl1enje je potekalo po nacionalnem dogovoru in pĺotokolu, kaľ se je odrazilo nabol1 primernemizborubolnikovzazdĺav\jenje.Zazdtavljenjesmo se odločali glede na velikost tumorja in stopnjo jetľne bolez- ni' Na novo je bilo uvedeno določanje zamejitve jetľne bolez- nipo Child-Pughu in zamejiĺĺe jetľnih tumoľjev po okudi' Kiľuĺško zdĺav\jeĺje jebilo opĺavljeno le pĺi zgodnjih tumoľ- jih in pri bolnikih z zadovoljivo jetľno funkcijo, V začetnem obdobju smo pĺi nekateĺih tumoľjih kombiniľali metodo pľeopeľativne kemoembolizacije za zmanjšanje tumorja in potem pfešli na opeĺacijo, vendaĺ smo zaľadi slabih ľezulta- tov to kmalu prekinili. Visok odstotek samo opeĺiľanih (407o) pomeni, da je bilo presejanje uspešno. Citostatsko zdĺavljenje, lĺi smo ga upoľabljali, je bila kemoembolizacija z mešanico lipiodola in mitomycina C. Upoľabili pa Smo ga samo pľi bol- nikihzzadovoljivo jetĺno funkcijo in pĺi tistih' kizaľadimĺll- tifokalnega vznika tumoĺja niso bili pĺimeľni za operacijo. Kasneje smo zače1i s peľkutano alkoholno skleľozacíjo, kate- ľe izid je podoben izidu jetľne kiruľgije, in s tem še nadalju- jemo. Danes zaradi wedbe tĺansplantacije jeteĺ pľesejanje bolnikov z jetľno ciľozo izvajamo še bolj stĺiktno, ker je tľans- plantacija edino ozdĺavi|veno zdravljenje za majhne HCC. obsevalno zdrav\jenje pľi HCC ni na mestu in tudi ni učin- kovito, indicirano je samo za poskus paliacije privelikem pove- čanju jeteľ in s tem povezanih teŹavah. Na onkološkem inštiĺ;ĺ.l je \eta1993 pĺičeldelovati ĺedni mul- tidisciplinaľni konzilij za jetľĺetumoĺje. Tam so bili pľedstav- l j eni skoĺa j vs i bolnik i iz Slovenij e. Y letih I99 3_97 je p otekala the Geneľal Hospital in Maĺibor, ln50/o aÍ the Department of Gastľoenteľology, UMC in tjubljana and 20/o atthe Depaĺtment of Paediatľic Suľgery and Intensive Caľe, UMC in Ljubljana. The ľelative five-yeaľ survival ľate was 7% higheľ in the years1993_97 than in the yeaĺs 1983-87 (Figure 1). The suľ- vivalimpľoved in the patients with locallzeddiseases andwas hĘheľ in the patients aged less than 75 years than in the patients oldeľ than that (Figuľe 3). The compaľison of the suľvival ľate of liveĺ canceľ patients in Slovenia with the suruival ľates in otheľ Euľopean Coun- tĺies is not possible because these countries app1y diffeľent coding for primary tumoľs, liveĺ metastases and non-speci- fied tumoľs. Saša Markouič, Department of Gastroenterologl, UMC, Ljubljana In the recent yeaĺs' an incľease in the incidence ĺate of pĺi- mary hepatocellulaĺ caĺcinoma (HCC) has been observed in the countries of geneľal wealth and pľospeĺity. In the yeaľs to Come' we may expect that it will continue to ľise. The main ĺeason is a very high pľopoľtion of popu1ation contľacted with hepatitis C' The second reason is an impľoved suľvivalof the patients with the ciľrhosis of the liveĺ, which is known to be pľecanceĺous; acfually' 950/o of HCC develop fĺom the ciľhotic liveľ. The thiľd reason is that the Slovenian gastľoenterologists gatheĺed in the joint pľogľam foľ eaľly detection of HCC in the patients with the ciľľhosis of the liveľ that was initiated by the Slovenian Association of Gastľoenteĺology and Hepatology' All patients with the ciľrhosis of the liveľ had the alpha-fetopľotein concentľation in the serum measuľed and an US examination of the liveĺ made every six months at the follow-up contÍols. That way, the tumoľs were detected eaľ- lieľ, whereas the age of the patients with newly detected liveĺ canceĺ declined accordingly. At the same time, new guidelines weľe adopted worldwide advocating that if the patient with liveľ ciľrhosis has a focal lesion detected by ultĺasound and alpha-fetoprotein concentľation >400, theĺe is enough evi- dence that he developed HCC; therefoľe, further histology and cytology confiĺmations aľe not necessary. The standaľd of treating the patients with HCC depends upon the stage of liveľ ciľľhosis, which is a true cause of death in the majoriĘ of these patíents. The patients with HCC die fľom liver cinhosis in the advanced stage ratheĺ than fĺom HCC. The stage C, teľmed accoľding to Child, is the advanced stage that does not allow going ahead with tľeating HCC. This may also explain why the percentage of patients who received spe- cific theĺapy is so small in Slovenia. In1993, we started to dĺaw up nationalguidelines foĺ diag- nostics and treament of HCC in cooperation with the Slovenian Association of Gastľoenteľology and Hepatology. \ľe followed National Agľeement and Pĺotocol, which ľesulted in a moľe convenient selection oľthe patients eligible foĺ tĺeatment, The tľeatment plans weľe made with ľegaĺd to the tumor size and stage of the liver cinhosis. In disease staging, we used the most ľecently introduced Child-Pugh's and okuda's stagíng meth- ods ĺoľ liveľ diseases and liveĺ tumors, ľespectlvely. Surgery ZICI (0{) 0-10) 2-12) n jetel ts diag- obseľ- s with c tľeat- n40o/o apy as otheľ- radto- weÍe ) tĺeat- ted to :ute of rt the L5o/oin 5 Y)4 )-tJ4 \-/4 ;+ t3-1997 ľnľŽlvrĺ1r BoLNIKoV z RAKoM V sLoVENuI 1983-1997 59 LIVT,R na onlĺološkenr inštituttt in sočasno v Tlstu tr"rc1i pľospektivna štucliia (1). Na Kliničnern ocldelku za abdominalno kiľuľgijo I(C in v SB Malibor'so pĺttekale zahtevne jetľne opeľacije. VIR was perfortnec1 only in tlie patients with tumoľs in eaľly stagcs anc1with satisfactory renal function' At first, we combined pľe- opeĺative chemoembolisation in ordeľ to reduce the size Za I0/ĺl večje lĺotv letih 19B3-B7 (slika 1). PleŽivetje se pripĺlsameznih ľIGURE 2: Relative five-yeaľ suľvival ofbladdeľ canceľ patients diag- nosed in the peľiod 1973_1997 by stage and peľiod of diagnosis. patients was higheľ (Table 1). The stage clistľibttticln at cliag- n()sis Was less favĺlrallle in the ĺlbseryatkln peľiocl 1988_92 than in 1Ĺ)83_87 lncl1993-97 (Tablc 2). In the periĺxl 1993_9] , lJgł ĺlf patients unclerwent Specific tľeat- ment' Sllfĺ]eľy alone wls applieĹl as prilnary tlcatment in the highest peľcentage ĺlf patients ft7rll),l3ilil of patients receivecl colnbinęd treatment clf stllgely' ľacliĺltlre rapy aĺrc1 clrenrother- apy, 99t were tľeateclwitlr surgery and ľacliotlreľapy, 89/o undeľ- went sllfgefy ancl clremĺlthęľapy' .lncI 20/ll sttľgcry ancl inrmunotlreľapy. In the ltlt.jĺ lľiry ĺlľ1leticnts, trxnstlÍťthľal ľesec- tiĺln (TtlR) was peľfĺlľmeťl. The Rcgistly ľcccivecl ľepĺlľts of on|y 77 tĺltll cystcctĺltriies ( 13-qĺ ĺlf a1l ĺlpeľatecl pltients) made ln the peľiĺrl 1993_97 ' T'he peĺcentages ĺlf incliviclual tľcatnent nlĺrĺalities weľe the same alsĺl in the yeaĺs 19lJĺ]_1992, whcre- as in the yeaĺs 1983-tt7, the percentages of the patients who tln(lerwent sllľgęry alĺlnc ancl ĺlťthĺlse whĺl wcre tľelted sur- gicllly ancl iľľacliatecľ weľe signiiicantly lrigher' while of thĺlsc whĺl ľcccivccl clrclnł,tltcľllpy lrlĺlnc, it was loweľ. l)ľit"lraty tĺe'.ltment wls staľtccl at thc Depaľtment ĺlf Llrĺtlĺlgy, t]MC in Ljirbl;ana ĺn 47ni, ĺlf palicĺlts, in 10?il in thc Genę].al lĺlclrlizecl ĺcgiĺlnrl (listent -.- illl 6z CANCER PATIT,NTS SURVIVAL IN SLOVENIA 1983-1997 PREŹĺVI ADDER MEHUR 100 80 100 80 860 .E s40 20 .Ś ĺn, o iŃ Żąo lct 4Ż) 40) 44) r (rz). /CI 20 0 3 2 3 4 0 4 5 -56) -52) -58) SIIKA 3: Relativno petletno pĺeživetje bolnlkov z ľakom sečnega mehuľja, zbolelih v letlh 1993-|997 po staťosti. stadijih bolezni ni povečalo (slika 2). Pľeživetje je bilo pľi moš- kih, śtaľih 55-64Ietzat4o/o manjše kot pľi mlajših Glika 3), Izsledki študije EUROCARE -3kaŹe1o, da je bilo v Evropi pov- pľečno Staľostno standardiziľano ľelativno petletno pľeživet- jezarakasečnega mehuľja pri moških 70 ,90/o(70:71',B) inpr| Łenskah 68,50/o (67,I_70), v Sloveniji pa pľi moških 45,20/o (40,1'_50,9) in pľi ženskah 56,40/o (49,3-64,6). Največje pľe- Živetje pľi moških jebilo 84,90/o na Islandiji in pĺi ženskah 77,4o/o na Tiľolskem v Avstľiji. Pľimeľjava med drźavami pa niveĺodostojna,ket je Slovenija v analizo vključila samo bol- nike z inv azijskim ľakom. Boris Sed'mak, Klinični oddelek za urologijo KC Zgodn1a diagnozaraka mehuĺja je ključnega po mena zaboIj- šo pĺognozo' Na vseh uľoloških oddelkih v Sloveniji sta se kot najpomembnejši pľeiskavi za diagnozo raka sečnega mehuĺ- ja upoĺabljali cistoskopija in histopatološka ocena tkiva po endoskopski ľesekciji. Razšiĺjenost bolezni je bila ocenjeva- na predvsem z ultrazvočno pľeiskavo, ľačunalniško tomo- grafijo, magnetno ľesonanco' intĺavenozno uľografijo in bimanuelno palpacijo v anesteziji med TUR tumoľja mehuľ- ja. Citološka analizauľina je bila uporabljena večinoma za sle- denje uspešnosti zdľavljenj a in manj pĺi začetĺi diagnostiki. Prizamejevanju bolezni je bila upoĺabljena TNM klasifikacija. Povľšinski raki sečnega mehlĄaTałI so bili zdravljeni s TUR in v pľimeru ponovitve poleg TUR še zintravezika\nimi insti- lacijami BCG ali mitomycina. Kaľcinom in Situ ie bilpoleg TUR zdĺavljen še z instilacijami BCG' Invazivni ľaki sečnega mehurja bi moĺali biti v opazovanem obdobju v večji meri zdľavljeni z radikalno cistektomijo. Radikalna cistektomija je zlati standaľd zdľavljenja mišič- no-invazijskih tumorjev prehodnoceličnega epitela mehuĺja v večini dľŽav po svetu. Indikacije zanjo so mišično-invazivni karcinom mehuľja T2-T4a, N0-NX, M0 in obsežni povľšinski papilarni ĺak mehuľja, ki ga ni mogoče z&aviti s konzeľva- tivnimi metodami. Poleg inkontinentnih derivacij so bile years FlGURf, 3l Relatlve five_yeaľ suĺvival of bladdeľ canceľ patients dĘ_ nosed ln the period 199L1997 by age. Hospital Šempeteľ pľi Novi Goľici, in9o/oineach of General Hospitals in Maĺiboľ and in Celje, in 8% in the General Hospital in Novo mesto, in 6% in the Geneľal Hospital in Slovenj Gradec, in 40/o in the General Hospital in lzola, in J\/o in the Geneĺal Hospital in Muľska Sobota, and in 2% in the Geneľal Hospital inJesenice. At the Institute of oncology, the pĺimary tľeatment was stafied only in 3% of patients. The relative five-yeaľ survivalrate was only I0/o higher in the years7993_97 than in the yeaľs I9B3_B7 (Figure 1). The suľ- vival at each individual stage of the disease did not improve (Figuľe 2). The survival of male patients in the age gľoup of 55_ó4 years was I40/o \oweÍ than that of youngeľ male patients (Figure 3). Accoľding to the EUROCARI-3 study results foľ the peľi- od 1990_94, in Europe, the age-stand ardized relatlve suľvival ĺate of the patients with bladder Cancef was 70 ,9Vo (7V71.8) in male patients and in female patients 68.50/o (67 .1.-70), while in Slovenia, il was 45,20/o (40.I_50.Đ in male patients and 56.4 (49.3_64.ó) in female patients. The highest ľates of 84.90/o and oť 77.40/o weľe observed respectively in male patients in lceland and in female patients in Tyrol in Austria. The comparison between countries may not be reliable because, in Slovenia, only the patients with invasive bladdeĺ Cancer weľe included into the study. Boris Sedmak, Department of Urologlt, UMC, Ljubljana Eaľly diagnosis of bladder CanceÍ is of essential importance for a moľe favorable prognosis. In the uľology depaftments of the geneľal hospitals in Slovenia, the diagnostics of blad- der cancer is based on two fundamental examination meth- ods, i. e. cytoscopy and histopathology of the tissue samples collected by endoscopic ľesection. The disease stage evalu- ation is made by ultľasonogľaphy, computeĺ tomogĺaphy, magnetic fesonance imaging, intľavenous uľogĺaphy and bimanual palpation duľing TUR of the bladdeľ tumor with the patient under anesthesia. Cytology of the urine is mainly used Ieta diag- )93-97 r dtag- nosls, iug2 treat- n the :ived ltheľ- ndeĺ- and esec- rts of ĺrade ment heľe- who l suľ- le of )weľ' logy, neral 1544 -*-- 4)-)4 -))_04 - 75+ Moški _ I>44 45-54 ))-o4 - tJr-/4 _ 75+ Ženske - Females -1997 ľnľŽlvn;r BoLNlKoV z RAKoM V sLoVENĺJl 1983-1997 63 śEcNl MEl pľeĹlvsclll pľi mlajših bo1nikih naľejene tucli lĺoĺltinenttre'Cock 1-ltluch a1i oľtĺltopni ĺrrehul'iz se!]1Tlent()V tankega in clcbele- gl čľevese. V rzbľanih pr'imeľih je bilo upĺlľebljerrĺl liľatliĺĺľajnĺl pľcclĺl- pelativnĺl ĺlbsevanje in acljuvantne 1ĺerrloteľapijl. V pl1neľu, cla je bolnilĺ ĺlcllilalljel cistclĺklnrijĺl in v izbl'anih pľinreľih je bi1 bolnilĺ zclľavljen s lĺombinilanim zclľavljenjerrr - TLTIł, lĺetnĺÍeĺepíjo in obsevanjem. V pľinreľtl neĺňčLrtljivclsti tulrrĺlľ- ja nl lĺenrĺ> in ľaclitĺeľlpijo ali pľi pĺlnovitvi tumĺlľje po pľecl- hclclnem ollsevanju itr 1icl-l-lĺltel'apiji je bila nar'ejena cistelĺtoniija' Reztrltati lĺolrrbiniĺanega nečina zc1ľavljenja so bili pľiteh slĺľbno izbľanih bĺllnlkih cklbľi(1). Pĺlgojza lĺĺlrnbi' niĺano zdľavljenje je clclbľo sĺx1elĺlvanje med uĺ'ĺtlĺlgi in clnlĺcl- logi. V LjLrbl1lni itrratrrĺl sĺlclelavci Iíiničnegl ĺlclclellĺa zlt uľĺllogijo I(C in on1ĺĺ11clš1ĺega inštinrta slĺttpnc ut'ĺllĺlš1iĺl-ĺln- kološlĺc 1ĺoĺlzilije, na lĺateľih obľavnavltmĺl lxllrllĺe z ľalĺĺltrr sečĺlega tlelrltl ja, 1ĺi so se zclľavrli pľi nas v Ljubljalri, in bol- nilĺe, kiso bili poslanirre lĺonzilij iz clľLlgilr uľobšlĺih ĺlc1c1cl- liov v Slĺlveniji' Tanja Ó(bľ, Onkoklški inšĺinlt LjllbL1arul 5-1ctno pľeŽivetje bĺl1ni1ĺov z ľelĺĺln scčnega tnelrutja se V ()paZ()VĹlnelI 15-letnern ĺlbc1ĺńju v Slĺlveniji ni spľemenilĺl. V ĺńclollju 19BB-92 smo lltlicekl pľiča nclĺĺtliko slebšelnu pľc- Živetjlr, veľjetnĺl tra ľačlttl man1šega cleleža ĺllłrejene llĺllezni' V zaclnjern ĺńclolljLr pa sln() spet ne ľ':ľni iz let 19,93-ĺ]7 Tĺl pľescneča, lĺejti opeľativne tehnilĺe kiľur'š1ĺega zclľavljcnje, lĺi je šc vccltro teĺneljni nlrčrn zclľavljenja tega ĺakl, so sc izpo- pĺllnile (2)' Doclaĺro sĺl se izbĺlljšale tllcli ĺlbsevalne tehtrike, clĺlbili smo učinlĺovite citostati1ĺe za pľehoclnĺlccličnega ralĺa (2). Iłazlog, cla se pt'cživetje oc1seclemclesetih let niizbĺĺ;- šalĺl, je islĺati v pľenrelĺl iz1ĺĺldščenilr tnĺlŽnĺlstilr nltrltidiscipli- lleľnega zclľavljenja (3) in v nezac1ostni lĺiľLrľgijl. Pĺlclatki za zaclnje obclobje 1993-97lĺlŽejĺl, cle je bilo satno olĺĺlli 307o bĺllnikov cle1ežnili poleg kiľuľšlĺegl zclľavljenje šc ĺlbsevanja ali lĺenroteľapijc Samo 139ó llolnilĺov je bilo zclľavl1cnrh s kĺlmbinacijo vselr tľc1r nečitrĺlv zcllavljenja. VecYina, 67 ]1,l-x'i' nilĺov jc bilo zclrevljenih sano s lĺiľuľgijĺl. Pľi večini ĺlpcľirlt- nih je bila nalejcne satno T[JR, lĺaľ ni zeclostno zclľavljenjc za invazijslĺega ľalĺa sečncgl tnelruľja (2), V ĺlbc1ol-l1tl 19()3_9] )c bilĺl Registr'ir pľijavljenih sattlo 77 tĺĺalnih cistelĺtĺlrnij ( 13 !í'). Majhen clelež ustľczno zclľavljenih bĺl1nikov ze invazijs1iega ľa1ĺa scčnega melruľja: z ľaclilĺa1no cistelĺtĺllrrijĺl ali pa s lĺĺlrn- binacijo TUR, ketnN o o. 40 Bĺĺĺĺt 2() 1s44 45-54 5s-64 65-74 75+ |'{ĺ lžnc vcľjctr pľcľltš, clirrgnc zrrscvk osl'lĺlv pĺlpĺl1l ĺlll 1ll'e izvr:n I ĺlih he: ljcnjc, r' ľegia nc, ne zt1ľlrvlj Ít'tr ĺr c l ĺ tstil'l, Nlt pľe trt lč1SÍ prr je v trrľi1a jr l;lrŹę z nim sil lrcrnat liĺl je l 0 3 ,2 3 4 0 , Ženskc _ Fenl:rles yeJfs 4 leta SLIKA 3: Relativno petletno pľeživetje boĹnikov z ľakom ledvic, zbolelih v letih 1993-1997 po starosti. izs1ec11ĺištLrclije EUROCARE-3 kaźejo, c1a je bib v Evľĺlpiptlv- plečno Staľostno standar'c1izilano ľelativno petletn() pĺeživetje ziJ ÍLIkLI ledvic pľi rnošlĺih 53,70ll (57,4_54,8) in pd ženslĺah 55,60/o$3,9_57,4), v Slĺlveniji pa pľi nxlških 43,5 % ę7 ,3_50,6) in pĺiŽenslĺah 4],90/,(47,Ę55,3)' Največje pr'eživetje prl moš- lĺih in pľi ženslĺah je bi1o na Tiľolslĺern v AVStľ1ii: 66,20i,l ozl- rome bJ,7o/0. Mirjana Žu,nter - PregeĘ, Kliľl.ični ĺldĺlelek za urolclgijtl I(C Zgoclrr1e odlĺľivanje se je izlxĺjšalĺl slnrcl pĺimošlĺilr zancliveč- jc upoľabe ttltľazvočnilr prcis1ĺav; podĺlben pojav smĺl ĺ-lpltzi- li za Ženslĺe že v B0. letih. Zgoclnje oĺlkľivanje jc izľeclno potnetlbnĺl, saj je ľelativno petletno pľeživet1e pľr omejeni bĺllezni 81 9t' pľi Ženslĺalr rlziľoma 77 9/o pľi rnoških. Z'zgod- nejšim ĺlclkľrvanjem lmlezni si lalrlĺo ľlzloźimo tuc1i dejstvo, c1a je pĺežrvet1e pľi obeh spĺllilr v Steľosti 45-54let najboljšc' Pľi mlajših od 45 let je bi1 cle1ež clmejene bolezni za l10/o nzlnj- ši lĺot v staľosti 45-54Iet' Pĺi njih se še ne pĺllnis1i na ĺa1ĺa in je zatĺl ocllĺľivanjc bolezni zakaslrekl. Pľistalcjših lxllnilĺih, sta- ľih65-]41et pa je bil clelež zgoclaj ĺxl1ĺľitihzl1'60/ĺ, manjši. Ali sttlĺl v 1etih 79L)3_()7 pLi njih v nranjšr meľi upoľebljali ultra- zvočne pľeiskave in nistnĺl v zadostni meľi upoštevali ĺizič- nih s1ĺtrpin7 Izbĺl1jšanje petletnege preźiveÍje za B0l, gľe izlĺljučno na lačtrn izbol1šanja pľeŽivetja pľi lnĺlških za II0/o, kaľ potľjuje clejstvo, cla je staclij bĺllezni najpomentbnejši napovec1nĺ clejavĺrilĺ pľeŽivetja. Nečin zclľav1jcnjl sc v tem obclobju ni potnetnhno spľemenil. Večĺ'ra oclĺasllh lxllnikov je bila samĺl tlperiĺanih (v letih 1993_97 zl70Avęč kcĺ v letih 19tJ3-ŕ]7). opeľativno zdlavljcnje je še veclno eclino trčinkĺlvito zclĺavljerrje' Samo cmbolizacija tumrlľja 15%) je brla narejena pĺi bĺĺnikih z mĺlčno napĺec1o- vaniltt tulnolnic, od tega v letih 1993-97 1006. v analizo ni bilo vključenih 14 0,5%i,) łlolnic, 1ĺeĺ je bil pĺi njih ľak ugcÍovljen šele ob sĺnľti. V opazovanem 15Jetnem ĺlbdobju je bila itrciclenca ľalĺa matel'- nlčnega Vľattl splYa ustaljena, sľec1i 90. 1et pa se je povečala. V letlh 19ĺ]3_ł]7 je llila gľoba incidenčna stopnja 1ó,9/100.000 Žensk, v letih1993*97 pa19,7/I00.000 Žensk. odstote1ĺ mikľoslĺopsko potľjenih pľimet'ov se je povečal z99%v 1etlh 19ĺ]3-ĺ]7 na 100% v letih 1993_97. Meclmikĺo- skopslĺo pĺÍľjenimi je bilo 78 9/o ploščatoceličlr jh, 17 o/o źlez- nih in 49ó neopľecleljenih karcinĺlmov. Staľĺlstna poĺazdelitev v anahzt> zajetih bolnic se je spľemeni1a (Labe1a 1). v lęĺh1993-97 je bilo več bolnic mlajših oct 55 let. Raz- šiľjenost bolezni ob diagnozi se je spremenila. V 1etih 1993_97 je hib več bolezniv omejenem staclijLr (tabela 2). V letih 199}97 je bikl specifično zc1ĺav1jenih 97 7ĺl bolnic' Pľvo zdľav11en;e 1e bi1o v 3C)0/ĺ, samo kiľuľško, v 33 9/o samĺl clbse- va1no (tele iĺrlali bĺahiľadroteľapija)' v 25 % kiľuľško in obse- valno, Citostatsko zclrzrvljenje salno ali v lĺombinacgi z opeĺacijo ali ollsevanjem je bilo upĺlrab1jeno v 30/o'Pwo zdĺavljenje se je pľičeb v 480/o na onkološkem inštitutu v Ljub1jani, v 31 %, na Ginekološkiklinikiv Ljtrb1jani, p<> 4o/ov SI3 v CeljLl in Maľi- boľu, po 20/ov SÍ] v lzĺĺi, Sklvenj Gĺaclcu in v Kranju, po 70/o v SB v Novem lnestu in na Ptuju teľ v bolnišnici v Postojni, pĺl 0,5 9ó v SB v Bĺežicah ilr v Muĺs1ĺi Soboti. Manjše število bolnic je bib zclravljeno v zasebnih ĺlrdinacijah in v SB naJesenicah. TABELA l: Maternični vľat. Bolnice vkliučene v analizo po staľosti in obdobju opazovanja. TABLE l: Ceľvix uteri. PatienĹs included in the analysis by age and peľiod of obseľvation. Strn^l,llltIi,Igll,lzl \1lľ.ll rIi'lgr'^i. Obdĺill1c/ 1\riĺlcl skupaji ^ll 83-87 fJl]-9Ż 93-97 01234, leta/yc:us SIIKA l: Relativno petletno preŽive$e bolnic z rakom mateľničnega vratu, zbolelih v letih 1983-1997 po obdobiu diagnoze. tlGURt' |: Relative Íive-yeaľ suľvival ofceĺvical canceľ patients diag- nosed in the períod 198T1997 by peľiod of diagnosis. In tlre peliod 7()83_9], a kltal of 2,677 femele patients weľe cliagnosecl with ce ryical Cenceľ; of these, 1,00ó females weĺc cliagnĺlscc1with this cancer in the periĺxl 19()3-()7 ' In 14 patients (0.59'0), cervicaI Cilnceľ Was cliagnĺlseĺ1 at clcath; these patients were theľefĺll'e not incluclccl in the analysis. At the beginning of the ĺlbseruecl 15-yeal'peľiĺlc1, the incic1cncc ĺlf ccĺvical Canccľ was rather stable, hut in tlre micl 1990s, lt incĺeased' In the peľiĺlcl 19ł]3-ĺ]7, tlre cľude incidencc ľate WeS 16.9/100,000 fenalcs, whereas in 1993_97, it was 19.7/100,000 ťeĺnales' In cĺlmpaľison to 19tJ3J7, the increasc of micľĺlscopically con_ fiľmed cases ln the ĺlbscryation peľiod 1993_97 was 196, i. c. fĺlrn 999ó tĺl 1009.1l. In tlre yeals 1993_9], the peĺccntage ĺlf sqttamĺllts-cell caľcinomas, ac1enĺlcarcinĺlmas, and non-SpeC]- ifiecl caľcinomas in the micĺoscopicalIy cĺlnfiĺmecl cases WaS 7 89Ą, l] 11) ancl 4%,, respectively. 'I'he ege clistributiĺln of paticnts includecl lnto the analysis has been changing (Table 1). In the peĺiod 199}97, a higher num- bcľ ĺlf peticnts youngeľ than 55 yeeľs Weľc incluĺ]ecl in the anelysis' The stage clistľibtrtiĺln at cliagnĺlsis a1so changed. In the peľiĺlcl 1993_9] , thc perccntage of localizecl disclse w'ts higher'tlraĺl that in two eaĺlieľ periĺlds (Table 2). In the peľiĺrl 19')3_L)7,979ó ĺlf patients unclctwent specific trcal ment. Suľgery alĺlne was appliccl as pĺimary tĺeatment in 39% ĺlf paticnts, JJ9(l were ĺlnly iľľacliated (tele- ancl/oľ bt'achyľa- clkltherapy), 251ó of patients reccivecl cĺlmllinec1 treattnent of TABEIA 2: Mateľnični vľat. Bolníce vključene v analizo po stadiju bolezni in obdobju opazovanja. TABIĽ 2; Ceľvix uteľi. Patients included in the analysis by sex, stage and peľiod of obseľvation. \rrdii/ St rgr (lhclĺĺljľ/ Slĺrpaji í)ĺlrcjľn/ Iłlziiĺjcn/ llrzscjan/ NťŻr).lll/ ])criĺlil All L,l,rliztĺl !l lltgiĺlnlll li' I)istant !l l]nknĺuln lĺl 100 u() E ť ; t,o 9 ;ś 40 o. 20 MATERNI' TABTI'A pte:tivel TABLE 3 periĺlĺl l gful,rlr;r/ Łrľll l98l-Nl lgss i,2 19!)3')1 ohJ,,hjľ/ I)ľll tl -_ 19r{l li7 l9$:l .!l 1!)eJ 17 V lctih je lĺot v 70. le lĺl (slik je: lĺĺlt 1 Izslcdk pľt:čtrc jĺ: 'la, rz 1b,20Á (slmo J)cteľ ] /.(]n\Kť lirrl:lI r 45-54 140 ]Żń 197 Żtnskc lr('llltlts l98]-ĺl7 19l']8'gŻ 1993,97 lipecifi ]iiľuľšk pašes nje se' I rile zc sticiľaí jc bilo ĺleugo 1c mož ĺlctn o icciclir terapij l'lĺ zl,g, i4a šte, tatov i Spozn vvcčji nične1 lošlĺi l ]xtlniš zdľavi ,14 1544 55rj4 ń5 74 ]5+ 8Ż4 8J9 1 ĺ )ĺl0 265 l5rl 451 Ż03 r12 1s4 49 5l.r 43 5,9 Ĺi'll 4,3 1,{l o,(r 0,(i 0 il 0 84 7r'l 13 s24 il5 39,4 ĺt.19 375 45'll ]{ĺ[) 5r() ś7 LJ Ą1Ż 4rl(i 4ŻŻ 53,ń 48,1i 4Ż,2 70 1983-87 l9sB-9Ż 199.L97 11Ż 113 1)5 CANCĹR PATIE'NTS SuRVIVAL ĺN SLoVENIA 1983-1997 PR[,ZIVI VRAI UTERI TABELA 3l Maternlční vfat. opazovano in ľelativno petletno pľeživďje po obdobju opazovanja s 95 0/o inteľvalom zaupaĺia(IZ). TABI-E 3: Ceľvix uteľi' obseľved and relative five-yeaľ suľvlval by peľiod ofobseľvation with 950lo confidence inteľval (CI). Opazovano / Observed (9'o) 0hdobje/ Pĺ:ľiĺxl Ženske/Females [eta/\tars 1 TZIU 3 IZIU 5 ruICI oniejen/localizecl ľazšiľjen/ĺegional razsejaďdistant vsi/all 100 54 59 6Ą ó0 65 71 80 83 8ó (17{/3) (80-86) (84-88) $7-63) (ó2_ó8) (6u74) (50-58) $g)2) 6147) 80 G 'Ł ä60 'Đ I 'Ň 40 o. 20 198}€7 1988-92 19)Ť97 Relativno / Relative (9'o) 1973:77 197u8Ż 1983-87 obdobje/period 198e.92 1993-97 Ženske/Fenrales Letall'errs ohdobje/ Period 1981-87 1988-92 199Ť97 (78-84) (81-87) (85-89) $947) (65-71) (70,76) 6543) 6941) (65-71) 59 63 ó8 63 ó8 73 81 u 87 1 rzlq 3 rzlu 5 tzlct SIIKA 2: Relativno p€tletno pľeživetje bolĺrtc z ľakom Íĺrat€mlčnega vľatu' zbolelih ý|etlht97T1997 po stadtju in obdobju diagnoze' tlGüR"L 2: Relative five-yeaľ suĺvivď of cervical canceľ patients dlag- nosed in the peľiod 1973_1997 by stage and period ofdiagnosis' Surgery and ľadiotheľapy, 30/o ĺeceived chemotheĺapy alone oľ in combination with suĺgery and radiothefapy. Pĺimary treat- ment was started at the Institute of Oncology in Ljubljana in 480/o of patients, in 3I0/o of patients, it was stafted at the Department of obstetľics and Gynaecology, UMC in Ljubljana, in 40/o in each of Geneĺal Hospitals in Maľiboľ and in Celje, in20/oin each of Geneľal Hospitals of lzola, Slovenj Gľadec, and Kľani, in 1% in each of Geneľal Hospitals in Novo mesto, Celje, Ptuj and Postoina, and in 0.50Ä in each of Geneľa1 Hospitals in BľeŽice and in Murska Sobota. The relative five-year suĺvival late was 9% higher in the years 1993_97 than in the yeaĺs I983_B7 (Figuľe 1). The suľ- vivalin the 1990s, Compaĺed to that of the 1970s, did not Sig- nificantly change in any of the disease stages (Figuĺe 2). The survival of the patients young eĺ than 45 yeaľS was by 4 6vohigh- er than that of the patients over 75 yeaľs old (Figuľe 3). Accoĺding to the EURoCARE-3 study ľesults ťoľ the peĺĹ od 1990-9 4, in Europe, the age-stand ar dized relative survival rate of the patients with cervical canceľ was59.90/o(5B.7_óI.D, while in Slovenia, itwas56'20/o(52.5_60.1). The highest ĺate oĺ66.8% was recoľded in Switzeľland (only ĺegistries in Basel and Geneva). Peter Fras, Institute of oncology Ĺjubljana Specific tľeatment of ceryical canceľ involves suľgery and irra- diation, a combination of both, and ín ľecent years, also com- bined tľeatment with chemotheľapy. In suĺgical tľeatment, no changes have been made lately. In390Á of patients who Weľe treated by surgery alone, the cancer was diagnosed in its ini- tial Stage when it was still opeľable; 250/o oť patĺents received postoperative iľľadiation llecause of most unfavoĺable prog- nostic factors. In a certain peícentage of patients, sulgery Can be caľied out afteĺ ĺaclical radicltheľapy if ľemission ís not com- plete oľ if ľecuľľence ís detected' This is the so-called 'salvage 3nce )90s, lnce was con- , i.e. 1e of pec- was ; has IUm- l the d. In was reat- 390/0 lyra- nt of tl wn 9/ĺ adiju stáge vletih1993_97 je bilo relativno petletno pľeŽivetje za9\/oveč je kot v letih 19B3-B7 (slika 1). V primeľjavi s pĺeŽivetjem v 70. letih pa Se v 90. letih pľeŽivet1e nipomembno poveča- 1o (s1ika 2). Pľibolnicah, mlajših od45let, jebiloza460/oveč- je kot pľi staľih75let in več Glika 3)' Izďedki študije EUROCARE-3kaźejo, da je bilo v Evľopipov- pĺečno staľostno standardtzirano ľelativno petletno pľeživet- je za ľaka materničnega vrattl59,90/o (5B,7_óI,1), v Sloveniji 56,20/0 (52,5-.60,1). Največje preži.vetje 1e bilo 6ó,8% v Śvici (samo območji registľov Basla in Żeneve), Peteľ Fras, onkološki inštitut Ljubĺjana Specifično onkoioško zdravljenje raka maternlčnega vľatu je kiruĺško, z obsevanjem, s kombinacijo obojega, v zadnjih letih pa še s kombinacijo s kemoteľapijo. Samo kiruľško zdrav\je- nje se v zadnjihletih ni spremenilo. Pľi bolnicah (390Á),kiso bile zdľavljene samo s kiruĺškim posegom' je bilľak diagno- sticiľan v začetnem, opeľabilnem stadiju bolezni. 250/obo1nic je bilo obsevanih po pľedhodnem kiruľškem posegu zaradi neugodnih napovednih dejavnikov' V določenem odstotku je možno kiruľško zdľavljenje tudi po predhodnem radikal- nem obsevanju, če ni popolnega ľegľesa ali se pojavi zgoďnji r'ecidiv ("salvage Suľgery-). Kombinacija obsevanja in kemo- terapije pĺi napľedovanih stadijih ĺaka mateľničneg a vľatu naj bi zagotavIjala boljše lezultat e zdravljenja. Zaradi premajhne- ga števi1a zdĺavljenih s tem načinom v Slovenijí svojih ľezul- tatov še ne moľemo oceniti. Spoznanje, da je najuspešnejše zdľavljenje določenih vľst ľaka v večjih centľih' upoštevamo' saj je večina bolnic z ľakom mateľ- ničnega vratl zdrav\jenih na onkološkem inštitutu, Gineko- loški kliniki v L1ubljani ter Ginekološkem oddelku Splošne bolnišnice v Mariboru. Še vedno pa se l7o/o zboĺelih začne zdraviti v dĺugih ustanovah. V večini pľimeĺov gÍe za ome- 1,0 0'ó 0,ó -1997 ľnľŽvryĺ BoLNlKoV z RAKoM V sLoVENl'JI ĺ983-1997 77 CERVIX UTERI letalyears SLll(A 3: Relativno petletno preživďje bolnic z ľakom matefđčnega vľatu' Żbolelih v letlh1993-1997 po staľosti. tlGURI' 3: Relative five-year suľvivď of cervicďcanceľ patíents dĘ_ nosed in the period 199F1997 by age. jeni IA stadij, včasih je bolezen ugotovljena naključno pĺi bol- nicah, ki so se zclľavile zaĺadi drugih ginekoloških obolen1. Za91Áizboljšano re1ativno petletno pĺeŽiYetje v letih 1993_97 v pľimeľjavi z\eti 1983-87 kate na izpopolnjene kiruĺške teh- nike z ustľezno poopeľativno nego' saj poleg tega, da zdra- virno kiruľško pretežno mlajše bo1nice z Iokalizirano boleznijo, zdľavimo kiruľško tucli staľejše bo1nice. Bistvenega izboljša- nja petletnega preźivetjav 90' 1etih v pľimeľjavi s preživetjem v 70. letih ni bilo, kar potľjuje , da pri zdravl1enju raka mater- ničnega vľatu nibilo ľaclikalnejših sprememb v načinu zdmv- ljenja' Kornbinacija vseh tľeh načinov zdravl1enja, kiruľškega, z obsevanjem in s kemoteĺapijobopokazala nroľebitno izbolj' šanje šele čez nekaj let. VIRA 1. Fras P' ecl' Doktrina zdľavljenja ginekološkilr lrrelignonrov' Ljubljana: onkološki inštitut' 1992' 2. StĺŽinaĺ\BaškovičM,BebarSetal'Ginekološkimalignomi: doktĺinazclrav- ljenja ginekoloških malignotrrov na onkološkem inštituttl in UniverŻitet- ni ginekološki kliniki. 2. rev. izd' LjLrbljana: Zvez'a slovenskih dľuštev za boi proti raku, 2001. Suľgery'. A combination of írradiation and chemotherapy foľ the tľeatment of cervical canceĺ in the advanced stages is consid- ered to yield better treatment results. Due to a 1imited numbeľ of patients who have been tľeated so faľ by this modality in Slovenia, we have not been able to make an evaluation of the treatment results. \N/e stfictly hold on to the geneĺal rule saying that the treat_ ment of cefiain canceľ types is moľe effective and successful in largeľ medical centeľs' The majoĺity of cervical Canceľ patients were treated at the Institute of Oncology Ljubljana, at the Depaľtment of obstetrics and Gynaecology, UMC in Ljubllana and at the Department of Gynecology of the General Hospital in Maĺiboľ. Sti11, 170lo of patients start theiľ tĺeatment in other institutions. These aľe usually the patients with the IA stage of the disease. In some cases, the disease was acci- dentally detected in the patients who were treated foľ otheľ gynecological diseases A ! percent betteĺ relative five-yeaľ survival in the peľi- od1993_97 than that in the peĺiod 1983_87 is the ľesult of the improved suľgical techniques and of a pĺopeí postopeĺative caľe of patients. As a matteľ of fact' we aĺe tĺeating suľgical- ly as much younger patients with localized disease as o1deľ ones. No significant improvement was obseľved in the five-year survival of the 1990s in compaľison to that of the i970s. This may be a proof that in the treatment modali- ty of ceľvical Canceľ no radical changes weĺe made, The effect of a combination oĺ all three treatments, of surgery, radio- theĺapy and chemotherapy' on the eventual improvement of suľvival, will be seen on1y afteľ a few yeaĺs. 100 u0 sś äoo .E o o. 20 0 3 4 r544 4r_>+ ))-04 - 0)-/4 _ 75+ vključ šele o V opa nične, c1enčl Ż4/t0 Oclstc opaz( v letih pľede malni Staľol nila ( skupi pom( Vletil zdray bľahi valnc cijis I na Gi tutu l po3( 2o/o v co MKB TABEI in ob TABTI perio I 1 i I Ż.*k. ! Femalął I =) I I pnĺŻ'I I I 3015 72 CANCER PATIEN{TS SURVIVAL IN SLOVENIA 1983-1C)97 ( UTERI MATERNIČNo TtLo 'oľthe rnsid- mbeľ MATERNICNO TE,LO CORPUS UTERJ MKB 8/ ICD 8: 1820 V obdobju 19$_97 je zbolelo za rakom mateľničnega teiesa 3015 bolníc, od tega v \etih 1993_97 I22B' V analizo ni bilo vključenih 31(Iw bolnic, keľ je bi1 pľi njih ľak ugotovljen šele ob smĺti. V opazovanem l5Jetnem obclobju se je incidenca rakamater ničnega telesa večala. V letih 1983_87 je bi1a gĺoba inci clenčna stopnja 17,3/100'000 žensk, v \etih 1993-97 pa 24/100,000 źensk. odstotek mikľoskopsko potĺjenih pľimeĺov je bil ves čas opazovanja 990/o. Med mikroskopsko potľienimi 1e bilo vletihl993_97740/oź1eznih,2l0/oadenoskvamoznih,20/onęo- pľedeljenih karcinomov in 3 %o kompleksnih mešanih in stľo- rnalnih malignoĺrrov. Starostna poĺazdelitev v analizo zajetih bolnic se je spĺeme- nila (tabe1a 1). V 1etih 1993_97 je bilo več bolnic v staľostni skupini od 65-74 1et' Razšiľjenost bolezni ob diagnozi se ni pomembno spremenila (tabela Z) . v letihl993-97 je bilo specifično zdravljęnih96% bolnic. Pĺvo zdrav\jenje je bilo v 60% kiĺuľško in obsevalno (tele- inlaii bĺahiľadioteĺapija), v 240/o samo kiruľško, v 12 7o samo obse- valno, v 2 % v kombinacijl s kemoterapijo, v 3 % v kombina- ciji s hoľmonsko teľapijo. Pruo zdľavljen je se je priče\o v 420/o na Ginekološki kliniki v tjub\jani,v 250/ona onkološkem inšti- tutu v Ljubljani, v I0 0/o v SB v Maľibonl, v 7 0/o v SB v Celju, poJ\/ov SB v Śempetru pľi Novi Goľici in Slovenj Gradcu, po 2% v SB v lzoli in Postojni, po I0/o v SB v Kranju, v Novem TABELA l: Maternično telo. Bolĺrice vključene v analŁo po starosti tn obdobju opazovanja. TABLE l: Corpus uteri. Patlents included ln the anďysis by age and perlod of obseľvatlon' Slaľosl ob diagnozl Age al diagno5is Obdobje/ Skupaj/ Period All -14 1544 45-54 5544 65-74 75+ 83-87 \Ug2 - 93-97 012345 leta/yeaľs SIIKA l: Relativno petletno pľeživetje bolĺric z ľakom materničnega telesa, zbolelih v letih 1983-1997 po obdobju dlagnoze. ľIGURL l l Relative five-year suĺvival of coľpus uteri cancef patients diagnosed in the peľiod t98Tt997 by period of diagnosis. In the peĺiod 1983-97, a total of 3,015 female patients weľe diagnosed with the canceÍ of the corpus uteĺi; of these, I,228 females were diagnosed with this canceľ in the peĺi- odl993_97.In J1 patients (1%o), coĺpus utericancerwas diag- nosed at death; these patients weľe theĺeĺoĺe not included in the analysis, In the observed15-year period, the incidence ofthe canceľ of the corpus uteľiwas incľeasing. In the peľiod 1983-87, the cľude incidence rate was I7 '3/I00,000 females' wheľeas tn 1993-97 , itwas 24/100,000 females. Thĺoughout the observation peĺiod 1993_97, the percentage of micĺoscopically confirmed cases was consistent, ĺeaching 990/o' In thę years 1993_97,the peľcentage of adenocarcinomas, adenosquamous-cell carcinomas, non-specified caľcinomas and complex mixed-rype ce1l caľcinomas togetheľ with stľomal and complex mlxed malignant tumors in the microscopically con- ĺirmed case s w as 7 40/o, 2I0/o, 20/o, anď 30/o, ľe Spectively. The age distľibution oťpatients included into the analysis has been changing (Table 1). In the peĺiod 1993-97 , a higheľ num- beľ of patients of the age gfoup of 65:4 yeaľS were includ- ed in the analysis, The stage distribution at diagnosis did not significantly change (Table 2). In the peľiod 1993-97,)6o/o oť patíensunderwent specific treat- ment. Suľgery in combination with iľľadiation (tele- and/or bľachyĺadiotheľapy) was applied as primary tľeatment in 60% of patients, 24o/o underwent suĺgery alone, 120/o weĺeonly irľa- TABLLA 2l Mateľnlčno telo. Bolnice vključene v analŁo po stadiju bolezni in obdobju opazovaĺja. TABLE 2: Corpus uteľi. Patients lncluded in the anĄsls by sex, stage and peľiod of obseľvatlon. stadij/ Stag€ Obdobje/ Skupaj/ onrejen/ Razšiľ1en/ Razsejan/ Neznan,' Peľiod Äll localized 9ó Regional 9ó Distant 9í Unknown 9ó 100 80 t äoo .F o 'Ň 4o o. s 20 lity in of the tľeat- essful ancer ljana, r{C in :neĺal "ment .h the acci- otheľ rative gical- oldeľ I the Lat of ila1i- effect 'adio- :nt of peľi- cf the -1997 ľRr'Žlvqr BoLNlKoV z RAKoM V sLoVENUl 1983-1997 17,6 77,3 76,1) /) Ženske Females 198|87 1988-92 1993-97 Ženske Females 1983-87 198&92 1993-97 839 9Ż9 1216 18 25 4Ż 152 170 191 326 212 131 y5 264 135 39() 389 198 8t9 6t1 9Ż9 718 1216 924 0,8 1,0 2,2 115 119 185 13,7 12,8 15,2 7 9 )7 66 8j 80 7,9 8,9 6,6 coRPus uTtRt TABILA 3: Maternično telo. opazovano in felativno petletno pľeživetje po obdobju opazovanja s 95 0/o lnteľvďom zalpaĺJa(IZ). TABIE 3: Coľpus uteľi. obseľved and relative five_yeať sufvival by pefiod ofobsefvatlon with 950/o conÍidence inteľval (CI). 100 opazovano/obseľed (|ó) 80 E .: e60 'Đ o 'Đ 40 o. 20 Ženske /Felrlles Leta/\tars 0bdobjc/ Periĺxl 1 tzld 3 rzlcr 5 vlcr 1983-87 1988-92 199y97 (84-88) (8&9Đ (87-91) (72-78) (73-79) (75-79) (6Ł7$) 65-71) (6u74) 67 ó8 71 7' 76 17 8ó 90 89 mestu' naJesenicah, na Ptuju in v Tĺbovliah teľ po 0,5 % v SB v BľeŽicah in Mr-rĺski Soboti. Y \etih1993_97 je bilo ľelativno petletno pľeŽivetje za50/oveč- je kot v letih l98ffi7 (slika 1). PľeŽivet1e se je poveča1o v vseh stadryih bolezni (slika 2). Pľibolnicah, mlajših od 65let, je bilo za I90/o oziÍoma 330Á večje kot pľi staľejših (slika 3). Izsledki študiie EUROCARE-3 kaźe1o, da je bilo v Evľopi pov- pľečno staľostno sIandar dlzlrano ľelativno petletno preživet- je za r aka mateľni čne ga telesa 7 J,4 0/o (7 2,2_7 4,6), v S l oveni j i 7 2,8 0/o (68,Ę7 /, !). Največje pr eźiv etje 1e bi1o 8 1, 1 % na Tirol- skeĺn v Avstriji. Peter Fras, onkološki inšilnłt I'jtłbljana Večanje incidence ĺaka mateĺničnega telesa ni vplivalo na število mikĺoskopsko potľjenih pfimerov' sajje še vedno 99%' Ta podatek poĘuje koĺistnost izdelane doktrine, sajta pĺedpisu1e diagnostični postopek pľi sunu na raka mateľničnega telesa, Večanje incidence pľi ženskah, staĘših od 75letkaźena aktivnej- ši diagnostični postopek in izboljšanje pľedopeľativnih plipľav' Povečano petletno pĺeživetje bolnic z ľegionalno rauširjeno boleznijo v ob dob1u 1993_97 v pľimerjavi z obdobjem I9Bffi7 pa prav tako każe naupoštevanje doktľinaľnih zahtev o nada- ljevanju zďravljeĺja po kirurškem posegu, Na Ginekološki k1inikiv Ljubljani, na onkološkem inštitutu teĺ Ginekološko-poľodniškem oddelku Splošne bolnišnice v Mariboru se začne zdraviti77\/obo\nic' Na ostalih gineko- lošk1h oddelkih se jih začne zdraviti230/o' Specifično onko- loško zdľavljenje ni bi1o mo goče prí 40/o bolnĺc zaradi staĺosti, napredovane bolezni in spľeml1a1očih dľugih bolezni. 50/o več1e petletno pľeŽivetje v letih 1993-97 v pľimerjavi zleti1983_87 kaŹe zvellko veĺjetnostjo na zgodnejše odkľi- van1e in tucli pľosvetljenost žensk, da sę źe ob prui pomeno- Peter Fras, Iľlstifute of oncologl Ĺjtłbljana An increased inciclence ĺatc of the canceÍ of the coľpus uteľi did not have any inf]uence upon the peĺcentage of micro- scopically confiľmed cases, which reached 997o and was con- sistent thľoughout the observation periocl' These data confirm the usefttlness oĺ the guidelines foľ the tľeatment of the can_ ceĺ of coľpus uteri that pĺescĺibe the diagnostic pĺoceduľe in case of a suspectecl malignancy. The incľeasing incidence in eldeĺly wolnen' aged over 75 yeaľs, points to ä moľe active cliagnostic pľocecluĺe ancl better preopeĺative management. 1983ą7 obdobje/peĺiĺxl 1 VIU 3 IZICI 5 V/CI 198V92 1993-91 SĹIKA 2l Relativno petletno pľeživetje bolnic z ľakom mateľnič- negatelesa, zbolellh v letih 197F1997 po stadiju in obdobju dlagnoze. FIGUR"E' 2l Relative five_year survivď ofcorpus uteri canceľ patients diagnosed in the period L973-|997 by stage and peĺiod ofdiag- nosls. diated, 2% of patients received combinecl treatment of radio- theľapy and chemotherapy,30/o ľeceived a combination of ľadiotlieľapy and hormonal theľapy. Pľimary tľeatment WaS stafiecl at the Depaftment of Obstetrics and Gynaecology, UMC in Ljubljana in 420/o of patients, at the Institute of Oncoiogy in Ljubljana in250/o of patients, in 100/o of patients' it was Staľt- ed in the Geneĺal Hospital in Maĺiboĺ, jn70/o ln the Geneĺal Hospital in Cel1e, ln 30/o in each of Geneĺal Hospitals in Sempeteĺ pľi Novi Goĺici, and Slovenj Gľadec, in 20/o in each of Geneľal Hospitals inlzola and Postojna, in 1% in each of Geneĺal Hospita1s in Kranj, Novo mesto, Jesenice, Ptuj and Trbov1je, and in 0.57o in each of GeneľalHospitals in BreŽice and in Muĺska Sobota. The ľelative five-yeaĺ sulvival ľate Was 5% higher in the years 1993_97 than in the yeaĺs 1983-87 (Figure 1). The stlľ- vival impľoved in all patients with the disease at eny Ętage (Figuľe 2)' The survivalof the patients younger thaň (l5 years was by 19%o higher than of patients 65-l4years old (Figure 3). Accoľding to the EURoCARE-3 study results foľ the peľi- od1990_94, in Euľope, the age-standarclized ľelative suryival rate of the patients with the Canceľ of the coľpus uteľi was 7 3.4Vo 0 2'2_74. ô, while in Slovenia, it w as 7 2.80/o (68'+7 7 .r. The highest ĺate of 81.1% was recoĺded in Tyľo1 in Austĺia. 1973-77 197U82 Relativno / Rel:rtive (ll) Ženske / Fcrrrlles Irta / \'eaľs Obdobje/ Period 1983-87 198V92 199T97 /0 77 81 81 81 83 89 o) 91 (87-91) (90-94) (89-9t (78-81) (78-84) (80-86) (72-80) (74-80) (78-84) pľipišĺ pľeisk zijemt pogos Izdaja Onkol ka Spl, pomol telesa ustan( clesetl agľesi ľov bc način Še veĺ ustan( kološl bolniš 100 pa t ĺ .t PREzrvl J vzl1l i : uRAĺ STIKA ĺ]0 ź^ uo .F U 'ś 40 o. 20 1' Fľas Onk 2. StĺŽ'i ljenj ni gl bni ! ljenla zzdra lna mĺ siceľ l daĺ to ľezu1L ob ve, telesa, ľlcuRI' /4 CANCE.R PATIEMS SURVIVAL IN SLOVE,NIA 1983-1997 TELO UTE,RI 100 The increased five-year suruival of the patients with ľegion- ally advanced disease in the peľiod 1993_97 in compaľison to the survival in the years 1983_87 is a pľoof that the posr operative treatment guidelines were obserued. oť the patients with the Canceľ of the coľpus lteľi, 770/o ľeceiveclpľimaly tĺeatment at the Depar1ment of obstetncs and Gynaecology, UMC in Ljubljana, at the Institute oĺ oncology in Ljubljana and at Depafiment of obstetľics and Gynaecology of the GeneľalHospital in Maľiboľ' only 23% of these patients ľeceived primary treatment at otheĺ gynecological depaĺtments. In 4o/o oť parients, it was impossib1e to app1y specific tľeatment mainly because of the o1d age of the patients, advanced stage of the disease, and otheľ comorbidities. A 57o higheľ five-yeaľ survival in the periodl993-97 than that in the peĺiod I983-B7 may be due to eaĺlieĺ detection of the disease and higheĺ awaľeness of postmenopausal women who visit the gynecologist as soon as they notice any bleeding. A contĺibution to the impľoved suruival may a1so be a moľe frequent use of US examinations, in particulaľ of the vaginal US. It is also very likely that Cuľettage is more often indicat- ed as diagnostic pľoceduľe. The publication of the,Guidelines ĺoľTĺeatment of Gynecological Canćeľs-, edited in I))21ointly by the following thľee centĺal health caľe institutions, uiz'Department of obstetľics and Gynecology, UMC in tjubljana, Institute of Oncology Ljubliana and Depaftment oťobstetrics and Gynecology in the Geneĺal Hospital in Maľíboĺ is an impoľtant contribution to a moľe stan- daľdized appľoach to the treatment of the cancef oĺ the coľ- pus utefi and to concentfating the patients with this canceľ in the above thľee centĺal health caľe institutions (1). The tľeat- ment ofthe canceľ ofthe coĺpus uteri has not changed much in the ĺecent decades; on the contĺary, it has become even less aggressive in the cases in which the disease was diagnosed in time. Suľgery has ľemained the tĺeatment of choice foľ this Canceľ. It has been observedĺhat}3)/oof patients are stil1ľeated in health institutions otheĺ than the Institute of oncology, Department of Obstetrics and Gynaecology, UMC in Ljubliana and Depaĺtment of obstetĺics and Gynecology at the Geneľal Hospital in Maľiboľ. The recommendations that the best Íeatment fesults aľe usually obained in the health centers with most experiences in the tľeatment of a paľticulaľ cancer, has not been fully bľought into effect. The surgica1 tľeatment of the canceľ of the coĺpus uteri in its early Stage is not that demanding as the suĺgery of otheľ gynecological canceĺs, nev' efiheless, this cannot justĘ the present tľeatment fesu1ts. Theiľ impľovement wi1l be noted in the yeaľs to Come' afteľ the rec- ońmendations contained in the "Guidelines forTreatment of Gynecological Canceľs" will have been strictly ťol1owed (2). 80 ä ĺ,o 'ŕ o .2 ,^ 'd 4u o. 20 t93-97 lľnič_ lobju Íents diag- rdio- rn of was UMC 'logy jtaľt- reral ls in each :h of and :źĺce the stlľ- itage ,ears 'eĐ. peľi- vival was 7ś) .na, uteľi icľo- con- rfiľm can- re in :e in :tive rent. -1997 012345 letalyeaľs SLll(A 3l Relativno petletno preävetie bolnic z ľakom mateľničnega telesa, zbolellh v letih 199L1997 po starostl. I|GURL 3: Relative five-yeaľ survivď of coľpus uteri canceť patients diagnosed in the períod 1993_1997 by age, pav zni krv av itvi oglasijo pri ginekologu, Določen dopľinos pľipišemo lahko tudi vedno pogostejši upoľabi ultľazvočnih pľeiskav, pĺedvsem vaginalnega ultĺazvoka, Veĺjetno so abľa- zije mateľnične votline kot diagnostičen postopek indiciľane pogosteie. Izdaja doktrinaĺnih stališč Ginekološke kiinike v Ljubljani, onkološkega inštituta teĺ Ginekološko-porodniškega oddel- 1ĺa Splošne bolnlšnice v Maĺiboru \eta1'992 (1) je verjetno pľi- pomogla k enotneišemu načinu zdľavlj enja raka mateľničnega telesa in ne nazaďnje h koncentľimnju teh bolnic v naštetih treh ustanovah. Zdravljenje ľaka materničnega te1esa se v zadnjih ciesetletjih ni bisrveno spľemenilo, postalo je celo nekaj manj agľesivno, vsaj za večino pĺavočasno diagnosticiľanih pľime- ľov bolezni. Kiruľško zdravljenje je še vedno najboljustrezen način zdravljenja. Še vedno pa ugotavljamo, da se Z3o/obolnic zdtaviv dľugih ustanovah in ne na onkološkem inštittttu, Univeľzitetni gine- kološki kiiniki v tjub1jani teľ Ginekološkem oddelku Splošne bolnišnice Maĺiboľ. Poudaľek, da so najbo1jš i r ezĺlltati zdr av - ljenja ľakavih bolezni v centľih, kjeľ imajo največ izkušenj zzdravljenjem' se še ni uveljavilv celoti. Zdravljenje kaĺcino- na mateľničnega telesa je v zgodnjih stadijih bolezni kiruľško siceľ manj zahtevno kot pri dľugih ginekoloških ľakih, ven- daľ to ne opĺavičuje sedanjega stanja, saj se bodo izboljšani r ęzu\tati zdľ avlj en j a 1ahko p okazaIi v nadal j n j ih ob dob j ih šele ob večjem upoštevanju doktrinaľnih pripoľočil (2). VIRA i' Fras P, ed. Doktľina zdravljenja ginekoloških rrralignonrov. Ljubljana: onkološki inštitut, 1992' 2' Stržinaľ V, Baškovič M, Bebar S et al. Ginekološki malignomi: doktrina zdĺav- ljenja ginekoloških malignomov na onkološkem inštitr.ltu in Univeĺzitet- ni ginekološki kliníki. 2' ĺev. izd' Ljubljan^: Zvez^ slovenskih clruštev za boj pľoti raku,2001' ľnrŽlveĺ;r. BoLNlKoV Z RAKoM V sLoVtNUI ĺ983-1997 75 JA]CNrr( OVARY MKB 8/ ICD 8: 1830 V obdobju 1983-97 je zbole1o za rukomjajčnikov 2399 bo|- nic, od tega v letih 1993_97 906.Y anallzo ni bilo vključenih 167 Ow bolnic, keľ je bil pĺi njih ĺak ugotovljen šele ob smĺti, V opazovanem 15letnem obdobJu se je incidencaľaka jajč- nikov večala. V 1etih 1983_87 jebila gľoba incidenčna stop- nja I3,7 / I00'000 žensk, v letih 1,99 3_97 pa 17,7 / I00'00 0 žensk. Y zadnjem obdobju so bile vključene tudibolnice z mejno maligninť nrmoľji. Mejno malignitumorjiso bili vĘučeniv rcd- no ľeglstĺacijo ĺaka šele leta 199l. V letih 1991_92 jih jebllo 46, v lerih 1993-97 pa I2B. odstotelĺ mikľoskopsko potľjenih pľimeľov se je povečal s 940/o v letih 1983-87 na 97 0/o v Ietih 1993-97 , Med mikroskop- sko potľjenimije bilo v letih1993_97 920/o aclenokarcinomov (od tega 1'6 0/o lnejno malignih), 4 % neopľedeljenih kaľcino- TABEtA la:Jajčnik' žlezni karclnomt. Bolnice vključene v analŁo po starosti in obdobju opazovanja. TABIE la: Ovary, adenocarcinoma. Patients included in the analy- sis by age and period of obseľvation' Staroĺ ob tliagnozi/ Agš al di18no'i\ 100 83-87 88-92 - 93_97 012345 leta/yeaĺs SLII(A l: Relativno petletno pľeživetje bo|nic z äeznim kaľcinomom iajčnlkov' zbolelih v letih L973-t997 po obdobju ďiagĺoze. ľIGURI' l: Relative five-year suľvival of ovarian adenocarcinoma patients diagnosed in the peľiod l97T|997 by peľiod of diagno- sis. In the peľiod I9B3-97, a total of 2,399 female patients were diagnosed with the ovarian Canceľ; of these, 906 females weľe diagnosed with this cancer in the period 1993-97, In 1ó7 patients (7Vo), ovarlan Cancef was diagnosed at death; these patients were theĺefoľe not included in the analysis. In the observed 15-yeaľ peľiod, the incidence of the ovaľi- an Canceľ was incľeasing. In the peĺiod 1983_87, the crude incidence fate was B,7 /100,000 females, wheľeas inl993_97 , it was 17.7/100,000 females. The tumoľS with bordeľline malignancy have been regulaľly registered only since 1991' In the peĺiod 1991-92,4ó cases weĺe ľegistered and, in 1993-97 ,1,28. In compaĺison to the obseruation peĺiod 1983_87' the peĺ_ centage of microscopical1y confirmed cases incľeased by 3% in the obseruation peĺiod 1993-97,i, e, ťrom94ĺ/oto97l/o.Inthe TABILA 2a:Jajčnlk' žlezni kaľcinomi. Bolnice vključene v analŁo po stadiju bolezni tn obdobju opazovanja. TABIE 2a: ovary, adenocaľcinoma. Patients included in the analy- sis by sex, stage and peľiod of obseľvation. Stadil/ Stage Ohdobje/ Skupaj/ Onlľjen/ Razšiľ1en/ Razsejan/ Neznan/ Period All Localized 9ô Regional 9/o Distant j'o Unknown 9ó 80 f .ż 7, 60 'Đ ;š 40 o. 20 obdobje/ Skupal/ Pcriod All -14 1544 45-54 5544 65-74 75+ lnov ln malign StaľoSt ŹIeznk. več bo nimi tt la 1). 1 lĺaľcin, je biia zeĺ'M ni (tab V letih nic, Pľ v Ż50/o ko, ob Pruo z v Ljubl vSBv pľiNo in Izol Io/o pa bolnic Če up v letih v letih cah v no bo za24l cahzs ka 4). Izsled pľečn je za Q7,3- obdobje/ Period nrcĺv{ TABTTA 1981-87 1988-92 1993-97 TABLE 3: suĺvival obĺIobje / Perrod 19ł]]-87 19rrtl,92 ||ĺ.)T97 /ťnsKť Femalcs 1981-87 198U92 1993-97 495 602 615 5Ż 75 63 0 0 1 127 134 131 105 123 160 162 194 182 49 76 78 Ženske 198}87 495 Females 198&92 602 199T97 615 64 12,9 83 95 15,8 14 100 16,2 84 17,0 342 12,3 428 13,7 426 69,1 71,L 69,3 1,0 0,8 0,8 TABEIA l b: Jajčnik' mejno mďigni. Bolnice vključene v anallzo po staľostí in obdobju opazovanJa' TABIE lb: ovary, bordeľľne' Patlents included in the analysis by age and peľiod of obseľvation. Sl.rroĺ oll Lliagnozi ' Agľ al Lli.rgn, ĺis Obdobjc/ Skupaj/ Period All IABEIA 2b:Jajčnik, mejno mallgnl. Bolnice vključene v analŁo po stadiju bolezni in obdobju opazovaĺja' TABLE 2bl Ovary, boľdeľline. Patients included in the analysis by sex, stage and periôd of obserwation. Stadii/ Stage -1.4 1544 45-54 5544 65:/4 75+ obclob1e/ Skupaj/onrcjen/ Razširjen/ Perrod All localizcd 9ó l(cgional Razselan/ Ncznan/ 9ó Distant 9/o llnknown łí Ženskc Fcmales 1983-87 1988-92 1993-91 Ženske Iiemales 1983-87 1988_9Ż r993-97 00 76,0 4 75,8 13 0 0 1 0 l 17 0 8,6 10,2 0 35 97 0 46 128 0 l 12 0 4 17 0 Ż7 0 18 48 0 46 12lJ 0 12 2Ą 0 15,2 13,3 0 0,0 0,8 /tc CANCE,R PATIEMS SURVIVAL IN SLOVENIA 1983-1997 -t ĺ /ARJT,S BIČNIK TABELA 3:JajčnĄ äezni kaľclnomi. opazovano in ľelatlvno petletĺro pĺeživetje po obdobju opazovanja s 95 0/o lnteľvalom zaupaĺja(l7). TABLE 3l ovary, adenocaľcinoma. obseľved and ľelative five-year suľvival by peľtod of ob,seĺvation wlth 950lo confidence inteľvď (CĐ. Opazovano /obseĺved (9ó) 0hdobje/ Period Ženske/Females leta/Yeaĺs 100 1. IZIU 3 IZII 5 IZICI 80 E 5 e60 'Đ o iŇ 40 o. 20 _-J mom €no- ü/eľe 198|87 198&92 199T97 $446) (65-73) (69-77) (30-38) 3tu4) 3947) Q1-29) (2y37) (29-31) 25 33 33 34 40 43 60 69 73 5 loma ň/ere Relativno / Relĺtive (0/o) 1973-77 197V82 1983-87 obclobje/peĺiod r98U92 1993-97 Ženske/Females [etal'ltaÍs obdobje/ Period 1 tzlu 3 rzlct 5 tzlcr SLlt(A 2l Relattvno petletĺro pľežívetje bolntc z žleznim kaĺcinomom jajčnikov, zbolelih v letih 1973-|997 po stađiju in obdobju díagnoze. tlGURL 2: Relative five_year sufvival of ovaľian adenocaľcinoma patients diagnosed in the peľlod 1973_1997 by stage and p€flod of dlagnosis. 1983-87 198&92 199T97 o()-o()l (67:75) (70-78) $141) 3U6) (42-50) (2Ę32) (29-37) (2341) mov in J\/o maIignomov kličnih Celic ter posamezni primeľi malignega gľanulozoceličnega tumoľja in malignega tekoma. Staľostna poľazdelitev V anallzo zajetih bolnic zinvazijskim źlęznimkaľcinomom Se ie spľemenila. V 1etih 1993_97 jębilo več bolnic StaÍih 65-741et' Med bolnicami Z me'no malig' nimi tumoľji pa je bilo največ mladih, staľih I5_44Iet(tabe- la 1). Razšiľjenost bo1euni ob diagnozi invazivnih Źlezĺih kaľcinomov se nipomembno spľemenila. V letih 1993_97 je bila še Vedno pľi 69o/obolnic odkrita źe razsejanaboIe- zen. Med mejno malignimi pa je bilo največ omeiene boleu- ĺi (tabela 2). Y \etih 1993_97 je bilo specifično zdľavljenih 917o vseh bo1- nic. Prvo zdravl1enjeje bilo v 56,5% kiruľško in citostatsko, v 250/osamo kirurško, v 10% samo citostatsko, v 5,5 % kirurš- ko, obsevalno in citostatsko inv L0/o kiľurško in obsevalno. Prvo zdĺavljenje se je pĺiče1o v 350/o na Ginekološki kliniki v Ljubljani, v 250/ona onkološkem inštitutu v Ljubljayi,v 1'30Á v SB v Maľibo ÍU, v 60/0 v SB v Celju, po 40/o v SB v Sempetľu pľi Novi Goĺici in Slovenj Gĺadcu, po )o/ov SB v Novem mestu in Izoli, po 20/o v bolnišnici v Kranju in v SB na Jesenicah, po 70/o pa v SB v Tľbovljah in na Ptuju. V manj kot 1% so bi1e bolnice zdravljene v SB v Bľežicah in v Postoini. Če upoštevamo Samo invazijske źlezne karcinome, je bilo v Ietih 1993_97 relativno petletno pľeživetje za 9 0/o večje kot v letih 1983-87 (slika I,tabela 3). Povečalo se je pĺi bolni- cah v vseh stadijih bolezni, največ pa pľi bolnicah z razseja' no boleznijo (slika 2)' Pri bo1nicah, mlajših od 55 let je bilo za 24o/o večje kot pľi staĺih ó5 let in več (slika 3). Pľi bolni- cah z mejno malignimi tumoľji pa je bilo pľeživetje 96Vo(sli- ka 4). Izsledki študiie EUROCARE-3 kaźejo, da je bilo v Evĺopi pov- pĺečno staľostno standar dizitano relatlvno petletno pretiv et- je za raka jajčnikov 31,90/o (30,9_32,9), v Sloveni1i 31,4% (27,3-36,2). Največje preźivetje jebllo 460ń na Islandiji. years 1993_97, the peľcentage of adenocarcinomas, non-spec- ified caľcinomas, and otheľ geľm cell malignancies in the micľoscopically confiľmed cases Was 92% (of these, 16% with borderline ma1ignancy), 40/o, and J%, respective1y. Theľe weľe also Some Cases of gľanu1osa-cell malignant tumors and malignant thecomas. The age distľibution of patients with invasive adenocaľcino- ma included into the analysis has been changing (Table 1). In the peľiod 1993_97, a higheľ numbeľ of patients of the age group of 65ł4yeaĺs were inc1uded in the analysis. In the gĺoup of patients with tumors with boĺderline malignancy, younger patients, aged berween IJ14years, pľevailed. The stage distľibution of invasive adenocaľcinomas at diagnosis did not significantly change (Table 2). Among the cases of boľ- deľline malignancies, the 1ocalized disease pľevailed. In the peńod 1993_97,91% of patients underwent specific treat- ment' Suľgery in combination with chemotherapy was applied as primary tľeatment lĺ 56.50/o of patients, 250/o of patients undeľwent suľgery alone, 10% ľeceived chemotherapy a1one, 5'50/oof patiensľeceived combined tľeatment of suľgery, ľadio- theľapy and chemotherapy, and 1%o ľeceived a combination of suĺgery and ľadiotherapy. Primary tľeatment was staĺted at the Department of obstetľics and Gynaecology, UMC in Ljlńljana in 350ń of patients, at the Institute of oncology in tjubljana in250/o oĺ patients, in 730/o of patients, it was Start- ed in the General Hospital in Maribor, in 6o/o in the General Hospital in Celje, in 40/o in each of General Hospitals in Śempeteĺ pľi Novi Goľici, and Slovenj Gradec, in 30/o in each of Geneĺal Hospitals in Novo mesto and in Izola,lnl\/oineach of Geneĺa1 Hospitals in Kľanj, andJesenice, in 1% in each of Geneľa1Hospitals in Tľbovlje and in Ptuj, and in 1ess thanll/o in each of General Hospitals in BľeŽice and in Postojna. The relative five-yeaĺ survival ľate of the patients with inva- sive adenocaľcinoma was 9% higheľ in the years 1993-97 than in the years 198ffi7 (Figuľe 1, Tab1e 3). The survivalimpľoved 28 33 37 36 42 46 61 71 74 /. In :ath; vaÍl- rude Lq7 riine 991, and, allzo naly- o/a tl iln peÍ- Ý 30/o r the ro po is by tl łn 0/o 1,0 0,8 0,8 0 0,0 0,8 1997 omeien'4ocalized - razširjen/ľegional - ĺazsejanldistant vsi/all ľnľŽlvn;ľ BoLNlKoV z RAKoM V sLoVENUl 1983-1997 77 OVAR]E.S 100 100 80 E .ä ř dso '5 .Ł 'Đ 40 o. 20 80 E ä ĺ,o 'Đ ,ri 40 o. 20 0 Ż3 leta/yeaľs 4 0 23 leta/yeaĺs SLlKA 3: Relatlvno petletno pľežtvetje bolnlc z žIeznim kaľcinomom jajčnikov' zbolelih v letih 199T-97 po staľosti. I|GURE 3: Relative five-yeaľ suľvival of ovarian adenocarcinoma patients dlagnosed in the peľiod I993_t997 by ase. Maryetka Uľšič - Vrščaj, onkoĺoški inšĺinł Ljtłbljana Pĺi podĺobni analizipodatkov za obdobje od 1eta 1983_97 je potľebno upoštevati delež mejno ma1ignih nrmorjev, ki so v gra- divo pĺiključeni šele od leta 1991", predvsem zaracli klinično ponrembno drugačnega poteka bolezni kot prj invazivnih ade- nokaľcinomih jajčnikov Glika 4). Zaklinično upoĺabo je bolj pľimeľen in pogosteje upoĺabljen izraz, t:udt v tuji literatur'i, tumoľji nizke stopnje malignosti - izraz me1no ma1igni tumoľ- ji namľeč lahko zavajakneustľeznim ukrcpom, kiveljajo pľed- ysem za nadzor bo1nic po zdľavljenju. Bolnice z mejno malignimi tumorji jajčnikov so večinoma mlajše od 50 let, z več- jim deležem oĺnejene bolezni ob diagnozi, z obnovitvi1o bolezni po 10 letih in kasneje in boljšim pľeŽivet1em. Večji odstotek milĺ'oskopsko potľjenih ľakov jajčnikov (za30/o), manjši odstotek patohistološko neopľedeljenih ľakov jajčni- kov (za )0Á), nanjši odstotek neztanega stadija (za 30Á) in nekoliko večji odstotek omejenega stadija pĺi invazivnih adenokarcino mih (za 3,5 0/o) kaŹejo na izbo1jšanje diagnostič- nih postopkov pĺi odkľivan1u ľaka 1ajčnikov v Ietih1993_97. Izboljšanje diagnostičnih postopkov temelji na izboljšanju in bolj mnoŽični upoľabi nekateľlh ključnih diagnostičnih metod za odkĺivanje ľaka jajčnikov (pogostejši upoĺabi abdominal- nega in vaginalnega ultľazvoka teľ uvajanju določevanja CA 1 2 5 kot osnovnega tumoľsk e ga označev alca za r aka jajčnikov, pľedvsenr v ginekoloških in splošnih arnbulantah). Zelover- jetno pa so ugodni podatki tudi odľaz boljše ozaveščenosti žensk o zgodnjih znaklh bolezni ln nenazadnje večjega stľo- kovnega znanja ĺa tem podľočju pĺi ginekologih in dlugih zclĺavnikih ne-onkologih' Povečanje pľeźivetja bolnic z t|eznimkaľcinomoĺn v obclob- jĺl198ť97 odraźaveč dejavnikov, ki pomembno vplivajo na pĺeŽivetje bolnic: večji deleŽ optima1no ľadikalno opeľiľanih bolnic (citoľedulĺci1a tumorskih mas z ostankotn manj kot 0,5 cm v pĺemeru največjega ostanka oz. po novem 0-1 g tumor- skega tkiva, kaĺ odgovaĺja pĺibližno 1x 1cm celokupnega S[ll(A 4: Relativno petletno pľeživetje bolnic z rakom jajčnikov, zbolellh v letlh l993_t997 po histološki vľsti' RGURI' 3: Relative five-yeaľ suĺvival ofovaľian canceľ patients diag- nosed in the peľiod 197}L997 by hystology. in all dlsease stages, wlth the impľovement being the high- est in the patients with advanced disease (Figuĺe 2). The suľ_ vival of the patients youngel than 55 yeaľs was 240/o hĺgheľ than that ofthe patients aged oveĺ 65 years (Figuĺe 3). In the patients with the tumoľs with boľdeĺline malignancy, the sur- vival was 960Á (Ftgure 4'), Accoľcling to the EUROCARE-3 stuc1y ľesults foľ the peri- od 1990-94 in Euľope, the age-standardizedľelative suĺvival ľate of the patients with ovaľian cancer wa s 31'90/o (30.9_32.Đ , while in S1ovenia' il'was37'40/tl(:27 '3_36.6' The highest ľate of 46oÁ was recoľcled in lceland. Marjetka Uršič - Vrščaj, Instihłte of oncology ĹjĺłbĘana A close analysis of the peĺiod 1983_97 should also take into consideĺation the percentage of tumoľs with boľderline malignancy that weľe inclucled into the study only ln 199I, mainly on account of its course of disease that is diffeĺent fľom that of invasive adenocaľcinoma oľ the ovaĺies (Figuľe 4; ' In clinical terminology, these tumoľs aĺe usually termed as fumors with ]ow malignancy gĺade. The teľm 'boľdeľlľle ma1ig- nancy' may be in fact misleading, actually making us apply inappľopľiate treatment measuľes that aľe noľmally applied in the follow-up of the patients after the theľapy. The patients with ovaľian tumoĺS of borderline malignancy aľe usua11y youngeľ than 50 yeaľs' At diagnosis, a higheľ peľcentage of patients with localized disease is observecl. After 10 oľ moĺe yeaľS' ľecuÍĺence ofthe disease may develop. Even so, theiĺ survival is betteĺ. The 30/o higher peľcentage ĺ-if micĺoscopically confirmed ovaľian cancers' 9% loweľ peIcentage of patohistologically non_specified ovaľian Cancers' J% lower peľcentage of tumors with unknown Stage and 3.50/o higher peľcentage of invasive adenocaľcinomas in its localizecl stlge xre the data that indi- cate to an impľovement of cliagnostic pľclcedures for ovaľi_ r544 45-54 ))-o4 0)_/lł _ 75+ adenokarcinotýac]enocaĺcinonia llrejno/boľdeĺline 7B CANCER PATIE.NTS SURVIVAL IN SLOVENIA 1 983_Igg7 VARIES Likov, peľ1- vival )29), | ľate ostanka tumorske mase) pľed kemoteľapijo ali najkasneje po štiĺih kľogih citostatikov (ľezultati dľugih ľaziskav na onko- loškem inštituĺ.l) in uvajanje novih citostatikov (1). De\eŹ jzvľ- šenih opeĺacij v več|ih centrih (Ginekološka klinika, onkološki inštitut, Maĺibor, Celje, Nova Gorica) jev zadnjem obdobju za 8o/o v ečji. To je pomemben podatek, saj je znano, da je deleż uspešno, ľadikalno, izvľšenih opeľacij večji v izurjenih centĺih (60-90 7o) kot v manjših' stľokovno manj izurjenih bolnišnicah (20-30w. Večji delež po sodobnih stĺokovnih kľiteĺijih kva- litetneje opeľiľanlh bolnic odĺaŹa tudi boljše stľokovno znanje opeľateľjev o nujnosti čim bolj ĺadikalnih pľimaľnih opeľaci- jah v sklopu celovitega zdravljenja ĺaka jajčnikov. an canceĺ achieved in the period 1993_97 ' This impľovement was due to a mofe aclvancecl and fľequent use of some key cliagnostic pľoceduľes in the ovarian canceľ detection in gyne_ cological and geneľal outpatient clepartments' viz. abdomi_ nalUS, vaginalUS, deteľmination of CA125, the fumormarkeľ foľ ovaľian Canceĺ. These encouĺagĺngdata may also ľeflect a higheĺ awareness of women of early cancer Symptoms and betteĺ knowiedge and expeľience of specialists in gynecolo- gy in this field as well as of other physicians, not specialized in oncology. The impľoved suruival of the patients with adenocaľcinoma observed in the years I98u97 is the resu1t of several factoľs influencing significantly the survival. These aľe: higher pro- poľtion of patients optimally tĺeated by radical Sufgery (C}'toľeduction of the tumof maSS with the ľesidue of less that 0.5 cm in dlameteľ oľ, accoľding to new standards, with the residue not exceeding 0-1 g oť tumor tissue, which matches the overal] residue of tumoľ mass of the size 1 x 1 cm) before chemotherapy or afteĺ four cycles of chemotheĺapy at the lat- est and application of new cytostatics (1). The percentage of patients tĺeated suľgical1y in largeľ health centers (at the olga Cerar, onkološki inštitut Ĺjubĺjana Povečanje ľelativnega petletn ega preŹiv etja za ) 0/o je ľudi r ezu| tat pfimeĺneišega sistemske ga zdravljen1a. V letih 1993_97 so bile že vse bolnice zdrav\jene S prepaťati platine, v prejšnjih letih pa ne. Pĺav tako je bilo sistemsko zdĺavljenje upoľablje- no v primarnem zdravljenju v večjem odstotklQZ%o), saj obse- vanje ni več pomembno. Začeli smo uvajati nove citostatike, v letu 1996 taksane. Tudi možnosti dodatne kemoteľapije so bile večje in večkĺat upoĺabljene (2). ' diag_ high- I SUf- igheĺ n the I SUr- Department of at the Institute obstetľics and Gynaeco1ogy, UMC in Ljubljana, of in Ljubljana, at GeneĺalHospitals rlnto ľ1ine t997, fĺom í). In 'd as nlig- pplv rlied ients ua11y 3e of noĺe their 'med cally moľS lsive indi- vaĺĺ- -1997 VIRA 1. ozols R, schwartz PE, Eifel PJ. ovaľian canceľ, fallopian tube caľcinoma, and peľitoneal caĺcinoma' In: deVita VTJĺ, Hellman S, Rosenberg SÁ, eds. Canceľ: pľinciples and pĺactice of oncology' óth ed. Philadelphia: Lippin- cott,200l: 1597432. 2. Ceraľ o. Sistemsko zdľavljenje tumoĺjev jajčnikov. In: LindtnerJ, Bešić N' Budihna M et al, eds. Doktĺini udfavljenja bolnikov z malignimi limfomi in bolnic z rakom rodil: zboĺnik 16 onkološki vikend. Ljubljana: Slovensko zdravniško drušwo, 2002: 103l' ly important since it is geneľal1y ľecognized that ľadical sur- gical interventions aĺe as rule moľe successful lf performed in laľger health centeľs with more skilled personnel(60-90%) than in smalleľ ones (20-307o). A considerably higheľ per- Centage of ovaľian Cancef patients who underwent high quality surgical tľeatment is a strong aĺgument in favoĺ oĺthe extended know1edge and skills of ouĺ gynecologists and of theiĺ awareness that, within the tľeatment plan foľ ovarian can- ceľ, pľimary Surgery as ľadical as possible is indispensable' olga Ceraľ, h'lstitute of oncologl Ĺjĺłbljana A !-percent incľease of the ľelative five-yeaľ sulvival is also due to more appropľiately planned systemic tľeatment. In the years 7993_97, a11 patients weľe tľeated with platinum dĺugs in contľast to the patients fľom earlieĺ peĺiods who neveľ ĺeceived these dĺugs. Moreoveľ, systemic treatment WaS more frequenÍIy , in720/o oÍ patients, applied aS pfimary treat- ment, and inadiation has lost its importance. It should be noted that, in 1996, nevĺ c1'tostatics, viz. taxanes, were intľoduced into clinical pľactice. The availabiliry of salvage chemother- apy was greater and was therefoľe applied more fľequently (2)' in Mariboľ, Celje, and in Novi Gorici) increased by B% in the last obseruation These data aľe extreme- ľnľŽlvrĺ;ĺ BoLNlKoV Z RAKoM V SLoVE'NUI 198}1997 79 PROST ĄTI PROSTATA PROSTATE MKB B/lCD B: 185 V ołx1ollju 1983_97 je zbolelo za ĺa1iom pĺostete 4108 bolni- lĺov, od tega v letilr 19%-97 1730.v analizo nibilo vključe- nih 424 ( 10 %) bolnikov, lĺeľ je bil pli njih ľak ugĺÍovljen šele ob smľti. V opazovanenr 15-letnem olxlollju se je inciclenca ľaka pľo- state zelo povečala. V 1etih 19tj3-i]7 jeblla gľoba inciclenc'na stopnja 23,9/100'000 rnoških, v 1etih 1993_97 pa 3óltoo.ooo moš- kih. odstotek milĺros1ĺopslĺo potljenih pĺiĺneľov se je povečal s B30/o y 1etih 19B3-B7 na 87 0/o v 1etih 1993-97. Mecl lttilĺľĺ-l- skopslĺo potľjenirni je bilo v leÍih 1993_97 740/o zlclęnoktltci- nomov' 250/o neopredeljenih lĺaľcinomov in posalnezni pľirneĺi pĺehoclnoce1ičnega, plošc'atoceličnega in clľobtroce- 1ičnega kaľciĺroma. Staľostna pĺlľazdelitev v ana1izo zajetilr bolni1ĺov se jc spľe- menila (tabela 1). V letih 19%-97 je bib več bolnikov v staĺo- sti55_14let. Razšiľjenost bolezni ob c1iagnozi se je spľeĺneni1a. odstotek neZnanegŹr stadi1a se je zmarrjšal, oclstotek ľazšiľje- ne bolezni pa nekoliko povečal (tabelzl 2). V letih 1993-97 1e bilo speciťično zclľavljenih 92 % bolnikov. Pruo zdľavljen1e je bilo v 36 % liiĺtrĺško in 1roĺmonslĺo ,v 280/o saĺrro kiľuĺškĺl, v 260/o samo hclrmonsko, v 3 9ó obseva1no in hoľmonsko, v 2% kiľurško, obsevalno in holmonskc's,v 20/o lĺiĺ"rśko in ali samo obsevalno, v 2 7o so bolniki clobili tLlĺli kerno- tenpijo. Pruo zdľavljeĄe se je pričelo v 30% na Kliničnem odclel- TABEIA 1l Pľostata. Botniki vključeni v aĺahzo po staľosti in obdobju opazovaĺia' TABLI, l: Pľostate. Patients included in the analysis by age and peri- od of obseĺvation' Sti'l()st (ĺl lt clilgnĺlsis ollilĺĺlje/ Sktlp:rji Ptriĺlcl All lvftlški 01Ż34\ lctlt/yelľs SIIKA l l Relativno petletno preživetje bolnikov z ľakom pľostate, zbolelih v letfü 1983-1997 po obdobju diagnoze. tlGURL l: Relative five-yeaľ suľvival ofpľostate cancer patients diag- nosed in the periođ 1983-1997 by period ofdiagnosis. In the periocl l9B3-9], a tĺÍa1of 4,108 patients wefe dragnosecl with the pľostate cancel; ĺlf these, 1,730 males weĺe c1iagnosed with thls canceÍ in tlre periocl 1993_97 ' In 424 ;ntlents ( 109 l, ), ploState Canceľ was diagnosec1 at cleath; tlrese pltients weľc theĺefoľe not incluc1ccl in the analysis' In the ollserycc1 15-ycaľ peľiĺld, the inciclence of the prclstltte canceľ increasecl consiclerałlly. Iĺl the pedcx1 198}€7, the cruc1e inciclence ľate was 23.9/100,000 males, where as ln 1993-9], it was 361100,000 males. In compaľison to the obseruation peľiocl 19B3_B7, the peľ- Centage of micľclscopically confiľmecl cases incľeasec1 by 'íl1l in the observation peĺiod 1993_97 , i' e' fĺom 830/o to 870/o. In the yeaľs r9%-9], the percentage of adenocaľcinomas ancl non-specifiecl CaľCinomas in the microscĺlpica11y cĺlnfiľĺnecl CaSeS WaS 740/o lnd 25%, ľespectively There weľe also solne cases ĺlf tľansitional-ce1l, sqLlelnous-Cell and small-cell caľci- noiltas. Thc age c1istľibLlticln of patients inc1uded into the analysis has been changing (Table 1). In thc pcriodl993-91, a higher num- beľ of patients of the age gloup of 55_] 4 yeaľs WeIe incltlcl- ed in the analysis. The stage distribution at cliagnosis changecl, The peľcentage of Cases of unknown stege cleclinecl, wheĺe- as the peĺcentage of ľegional clisease s1ightĘ incĺeasecl(Table 2) In the periocl 1993_97 ,92% of patients undelwent specifrc tľear ment. Suľgery in combinatiĺln with hormonal theľapv was TABEIA 2: Prostata. Bolniki vključeĺiv anal]zo po stadiju bolezni in obdobju opazovaĺja' TABLE 2: Prostate. Patients included in the analysis by sex, stage and períod of obseľvation. sttldij/Staĺ]e 100 83-87 ĺJtj'92 8() F .a ř ä ()0 .E 9) 'š 40 o. ;ę 'Ż0 93-91 23 30 43 ]\ĺrlcs 14 1544 45 54 55114 65-1Ą 75+ r)hĺlĺlllje/ SkLlp.lj/ í)nltjcni Ptľiĺxl All Lĺlcalizĺl 1l9ĺł] l'17 i 9Rj]_9Ż 1991-97 Iłrziiljen/ Rrzsejłrl/ Nľznltn/ !ll Rĺ:giĺln:rl qĺ ])ĺst]nt !b t]nknolvn lĺ Ń,,il'l ,\ĺllts 1:ł | 1t3 2h(; 351 3,1Ą l|)Ż 488 555 537 995 113,i 1 555 519 511 781 () ) !(' 4s.l 111 5(),2 Ż1I 195 Ż4l 3i9 l9,Ĺj ŻŻ,!) ŻÚ'5 1!r 19,3 Ż63 23,) )Ą4 15J ll,9 9,S 13,(; lĺtl za t vSIlv ĺ]leStu Gĺlľici nih zd lĺlšlĺeĺ] llĺllnilł V letih 1c lĺot llolniĹ nejvei 55lct petih: (slika lzsled pľečn vetje : ę8,+ v Avs PROSTAT/ PREZI\ Anĺł.r Oll,l,ĺlje / Łt'l! - 1()8 i-87 1,'lhĺ'9Ż l9e.l-97 TAB[tA obĺlobjl TABLE 3r od of ol ĺ ll'J,'lljc/ Perirrcl _ 1,,'sj-ĺ']7 l (]bs-9Ż lv).J !)7 ob rĺ clĺńi. stičnu n'lĺlšk pľeV( pľ()St| cije a nĺl še ali ľai lahlĺĺ Sum slĺcgĺ ĺję1]a ultľa: BO 1983,87 t95 1988,!)2 1134 i99l-97 1555 cANcER PATIENTS SuRVIVAL lN SLoVENĺA 1 983- 1 997 OSTATE PROSTATA TABEIA 3l Pľostat^,OpazovaĺrLo in ľelatlvno petletno pľeživetje po obdobju opazovaĺĺja s 95 0/o lntervalom zallpaĺja (IZ). TABIE 3: Pľostate. obseľved and ľelative five-year suľvivď by perl- od of obseľvatlon wlth 950lo confidence inteľval (CI). opazol'ano /Obseľed (0/o) 0bdobje/ lvĺoški/Males [eta/Years 100 Period 1 VIU 3 TZIU 5 \ZICT 80 E .ř äó0 'Đ o 'ľ't 40 Ě o. 20 1983-e7 1988-92 1993-97 (ó8_74) (7t-77) (75:79) (4Mó) G349) (ĄG52) (25-31) (27-33) (i2-18) 5 ostate, sdĘ- nosed nosed I0o/o), weľe lstate Crude t3-97, 28 30 35 43 Ą6 49 71 lą 71 Relatĺvno /Relative (9'o) 1973_77 197ť82 1983-87 obclobje/period 198U92 1993-91 lvĺoški/Males Leta/Years Obdobje/ Period 1 IZ/U 3 IZ/CI ' ru/CI 1983,87 i98&92 t993-97 ku za uľologijo KC V Ljubljani, v 760/o v SB v Maľiboru , v I20/o v SB v Ce1ju, v 8 % v SB v Slovenj Gľadcu, po 7 0/o v SB v Novem l-nestll in v Muĺski Soboti, v 60/o v SB v Sempetru pľi Novi Goľici, y 30/o y SB v lzoli, po 20/o v SB na Jesenicah, pľi zaseb- nili zdľavnikilr in na drugih kliničnih oddelkih KC. Na onko- loškenr inštitlttu v Ljubljani pa je pľičelo pruo zdravIjenje 50/o bolnikov. V 1etih 199}97 je bilo ľelativno petletno preŽivetje za7 o/oveč- je kot v 1etih 1983-87 (slika 1). Pľeživetje se je povečalo pľi bolnikih z omeieno in ĺazšiľjeno boleznijo. Pleživetie ie bi1o naivečie pľi bo1nikih, sÍaĺlh55_741et. Pĺi bolnikih mlajših od 55 let je bilo pľeŽivetje manjše Samo dve leti po diagnozi, po petih letih pa je bilo maniše le pľi najstaĺejši skupinibolnikov Glíka 3). Izsledkištudrje EURoCARI-3 kaźejo, da je bi1o v Evľopi pov' prečno Starostno standardizirano ĺelativno petletno pĺeži- vetje za raka pľostate 61',5Vo 69,8-63,2), v S\oveniji 47,30/o (38,Ę58,2). Največje pľeživetje \ebilo 83,60/o na Tiľolskem v Avstľiji. Ancĺrej Kľnetec, Klinični od'delek za ĺłrologijo KC ob ľastoči incidenci se kaź'e pomik pľoti sľednji življenjski dobi. K temu 1e pľipomogla hitľejša in bolj natančna diagno' stična obdelava, po dľugi stľani pa tudi boljša ozaveščenost moških' Bolniki pľej obiščejo uľolo ga zaradi ÍeŹav ali pa zaradi pľeventivnih ruzlogoy' Rak pľostate, ko je omejen na Samo pľostato, le ĺedko povzľoča težave v smislu znamenj obstruk- cije ali draŹenja spodnjih sečil, v kolikoľ ni istočasno pľisot- no še benigno povečanje pľostate. Sele pľilokalno ľazšiľieni aliĺazse1anibo1ezni se lahko poiavijo dizurične teŹave,Tako si lahko tudi ľazlagamo poĺast odstotka razšiĄene oblike bo1ezni. Sum na ľaka pľostate Se navadno postavi na osnovi tumof- skega označevalca serumskega pľostatičnega specifičnega anti- gena (PSA), dokončno potľditev pa omogoča tľansrektalna ultrazvočna pľeiskava z biopsijo pľostate. Ceplav ie digitoľek- SIIKA 2l Relativno petletno prežlvetje bolnikov z ľakom pľostate, zbolelih v letih 1973_|997 po stadiju in obdobju ďiagĺoze. tlGURI' 2: Relative fĺve-yeaľ survivď of pľostate canceľ patients dĘ- nosed ln the peĺod1973_1997 by stage and peľiod ofdiagnosis. applied as primary tľeatmentin360/o of patients, 28% of patients underwent Suľgery alone,260/o ĺeceived hoľmonal therapy alone, 30/o received ľadiotheľapy and hoľmonal theĺapy, 20/o ľeceived Suľgery' ĺadio- and hoĺmonal theľapy, 20/o of patienÍs ľeceived suľgery and/ or ĺadiotheľapy alon e, and 20/rl receĺved also chemotheĺapy. Pľimary treatment was staľted at the Depaľtment of Uľology, UMC in tjubljana in300/o of patients, in the Geneĺal Hospital in Maribor in 1'60/o of patients' in I20/o jnthe Geneĺal Hospital in Celje, in 8% in the General Hospital in Slovenj Gľadec, in 7\/oineachof General Hospitals in Novo mesto and in Muľska Sobota, in ó% in Šempeter pľi Novi Goĺici, in J% in the General Hospital inlzola, in 20/o in the Geneľal Hospital in Jesenice and in private health institutions as well as otheľ departments at UMC in Ljubljana' At the Instifute of oncology, pľimary treat- ment was staľted in 5% of pĺostate Canceĺ patients. The relative flve-yeaĺ sulviva1 ĺate of the patients with inva- sive adenocaľcinoma was 7% higheľ in the years 1993_97 than in the years 198ffi7 (Figuľe 1, Table 3). The suryivalimpĺoved in the patients with localized and ľegiona1diseases. The high- est survival was obserued in the patients aged between 55_74 yeaĺs.In the patients younger than 55 years, the sur- vival slightly decreased two yeaĺs afteĺ the diagnosis, wheľe- as five yeaĺs afteĺ the diagnosis, it was 1oweľ on1y in the o1dest gĺoup of patients (Figure 3). According to the EUROCARE-3 study results foĺ the peĺi- od 1990-94 in Euľope, the age-standardizedľelative survival rate oťthe patients with plostate Cancef was6l.5Vo(:59.843.2), while in Slovenia, itwas 47,30/o(3B.Ę5a'Đ. The highest ľate of 83'60Á was ľecoľded in Tyľol in Austria. Andrej Km.etec, Depaftmełxt of Lĺrologt, LĺAIC, Ĺjubljana The highest increase of pĺostate canceľ incidence is observed in the patienm of middle yeaĺs. This is attĺibutable to more rapid and accuľate -)4 - ))-04 80 E .a ä ĺ'o 'Đ o ;Ň 40 o. s 20 0 Ż3 1etalyeaĺs 4 82 cANcĹR PAT|E'MS SuRVIVAL |N SLoVENIA 1983-1997 PROSTATA ĽĽ this dis- itate ruc- 1y iĺ cps. rced med ase, the nof '.am- ugh pri- nto tow :ctal ;the lcial .han rsed also tan l-up Ltive 'the om- 1Ceĺ rice ves, em- um- ;ing )om 'aÍ'ę, rost- ase. 'aw- lase this )oĺe efe- pľi- eľal res- uid- itate 'ĺval and ,tate ind- lľed 1997 Petletno pľeživetje se ie v opazovanem obdob jul983_97 pove- čalo. Glede nato, da smo uvedii dokaj široko presejanje moš- lĺih po 50' letll staľosti z določanjem PSA in s pľeventivnimi pľegledi, menim, da lahko s tako šiĺoko aktivnostjo odkĺije- ino večje število bolnik ov z začetno obliko boiezni in jih tudi ozdĺavimo. I(oliko bomo uspešni pľi tej šiľoko zastavljeniaktivnosti odkľi- vanjainzdravljenja, nam bo pokazalo naslednje obdobje opa- zovanja. France Marolĺ, onkološki inštitut Ljubl1ana Še vedno pľeseneča pľemajhno število mikľoskopsko potľ- jenih pľimeľov. Večji odstotek mlajših si lahko ľazloŽimo s šiĺo- ko upombo PSA v zadnjem obdobju tudi v Slovenlji. V začetku !0. let je bilo na voljo tudi večje število diagnostičnih pľeiskav zanatančno zamejitev bolezni. Zato 'e bilVečji odstotek bolez- ni opľedeljen kot ľazšiľjen. Pĺeseneča velik odstotek bolnikov, ki so bili zdľavljeni hor- monsko in majhen odstotek obsevanih. Tudi pľi ľaku pÍostate bibil na mestu mu1tidisciplinaĺen pĺistop Že v času pvega zdravIjenja (5)' Takšnega pľistopa zaenkratv Sloveniji še ni. Stanje je pľaktično enako stanju ob koncu B0' let. PľeŽivetje bi se lahko izboljšalo zbolje planĺranim pĺvim zďĺavl1enjem, z boljšo diagnostiko, z nadal1njim razv ojem kiruľgije in obli- kovanjem skupinskega pľistopa, kot je na pľimeľ pľi ľaku ščit- nice in rakih glave in vľatu. VIRI 1. otto SJ, Koning HJ' Screening foľ prostate cancer - is moĺtality ĺeduction alĺeady proven? In: Kuĺh HK, Mickisch HG, Schĺodeľ FH, eds. Renal, blad- deľ, pľostate and testirular update. London: The Partenon Publishing Group 2000: 159-66, 2. Huland H' Radical pľostatectomy| options and issues. Euľ Urol 2001; 39: suppl 1: 3-9. 3. Poppel van H. Neoadjuvant hoľmone therapy and radical pĺostatectomy: the jury is still out. Eur Uĺol Ż001;39: suppl 1: 10-4. 4. Abľahamson ÁP' Tľeatment oflocally advanced plostate cancer_ a new ľole foľ antiandrogen monotherapy? Eur Urol 2001; 39: suppl 1: 22-B' 5. Caĺrol PR, Lee KL, Fuks Z! Kantoĺf P!ľ. Canceľ of the pľostate' In: devita VTJq Hellman S, Rosenberg SA, ecJs. Cancer: principles and pmctice ofonco- logy, 6th ed, Philadelphia: Lippincott, 2001:1418-79. \(ie will be able to evaluate the effect of this wide ľange of activ- ities related to the detection and tľeatment of the pľostate can- ceľ only in the analyses of the next observation period. France Marolt, InstitLłte of oncologjl Ĺjubljana A small numbeľ of micĺoscopically confirmed cases of the pľostate canceľ is ľatheľ suĺpĺising. An increased numbeĺ of detected pľosÍate CanceÍ cases in youngeľ men may be attľib- uted to the recent widely used PSA determination in Slovenia. In the early 1990s, moĺe diagnostic techniques were available for the disease staging, which can also explain why a higher peľCentage of cases was staged as ľegional disease. At the same time, the data showing a consideľably high peĺ- centage of patients who ľeceived hoľmonal therapy and rather low percentage of iradiated patients are also startling. In the treatment of prostate canceľ, a multidisciplinary approach should have been applied aIready in planning pĺi- mary tľeatment (5). Such an appĺoach has not yet been established. The situation today is much the same as it was by the end of the 19B0s. The suĺvivalcould have been betteľ with a moľe sensible planning of pľimary tľeatment, with beĺ teľ diagnostics, with futher advances in surgery and estab- lishing atęam appľoach to the tĺeatment of prostate Canceľ' as it has been introduced in the tľeatment of thyľoid, andhead and neck CanceÍS' ľnr'Žlvĺr;r BoLNlKoV z RAKoM V sLoVENUI 198}1997 83 TESIS MODO TE,STIS MI(B 8/IcD B: 1Bó V obdobju f9$-97 je zbolelo za rakorn moda 785 bolnikov, od tega v lęÍih 1993-97 335 ' v analizo ni bil vkljLrčen 1 bol- nik, keľ je bil pľi njem ľak ugotovljen šele ob srnľti. V opazovanem 15Jetnern obdobju se je incidenca ľaka moda večala. V letih 1983-8] je bila gľoba incidenčna stopnja 4,4/1'00'000 moških, v Ietih1993-97 pa7/100.000 moških' odstotek mikĺoskopsko potľjenih primeĺov se je povečal s 87 0/o v letih 1983_87 na 930/o v letih 1,993-97' Med mikĺo- skopsko potľjenimi je bilo v letih1'993_97 45% seminomov, 46o/o dľugihmalignoĺnov kličnih celic (embľionalni kaĺcino- mi, tumoľji ľumenjakove vĺečke, teĺatokaľcinonri in ĺnešani tunoqi), 6 % horiokarcinomov' 3 % ne-Hoĺlgkinovih lĺmfomov in en pľlnrer hemangiosarkoma. Stalostna porazdelitev v analĺzo zajetilr bolnikov se je spre- menlla (tabela 1). V letih 1993_97 je bilo več bolnikov v staľo- stil5-441et. Razširjenost bo1ezni ob cliagnozi se je spľemeni1a. V zaclnjem obdobju je bilo zandinaÍančnejše diagnostike več bo1nikov z razširjeno bolezni1o ob diagnozi. Z nzsejano boleznijo pa je bilo odkľitih manj bo1nikov (tabela 2). V letih 1993-97 je bilo specifično zdľavljenih 99% bolnikov. Prvo zdĺav11enje je bilo v ó3 % kiruľško in citostastsko,v 2I0/o samo kiľtlrško in v 15 % kiľuľško in obseva1no in v 1% kiruľš- ko' citostastsko in obseva1no. Pruo zdľavljenje se je pľlčelo v 530/,lna Kliničnem oddelku za uro1ogijo KC v Ljubljani,po)o/o v SB v Maľiboľu in Celju, y7\/ov SB v Slovenj Gradcu, v 6% TABEtA l: Moda. Bolnikí vključeni v analŁo po staľosti in obdobju opazovatja, TABLE l: Testis. Patients included ín the analysis by age and peľĹ od of obseľvation. Staĺoĺ ob ĺliagnozi/Age :rt Lliagn' 'sli Obdobje/ Skup:rjl Peľioĺl All 83Ą7 88-92 - )3_97 012345 leta/yeaĺs SIIKA l: Relatlvno petletno preživetje bolnikov z ľakom mod, zbolellh v letih 1983-1997 po obdobju diagnoze. I|GURE l: Relative five-year suľvival oftesticulaĺ cancer patients diagnosed in the period 1983-1997 by peľiod ofdiagnosis. In the period 1983-97 , atotal of 785 patients were diagnosed with the testiculaľ cancef; of these, 335 males were diagnosed with this Canceľ in the peľiod 1993_97 ' In 1 patient, testicu- laĺ cancer was diagnosed at death; therefore' he was not included in the analysis. In the obserued l5-year period, the incidence of testiculaľ can- CeI was incľeasing. In the period 799ffi7 , the crude incidence ľate was 4.4/100,000 males, whereas in 1993_97, it was 7/100,000 ma1es. In comparison to the obseruation peľiod 1983_87 , the per- Centage of micľoscĺlpically confiĺmed cases incľeased by ó% in the observation peľiod 1993_97, i' e. from 870/oto930/o'In the yeaĺs 1993_97 , the peľcentage of seminomas, of otheľ geľm cell ma1ignancres (embryomas, yolk sac tumoľS, teratocarci- nomas and mixed tumoľ types), choriocaľcinomas, and non-Hodgkin lymphomas in the microscopically confirmecl Cases WaS 450/o, 460/o,60/o and 3%; theĺe was one CaSe oť heman' giosarcoma. The age distĺibution of patients included into the analysis has been changing (Table 1). In the period1993-97, a higheľ num- beľ of patients of the age gľoup of 1544 years weľe includ- ed in the analysis. The stage distĺibution at diagnosis changecl, too. The increase of the percentage of patients with region- a1 disease at diagnosis was due to moľe accuĺate diagnostic techniques, wheĺeas the number of the patients with metasta- tic disease was considerably lower (Table 2). TABELA 2l Moda' Bolntki vključeni v analizo po stadiju boleznl in obdobiu opazovania. TABIE 2: Testis. Patients included in the analysis by sex, stage and peľiod of obseľvation. Stadq/Stage 100 80 E .Ł Ł e60 'Ł ,Đ 4IJ o. 20 _l4 15-Ą4 45-54 5544 b5-74 ]5+ obdobje/ Skupa1/ orlrcjcn/ lłazšiľjen/ Rĺzscjan/ Ncznan/ Perlocl Äll l,ocalized 9í Regional 9ó Distant l)/0 t]nknown 9ó 'zeraka MODO N prcŽlv_ĺ Olilĺlbje Period 19rl|87 198t]-9Ż 1'ĺ)|91 Ohilobje Peĺiod ajveč TAB[LA TABTE od of 1,rl1l-87 l l,|)łJ'9Ż ]2łz ] vSBvtr v obdq živetje ] lĺĺx prii rlomi fr cclic (ĺł ĺzsleclil prečnd Maryett, Pĺeživ( opÄZo'l način j ja spľe| IetaI) nomol gavke: kľajev) je biloi pritistil Smo pł uvecllii ja amť Pĺiraź tipo li biniľa1 je pral v Šemp .Tcsenicl zdravlji V letihl večje Ę pľiholl Nĺoški Malrs 1981-87 19ĺ]l]-9Ż 1993,91 ivĺošlĺi 1981-87 1981J-92 1993-97 204 241 333 11Ż Ż05 293 21, 11 20 2 Ą 'Ż 5 15 I Ż04 Ż41 J3l 28,4 ĄŻ 38,5 35 31 '2 Ą5 10Ż 111 1ó1 50,0 58 47 'Ą 95 4ĺ']'3 1ŻĄ 20,6 1Ą,Ż 1 3,5 1,0 0,ir 0,9 84 Nĺlles CANCE.R PATI E MS SURVIVAL IN SLOVE,NIA I 98T1 997 TESTIS MODO TABEIA 3l Moda. opazovano in ľelativno petletno preživetje po obdobiu opazovanja s 95 o/o iĺteľvalom zaupania (tZ). TABLE 3: Testis. obseľved and ľelative five_year suľvival by peri_ od of obseľvation with 950/o confidence inteľvď (CI)' Opazovano / obseĺved (0Ą Moški/Males leta/Years 100 0bdobje/ Peĺiod 1 IZIU 3 IZI1 5 IZICT 80 G .Ę äó0 .F o ;Ň 40 o. s 20 1983-87 198&92 199Ť91 (8t-9t (91-97) (95-99) (77-85) (85-93) 01-97) (r5-87) (83-91) (90-96) 5 L ÍIIod, ttients :IOSCd nosed )sticu- rs not r can- Jence t was 89 94 97 8Ż 89 94 81 87 93 1 IZI] 3 IZIU 5 VICI r98U92 1993-97 SLllG 2: Relativno petletno pľeživetje bolnikov z ľakom mod, zbolelih v letih 1973-1997 po stadiju ln obdobfu diagnoze. IIGURE 2l Relative five_year srrrvival oftesticulaf canceľ patients dlag- nosed in the penod 1973-|997 by stage and period of dĘnosis. In the period 1993_97,990/o of patlens undelwent Specific tľeat- ment. Suľgery in combination With Chemotherapy was applied aS pľimary tf ea Íment in 630/o of patients, 210/o of patients under- went Sufgery alone, 15% of patients ľeceived surgery and ĺadio- therapy, and I0/o suľgery' chemo-, and ĺadiother apy . P Íirnary tľeatment WaS Staľted at the Department oľ Uľology, UMC in Ljubljana in 530/o of paÍseĺts' in the General Hospitals in Maľiboľ and Celje in)0/o of patients, in 7% in the Geneĺal Hospital in Slovenj Gĺadec, in6o/olnthe Geneľal Hospital in Novo mesto' in 50/o in the General Hospital in Muľska Sobota, in 4,50/o the General Hospital in Šempeteľ pľi Noví Gorici, inŁ.5o/o inthe Geneľal Hospital in|zola, in 1% in the Geneľal Hospital in Jesenice. At the Institute of oncology, primary tľeatment was staľted in 27o of testiculaĺ canceľ patients. The relative five-yeaľ survival rate oľthe patients was l30ńhĘh- eľ in the years 1993_97 thanln the yeaĺs I9Bffi7 Gable 1)' The survival impľoved in the patients with ľegional and metastat- ic diseases, in the ĺespective peľiods 198u92andl993_97.The suruival of the patients below the age of 45 years was pľac- tically the same aS of the patients in the age gĺoup oĺ 4Ť54 yeaĺs (Figuĺe 3). The survival oĺ patients with seminoma was higher then that of patients with otheľ geĺm cell ma1ig' nancies (Figuľe 4). According to the EURoCARE-3 study ľesu1ts foĺ the peľi- od 1990_9 4 in Europe, the age-stand aľ dized relative survival ľate of the patients with testicular cancer was 86 .80Á (85 .R8 .Đ , while in Slovenia, it was 89.8% (86.G93.1). The highest rate of 94.30/o was recorded in Noľway. Marjeta Stanounik, Institute of Oncologt Ljubljana The survival of patients with localized disease was high thľoughout the obseruation peľiod and was not significantly incľeasing. The treatment modalities foĺ these patients did not change much, except in1992in the tľeatment of patients with seminoma. Until then, all patients with localized seminoma Relativno/ Relative (9/o) 1973-77 1978-82 1983-87 obdobje/peĺiod Moški/Males leta/Yeaľs obdobjel Period 1983-87 198&9Ż 199T97 90 95 97 (8G94) 02-98) 05-99) (78-88) $G94) oT99) (77-89) (85-95) oT99) 83 90 96 8J 90 96 ] peľ- ty 60/o io/0. In 'germ carci- , and Lrmed tman- v SB v Novem mestu' V 5 % v SB v Muľski Soboti, v 4,50/o v SB v Sempetru pľi Novi Goĺici, v 2,50/ov SB v lzoli, v 1% v SB na Jesenicah' Na onko1oškem inštitutu V Ljubljani sta pĺičela pruo zdr avljenje 2 % bolnikov. v \etlh 1993_97 je bilo ľelativno petletno preŽivetje za I30/o večje kot v letih 1983_87 (slika 1). Pľeživetje se je povečalo pľi bolnikih z ÍazšiÍjeno in razsejano boleznijo, z razšir1eno v obdobju I9B&.92, z razsejano pa v obdobju 1993-97, P re- živetje je bilo pĺi bolnikih do 45.Ietastaľosti pľaktično enako kot pri tistih starih 45 do 54let (slika 3), pľi bolnikih s semi- nomi pa večje kot pľi bolnikih z ostalími malignomi kličnih ceiic (slika 4). Izsledki študije EUROCARE-3 kaźe)o, da je bilo v Evĺopi pov- pľečno Staľostno standardizirano relativno petletno pľeživetje zaľakamoda9í,B0/o(B5,4{;8,3),vSlovenÜi89,80Á(86,6-93,7). Največje pľeživetje jebi\o 94,30/o na Norueškem. Marleta, Stanounik, onkološki inštitut Ijubljana PľeŽivetje bo]nikov z omejeno boleznijo je bilo v vseh 1etih opazovanja zelo veliko in se ni bistveno povečevalo' Tudi načlnzdrav\jenja teh bolnikov se ni mnogo spľeminjal. Več- ja sprememba v načinu zďĺĄenjabolníkov s seminomije bila IeÍa1992' Do tega 1eta smo vsem bolnikom z omejenim semĹ nomom po orhidektomiji dodatno obsevali ľegionalne bez- gavke. obsevanje je bilo dolgotľajno in bolnike iz oddaljenih kľajev smo moľali hospita|izirati. Śtudije pa so pokazaIe, da je bilo pľeŽivetje in število ĺelapsov pĺi obsevanih bolnikih in pľi tistih z dopolnilno kemoterapijo s kaľboplatinomenako.Zato smo po letu 1992 kot dopolnilno zdravljenje pri teh bolnikih uvedli kaľboplatin' Zdravl1enje je bistveno kajše, lahko se izva- ja ambulantno in stľanski toksični učinki so minimalni (1)' Pľi ĺazšiľjeni in razsejani bolezni se je preživetj e začelo veča- tipo letu 1978,ko smo v zdĺavljenje uvedli cisplatin. Kom- biniĺanje z novimi učinkovitimi citostatiki (etopozid, ifosfamid) je pĺav tako pľipomoglo k večjemu preživetju. Tudi napľedek is has num- rclud- nged, :gion- rostic ÍasÍa- :zĺi7ĺ panď Vo nnl 0wn ,0 0,0 i 0,9 onejen/localized "-''-_ ĺazšiĺjen/regional razsejanldistant vsi/all 11997 PREŽNETJE BoLNIKoV Z RAKoM V sLoVENUl ĺ98}1997 85 100 1)-44 ' 45-54 100 80 E .Ł ř a60 .F a .Ł 'U 4ĺJ o. Ś 20 80 .ł E äĺo 'Đ o ,N g4u o. 20 SLII(A 3: Relatlvno petletno pľeživetje bolnikov z rakom mod, zbolelih v letlh t993-t997 po staľosti. I|GURE 3: Relative five-year suľvivď of testiculaľ canceľ patients diagnosed in the period 1993-1997 by age. 1983-87 SLlt(A 4l Relativno petletno pľeživetie bolnikov z ľakom mod, zbolelih v letlh 1983-1997 po obdobjih dtagnoze in histološki vrsti. FIGUR'E 4l Relative five-yeaľ srľvival of testiculaľ canceľ patlents dĘ- nosed in the period 1983-1997 by peĺiod of diagnosls and histology. 0 23 letalyears 4 198U92 obdobje/peĺiod 1993-e7 VIR V opeĺativnitehniki je doprineselk večji učinkovitosti pose- gov in k zmanišaniu poopeľativnih zap\etov. Zaprepĺečeva- nje zapletov po intenzivni kemoterapłi smo po letrr 1993 pĺIčeli uporabljati Iastne faktoĺje, kaĺ je pľipomoglo k boljšim ĺezu1- tatom zdravllenja. Večji odstotek mikľoskopsko potrjenih pĺimeĺov je omogo- čil večjemu šteYilu bolnikov najbolj ustľezen načln zdravlje- nja' Zavečje pľeživetje je bila pomembna tudi koncentľacija bolnikov v dveh centľih (onkološki inštitut ali Klinični odde- 1ek za uĺologijo KC), kjeľ se je nadaljevalo primaĺno zdĺav- ljenje, ne glede na to, kje v Slovenijije bilo pĺičeto. Čepĺav je deleźbolnikov z omejeno boleznijo večji, jih je še vedno pľeveč odkľitih z Íazšlrjęno ali razsejano boleznijo. očitno se diagnostične metode v zadn1ihletih niso bis&eno izboljšale, pa tudi ozaveščenost moških ni večja. Potĺebno bo vložiti še več truda v izol:razbo zdravnikov in mladostnikov. Bosl GJ, Bajoĺin DĘ Scheinfeld J, Motzeľ RJ, Chaganti RSK. Canceľ of the testis. In: deVita VUq Hellman S, Rosenberg SA, eds' Canceľ: pľinciples and pĺactice of oncology. óth ed. Philadelphia: Lippincott, 2001: 149I-518' underwent orchidectomy and ľeceived postopeĺative iľľadi- ation to regional lymph nodes. As radiotheľapy usually last- ed long, the patients fľom otheľ ľegions had to be hospltalizecl. The end-ĺesults oĺ studies that compaľed the survivals of ancl ĺe1apses in the patients tľeated by ĺadiotherapy or by adjuvant chemotheĺapy with carboplatin were practica1ly the same, And for that ľeason' these patients aľe receiving the adjuvant chemotherapy with caĺboplatin fľom 1992 onwaľds. This theľ- apy is less time-consuming, It can be performed aiso in out-paľ- tient depaľtments and has minimal toxic effects (1). The suĺvival of patients with ľegiona1 and metastatic disease staĺted to gfow up after the year 1978 when the therapy with cisplatin was intľoduced' The combinations of new Cytosta- tics (etoposide and ifosfamide) as well as Some impĺovements in surgical techniques that reduced consideĺably postopeĺa- tive complications had a favorab\ę effect on survival. In the pľevention of postchemotherapeutic comp1ications, we have been using gľowth factoľs since 1993, which impľoved con- sideľably the tľeatment results. A higheĺ pefcentage of microscopical1y confiĺmed cases enabled that moľe patients received the most plopeĺ1y Select- ed tĺeatment modality. Another factor that had a positive effect on survival was the concentration of testicular canceľ patients in two health centers, alz Institute of Oncology in Llubljana and Department of Uľology, UMC, Ljubljana' Allthe patients were referred to these two CenteÍS foĺ fuľther treatment, iľfe- spective of the fact that they had received pľimary therapy in any otheĺ heaith institution in Slovenia. Though the percentage of patients with localized disease has been observed to be higher, the patients with advanced dis- ease ale neveĺtheless too many. Evidently, no pľogľess has been made in recent yeaľs in the ĺield of diagnostics, neitheĺ any attempt to increase the awaľeness of men oĺ the risks of this cancer, In the future, more eĺfoľts should be put into Spe- cial training of physicians and educating the youngsteĺs' MKB TABTI by sd Moški tr'ĺrles Ženske. Fenialei I ) '; PREZtI v leti Staĺo ni1a.' nozi.l se je vom ni (ra V letil Pĺvo i kiľuľl z osü v 201 fufu \ł gło ii dernl po 4l ,, IABEI starol Vobd ki in 487 Źl V opa ga mt na sq v letill I odstd - Seminoni/Seminoma - ostali geľminativni/otheĺ germ cell 86 cANcER PATIENIľS suRV|VAL lN SLoVENIA l983-t997 ESTIS MALIGNI MELANOM MALIGNI ME.LANOM MALIGNANT MELANOMA MIG B/ICD 8:17Ż Starost ob diagnozi/ Age at diagnosis Obdobje/ Skupaj/ Period All V obdobju 198397 je zbolel za malignim melanomom 901 moš- ki in 1'144 Žensk, od tega v letih 1993_97 423 moških in 4B7 Žensk.Y analizo ni bilo vključenih74 (20/o) bolnikov. Y opazovanem 15-letnem obdobju se je incidenca maligne- ga melanoma večala. V letih 1983-87 jebila gľoba incidenč- na Stopnia 4j/rc0,000 moških in 5,8/100'000 Žensk, v letih 1993-97 pa 8,8/100.000 moških in 9,ó/100.000 žensk' odstotek mikoskopsko potĺjenih primeĺov s e je povečal z980/o v letih 1983-87 na 7000/ov letih 1,993-97 . Starostna poľazdelitevv analizo zajetihbolnikov se je spľeme- nila.Y zadnjemobdobju je bil največjl delet bolnikov ob diag- nozi mlajši od 45let(tabe\a 1). Razšilenost bolezni ob díagnozi se je spĺemenila, V letih 1993_97 je bilo odkĺite več bolezni v omejenem in Íazširjenem in manjv razsejanem stadiju bolez- ni (tabela 2), Povpľečna debelina tumoľja se je manjšala (1). V letih 1993-97 jebi|o specifično zdľavljenih 987o bolnikov. Prvo z&avl)enje je bilo v največjem odstotku (63Vo) samo kiruĺško, v J20/o pa kombinacija opeĺacije in imunoteľapije; z ostalimi kombinacijami je bilo zdravljenih 5% bolnikov. y 200/0 so pľičeli s prvim zdravl)enjem na onkološkem inštĹ tutu v Ljubljani,v l)o/ona\šlinčnem oddelku za plastično kiruľ- gijo in opekline KC v Ljubljani, v 107o na Kliničnem oddelku za dermatoveneÍologijo KC, v 20% v SB vMariboru, v 7% v Celju, po 40/o v Sempetru pri Novi Goľici in Novem mestu, po 3%o TABEIA t l Mďigni melanom. Bolntkt vključeni v anallzo po spolu, starosti in obdobiu opazovanla. TABIE ll Malignant melanoma. Patients included in the analysls by sex, age and peľlod ofobseľvatíon. 20 83-87 88-92 - 93_97 012345 letalyears SL|KA ĺ: Relatlvno petletno pľeživetje bolnlkov z mallgnim melanomom, zbolelih v letih 1983-1997 po obdobju dtagrtoze. Í|GURL l l Relative five_yeaĺ suĺvlvď of mďiglant melanoma patients diagnosed in the peľiod 1983-1997 by peľiod of diagnosis. TABEIA 2: Maligni melanom. Bolnlkl vključeni v analŁo po spolu, stadiiu boleznt ln obdobiu opazovaĺja, TABLE 2: Malignant melanoma. Patlents included in the anďysis by sex, stage and perlod ofobseľvation. Stadii/Sĺage Obdob1e/ Skupaj/ Omejen/ Ra*iľjen/ Razsejan/ Neznan/ Period All localized % Regional % Distant % Unknown 9ó In the period 1983-97, a total of 901 male and 1,744 female patients weĺe diagnosed with malignant melanoma; of these, 432 males and 487 females weľe diagnosed with this cancer in the period 1993-97, Seventy-four patients (2%) were not included in the analysis. In the observed l5-year peľiod, the incidence of malignant melanoma was incĺeasing. In 198}37, the crude incidence mte was 4.5/700,000 in males and 5,8/100,000 in females, whereas 'n 1D3_97,it was 8.8/100,000 in males and 9.6/100,000 in ťemales' In compaĺison to1983-87,the incľease of micľoscopically con- firmed cases in the observation period 1993-97 was 20/0, i. e. from9\o/o to 100%. The age distĺibution of patients included into the analysis has changed. In the last observation peĺiod, a higheĺ number of patients aged less than 45 yeaľS was detected at diagnosis (Tab1e 1). The stage disľibution at diagnosis changed, too. In the last obseryation period 1993-97,a higheĺ peĺcentage of patients with localized and ľegional disease and a loweľ peĺcentage of patients with metastatic disease were obserued (Table 2). A slight äecĺease of the mean thickness oĺthe fumor was hoted (1).- In the peĺiod 1993-97,980/o of patients undetwent specific tľeatment. Surgery alone was applied as pľimary tľeatment in 630/o of patients, 320/o of patients weľe tľeated with a combi- nation of suľgery and immunotheľapy, and 50/owere treated with other combinations. Pľimary tĺeatment was started at the 100 80 .: aÓ0 'Đ o ;fi Ą0 o. )3-97 nod, lĺsti. diaC- logy. 'adi- last zed. and vant. And vant heľ- par- 3ase with )sta- ents 'eÍa- . the tave lon- ASES lect- ffect ents iana ents ire- ry in '14 1ý4 45-54 5544 65-]4 75+ r has dis- has ther is of spe- Moški Males 198347 198U92 1993-97 198 266 ą14 46 66 117 56 64 95 32 48 8ó 45 56 82 19 32 44 Moški Males 198347 198U92 199T97 198 266 ĄŻ4 142 184 314 71,7 69,2 74,1 13,1 18,1 17,9 9,6 8,ó 4,5 11 10 15 19 23 19 26 Ą9 76 5,6 3,8 3,5 .1c)97 ľnľŽlvĺr;ĺ BoLNIKoV z RAKoM V sLoVĹNIJl 198T1997 10,6 15,7 12,3 87 4,4 2,5 3,8 12 9 18 1,3 5,0 2,9 20 18 14 273 212 77,1 29 3st 274 i6,B 56 480 389 81,0 59 Ženske I98T81 Fcmales 1988-92 1993-97 56 55 89 40 42 64 44 80 95 41 ó8 110 91 111 122 Zenske Females 198fr1 198U92 199T97 111, 357 480 MALlGNANT Mt'LANoMĄ TABEIA 3: Maligni melanom. opazovano in ľelativno petletno pľeživetje po spolu in obdobjuopazovaĺjas 95 0/o inteľvalom zaupania (IŻ). TABIE 3: Malignant melanoma. obseľved and ľelative five-year swvival by sex and period of obseľvation with 95% confidence inteľval (cl). Oplzor'anĺl/ obstn'eĺl (9i) tr'ĺĺlŠki/ trĺa]cs Lcta/ \taľs Žcnskc/ Fcrrrales I.ťtl/\'ears 0llclĺlbjc/ Prĺiĺxl , 1'.|lC) 3 IZlÜ 5 I7'|C.I I VICI 3 ]'ĹlU 5 IZIC'I 1981-87 1988-!)2 1993-97 (71-81) (71-rJ1) (8(F9Ż) (40 54) (ĺ8_(r0) (ó7-75) Q9-43) (]Ń8) (5lr 68) (79 89) (tr7-!)3.) (88-94) ( 57-ó9) ((t(r]6) (71-81) (47,se) (5(r(Íil 67-7t 63 1I 17 ril 9l) 91 36 Ą) bJ 4T s4 11 l1 1(: łJ9 sl (r1 l1 Relatirłlo/ Relatil'c (!ĺ) lrĺoški/ ]rĺales Ĺct:t/\tĺľs Žt'llske/ |'t'ntales Letl/łtrrs Ohclobje / 1'cľiocl 1 IZIC] 3 IZICI 5 VIC,I , \7ICI 3 \ZIC] 5 IZI CI 1983-87 1988,92 1993,97 (r0 (\7 7!) b7 15 82 85 91 9J 4Ż Ą9 71 51 59 l1 t9 78 9l (73-85) (73-8.) (8rJ,94) (43 5e) (5Ż-'óÓ) (7Ż-82) (]Ł50) (42-Í' (67-19) (80 90) (rilJ-!)4) (90-.9(t ( 57-ó1)) (ó('(,) (73 8l) (51-67) (r1-73) (7ŁlJ4) onlelel.) Ll7š1ľjen - lazscjan 100 tt( ) E ĺlĺ) o o .= 1łĺ) trlĺoški _ Malcs 100 tJ0 (í) .() 2(t E 20 197 3,77 19lU8Z 1983-87 obclobjc 1988 9Ż 1993_97 1973-77 197?,-82 19rJ3-87 peľiocl 19riiJ-92 It)93-()7 SLIKA 2l Relativno petletno pfežívetje bolnikov z malignim melanomom, zbolelih v letih 1973-1997 po stadiju in obdobju diagĺroze. v Sklvenj Graclcu in v Muľski Soboti, v 2,50/ov zasebnih ol'c1i- naci,ah, po 2o/ĺl v lzo1i in na Kliničnetn odde1iĺu Za Splošno kiľr:rgijo I(C, v 1% naJesenicalr. Posamezne bolnilĺe So ope- ľiľali še na ĹlľLlgih lĺliničnih oc1clelkih KC teľ v bolnišnicah Trbovlje, Ptuj in Brežice. V letih 1993_97 je bib relativno pet1etno pľežlvetĺe za 240/o večje kot v letih 1983-87 klika 1). Pľeživetje se je povečalĺl pľilxllnikih Z omeieno in lazširjerro boleznijo, bo11 pľi rnoš- kih kĺĺ pľi ženskah. Glecle na Staľost ie bilo pLi ženskah pľe- živetje večje pľi rnlajših oc1 ó5 1et. Pľi rnošlĺih pa je bilĺl pleŽivctje večje pri mlajših od 55 let' V staľosti 65-74let jebilro ()pezoYlno pĺeživetĺe eneko tistemll v staľ()Sti 55-ó4 let, ľelativno pa je bib zarudinačinaizľačunavanja večje (s1ika 3)' IzsleclkištLrclije EUROCARE-3 kažejĺl, c1a je bib v Evľopipĺlv- pľečno staľostno stanclaľdizirano ľelativno petletno pleživet- je pľi bolnikih z rrralignim melanomom pľi mošlĺih 74'79ł, ę2,9_76,6 in pĺi ženskah 84,4\ll (83,2-85,5), v Sloveniji pa pri ĺnoških 60, 6 0/0 Ó3,9_ó8j) in pli ženskah 7 0,L 0/,, 64,G7 6,I). Najvcčje pr'eŽivetje pľi noških 1e bilo 87,30/,l na Tiľ-/4 _ 75+ Skupaj -All 92 CANCER PATIEMS SURVIVAL IN SLOVENIA 1983-1997 sARKoMl MĹHKIH TK|V )MAS Qz). (cD. Đ 9) 6) Branko Zakotnik, onkološki inštitut Ijublj ana V pĺimerjavi z ostalimi evľopskimi drŹavami smo pĺav pri zdľavljenju saľkomov mehkih tkiv med najbolj uspešnimi. Raz- logi za to so: centfalizirano zdľavljenje, multidisciplinaľni pľi- stop, uspešna kiĺuĺgija s histološko kontľo1o ľadikalnosti opeĺacije, planiľano prvo zdravljenje na konziliju in sodelo- vanje v mednarodnih ľaziskavah, Le ľedki bolniki ob plani- ľanju kombini ranega zdravljenja niso pľedstavljeni na konziliju. Verjetno pabi rezultate lahko še izboljšali. V vsem petnaist- letnem obdobju se je namľeč celokupno ľeIativno pet1etno pľeživetje le malo izboljšalo (slika 1)' V zadnjem petletnem obdob j u se j e izbol|šalo le pĺi ĺ azsejani bolezni (v eĄetno zar adi agľesivnejšeg a zdravljenja z operacijo in citostatiki). Pľi lokali- ziľaniboleznipa se je poslabšalo (veľjetno zaľadi nestĺokov- ne1a pvega zdravIjenja) (slika 2). Kiruľg se ne bi smel lotiti pvega zdľavl1enja bľez podpoľe patologa, ki po standaľdih opľedeli ľadikalnost opeľacije in podľobneje opľedeli vĺsto teh ľedkih malignomov. ob nepľavilnem pruem zdĺavljenju je veľjetnost lokalnega recidiva in pljučnih metastaz velika. Relativno petletno pľeživetje pa je pľi bolnikih z razsejano boleznljo, za katero danes še nimamo ustĺeznih zdravil, poľazno (1). patients and in ťemale patients 55.6Vo (52'Ł59), while in Ślovenia, it' w as 56.20/o (42.I_7 ) in male patients and 62.50/o (50.8-7ó.8) in female patients. The highest ĺates of 61'87o and of 64.zoĺo were observed ĺespectively in male patients in tlľee ľegions in Fĺance: Bas-Rhin, Calvados and Cote d'oĺ and in female patients in Tyľo1 in Austria. Branko Zakotnik, hlstitute of oncologjl LjubĘana The comparison with other European countries ľeveals that Slovenia with its soft tissue Sarcoma tľeatment ľesults ľanks among the most successful countľies, Such effectiveness stems fľom centralized and multidisciplinary tfeatment appľoach, successful surgical interuention with histologica1- ly contĺolled ĺadicaiity, treatment plan made by the Multidisciplinary Advisory Team for Sarcomas and paĺicipa- tion in inteľnational ĺeseaľch studies. Very few patients underwent combined treatment that had not been planned by Multidsciplinary Advisory Team, The treatment ľesults could eventually be fuĺtheľ improved. In the whole l5-year observation period, the oveĺall ľelative five-yeaľ sutvivalinsignificantly increased (Figure 1). In the last five-year obseľvation peľiod, a consideľable ĺise was observed only in the patients with metastatic disease, which is possi- bly due to more aggľessive tľeatment modality, combining suĺ- gery and chemotheľapy. In the patients with localized dlsease, the surviva] declined pľobably because of inadequate pĺimary treatment (Figure 2). A suĺgeon should never Stafi pľimary treatment without the support of a pathologist who assesses the ĺadicality of opeľation according to the set standaľds and deteĺmines the type of this rather ľare malignancy. After impľopeľ primary tĺeatment, the development of loca1 recuĺ- ľence and lung metastases is very likely. The relative ťive-year surviva1 ľate of the patients with distant metastases, foĺ which no pĺopeĺ drugs are available, is dľamatically low (1). ) 6) l) úih ents ein nts. rgh- sin Ihe 4Vo on- :. In )2), the Đ. iur- lbs. ĺin the nle IcĐ7 VIR 1. Bĺennan MĘ Alektiaľ KM, Maki RG' Soft tissue saľcoma. In: deVita Vl Jľ, Hellman S, Rosenbeľg SA, editors. Canceĺ: pľinciples and pľactice of oncology, Vol, 2. Philadelphia: Lippincott, 2001: 1841-91.. ľnrŽvĺr;ĺ ool-ľĺIKoV z RAKoM V sLoVENI|l 1983-1997 93 BONE, SARCOMAS IOSTNI SARJ(OMI BONE SARCOMAS MI(B 8/lCD 8: 170 V obdobju 1983_97 1e zbolelo za kostnimi saľkomi 108 moških in 109 žensk, od tega v\etih1993_97 37 moških in33źęnsk' Y analizo so bi1i vključeni vsi bolniki. V opazovanem 15łetnem obdobju se incidenca kostnilr saĺ- komov ni spľemeni1a. V letih I9B3_B7 je bila gľoba inci- denčna stopnja 0,9/100.000 moških in 0,7/100.000 žensk, vletĺh1993_97 pa 0,8/100'000 moških in 0,6/100.000 žensk. Staľostna poľazdelitev y analizo zajetih bolnikov se je le nekoliko spľemenila (tabela 1). Razšiľjenost bolezni ob diagnozi se je spremenila pľi osteosarkomih Gabela 2). Y Ietih1993-97 je bilo več bolnikov odkľitih v začetnem sta- diiu (T1) bolezni. v letih1'993_97 je bilo Samo z opeĺaci1o zdľavl1enih 290Ábol- nikov, z operacijo in citostatiki 260/0, samo s ciÍostati\44 - 4>->4 - ))-04 - b>-/4 - 75+ Moški - Males I>4+ +r_>+ ))-04 - łĎ_/+ _ 75+ Ženske _ Females PREŽIVET;E BoLNlKoV z RAKoM V sLoVENlJI 198:-1997 99 HODCKIN LYMPHOMA HODGI(INOV LIMFOM HODGI(IN LYMPHOMA MKB B/lCD 8: 201 V obdobju 1,983-97 je zbolelo za Hodgkinovim limfomom 326 moških in 245 źensk, ocl tega v letlh 7993_97 10ó rnoš- kih in 93 žensk' V anallzo ni bilo vključenih 14 (2,50/o) bo1- nikov, keľ je bil pľi njih limfom ugotovljen šele ob smľti. V opazovanem 15łetnem obdobju je bila incidenca Hodgki- novega limfoma ustaljena' V letih 1983-87 jebila gĺoba inci- denčna stopnja 2,4/100'000 moških in 1,5/100.000 Žensk, v \etih 1993_97 pa 2,2/ 1'00.000 moških in 1,8/1 00. 000 žensk' Staľostna poľazdelitev v analizo zajetih bolnikov se je spľe- meni1a (tabela 1). V ietih 1993_97 je bilo več bolnikov v sta- ľostni skupini 15-44let. Razšiľjenost bo1ezni ob diagnozi se ni pomembno spremenila, 1e v letih 198U92 je bilo nekoli- ko več bo1ezni odkľite v začetnem stadiju (tabela 2). Y letih 199 3-97 j e bil o zdr avljenih 9 6 % b olnlkov. P rv o zdr av - ljenje je bilo v največjem odstotku (44 %Đ kombiniľano: obse- valno in citostatsko, v 420/o samo citostatsko, v 1,30/o samo obsevalno. y B50/o so pľičeli s pruim zdĺavljenjem na onko- loškem inštitrrtu v Ljubljani, v I1'0/o na Pediatľični kliniki v Ljub1jani, y 20/ov Maľiboľu inv 10/ov Celju. Y letjh1993_97 je bilo ľelativno petletno pĺeŽivetje za81/oveč' je kot v letih 1983-87 (slika 1). Največje spĺenreĺnbe v preti- vetju so bile v stadiju III in IV pľi obeh spolih (slika 2). Pľeživetje je bilo na1večje pri otľocih in odĺas1ih do 54' leta TABEIA ll Hodgkinov limfom. Bolntkt vključeni v aĺalizo po spolu, staľosti in obdobju opazovaĺja, TABIE I r Hodgkin lymphoma. Patients included in the analysis by sex' age and peľiod of obseľvation. 5ĺĺrusl ol' ĺljrgnozil Agc at tliagnu.is Obclobje/ Skuprj/ Period All -14 100 80 E .z ř aó0 'Đ .: 'ü 4U o. 20 1544 45-54 554Ą 65-]4 75+ 83-87 8U92 - 93-97 012345 leta/yeaľs SL|KA l; Relativno petletno pľeživet1'e bolnlkov s Hodgkinovim limfomom, zbolelih v letih 1983-1997 po obdobju diagnoze. FlGUR"t l: Relatlve five-year suľvivď of Hodgkin lymphoma patients diagnosed in the peľiod ĺ.ý8}1997 by peľiod of diagnosis. In the peĺiod 1983_97, a total of 326 male and 245 female patients were diagnosed with Hodgkin lymphoma; of these, 106 ma1es and 93 females weĺe díagnosed n the peľiod 1993_97. In 14 patients (2.5W, Hodgkin lymphoma was diagnosed at death; theĺefoĺe, they weľe not inclucled in the analysis' In the obserued 15-yeaľ peľiod, the incidence of Hodgkin lym- phoma was steady. InI9B3-87,the cnrde incidence ľate was 2,4/100,000 in males and 1.5/100,000 in females' wheľeas in 7993-97 , it was 2,2/\00,000 in males and 1.8/100,000 in females. The age distľibution of patients included into the analysis has changed (Table 1). In the observation peĺiod 1993_97, a high- eĺ numbeĺ of patients was obserueĺ] in the age gĺoup of 7544years. The stage distľibution at diagnosis has not sig- nificantly changed. only in the peľiod I98u92, a higheľ peľ- Centage of patients with the disease in eaľ1y stage was noted (Table 2). In the peľiod 1993_97 ,9ó% of patients undelwent speciflc tĺeat- ment. In most cases (440/o), primary treatment was combined chemothe rapy and ľaclioth erapy , 420/o of patients weľe tIeat- ed by chemotheĺapy alone, and 130Áby ĺadiotherapy alone. Pľimary tfeatment was started at the Institute of oncology Ljubljana tn 850/o of patients, in 710/o at the Department of TABIIA 2: Hodgkinov llmfom' Bolniki vključenl v aĺalŁo po stadiju bolezni in obdobju opazovaĺja. TABLL 2: Hodgkin lymphoma. Patients included in the analysis by sex, stage and peľlod of obseľvation' Stadij/Stage Obdobje/ Skupaj/ Period All Neznan/ I+]] gó III+IV 9ô l]nknown 9il s 0 0 ś s{ ĺ f( a u n Jq (1 lX N vi i4 ł p b h V i Pl . s ľ R d 198!87 1988-92 1993-97 18,0 45,0 48,0 51,0 55,0 48,0 177 181 197 90 100 94 85 83 95 2 0 8 1,0 1,0 14 13 1:2 13 14 I 53 51ł 65 1j 15 ł] 105 107 t04 ]Vĺoški 1983 ĺ:]7 1988-9Ż 199197 ]!ĺalcs Ženske Feulrles 19ĺ:]3'87 19r18,92 1993f)7 1Ż 1 1l 33 51 r6 8 5 I 12 76 9l 100 CANCER PATIEMS SURVIVAL IN SLOVT,NIA 198T1997 'HOMA HODGKJNOV LIMTOM TABELA 3: Hodgktnov ľmfom. opazovano in ľelativno petletno pľeävetje po spolu in obdobju opazovanj as 95o/o intervalomzallpaĺja(IZ). TABIE 3: HoĘkin Ęmphoma obseĺvď and relative fĺve_yeaľ suĺvival by séx and pefiod of obseľvađon wlth 950lo confidence inteľval (CD. opazovano / obseľed (ło) Moški/Males Leta / Yeaľs Ženske/Females Leta/Years Obdoble/ Period 1 IZICI 3 IZIO 5 TZICI 1 tzlcr 3 rzlct 5 tzlcr 198]-87 198U92 1993-97 88 93 89 (82-94) (8Ĺ98) (83-9t (6R2) (r549) oG90) 6u76) (ó7-83) (71-87) (7Ť91) (92-100) (19-93) (ó1-8, (8Ł98) (7Ę90) (5&80) (1u94) (68-8ó) 82 96 8ó 73 82 83 67 75 79 69 8ó 77 72 91 o) Relativno / Relative (9ó) ______J 5 Moški/Males leta / Yeaĺs Ženske/Females leta / Years obdobie/ Period 1 VIU 3 IZ/U 5 V/CI 1 Żlcl 3 IZlq 5 lzlcI lovlm 1983-87 198U92 199T97 (82-96) (89-99) (85-9Đ (67-85) (7G92) (7v94) (62-82) (70-88) (7ý93) (7Ł92) (63-71) (80-94) (ó5-87) (85-9t) (7G92) (ó48Đ (80-9ó) (72-90) 83 67 87 72 79 84 89 94 9t €. 76 84 8ó 76 o) 84 76 88 8l rtients lmale .hese, t3-97. ied at rlym- 3 WaS efeas r00 in 100 100 80 E ieo 'Đ o ;Ň i^ g'' o. z0 80 E á60 Ř .F I :Ň 40 o. s 20 is has high- rp of rt sig- r peľ- roted 1973-77 1975'8.2 1983-87 obdobje/peĺiod 198U92 1993-97 0 23 Ieta/years 4 5 treat- rined tÍeat- .lone. rlogy )nt of zo po sis by o/o 1,0 4,0 S[lt(A 2: Relativno petletno prežlvetje bolnikov s Hodgklnovtm llmfomoĺq zboleľh v letlh197T1997 po stadiju in obdoĘu dĘnoze. tlGuRE 2: Re|ative five_yeaľ suľvlval of Hodgkin lymphoma patlents dĘnosed in the peńod197|1997 by stage and pertod of dtagnosis. staľosti (87-91w (slika 3). ocena pľeživetja bolnikov, staĺej- ših od 55 \et, je nezanes\jiva zaĺadi majhnega števila pľime- ľov v posameznih Staľostnih skupinah Gabela 1). Izsledki študije EUROCARE-3kaźejo, da je bilo v Evropi pov- pfečno Staľostno standardizirano relativno petletno pľeživet- je bolnikov s Hodgkinovim limfomom pľi moških 73,5% 0r-76,2) in pľi Ženskah 80,20/o(7B,7_B2,2), v Sloveniji pa pĺi moških 7 5,6 0/o (65,7 _Bó, 8) in pľi ženskah 7 6,2 0/o (7 0,7 -82,2). Največje preżivetje pľi moških jebiIo B9,50/o na Tiľolskem v Aĺstľiji in pľi ženskah90,9Vo na območjih legistľov Basla inZeneve v Svici. Ma,rjeta Vouk, onkološki inštitut ĹjubĘana Pomembna mejnika v diagnostikiHodgkinovega limfoma sta bila uvedba ľačunalniške tomogľafije pÍsnega koša in tľebu- ha (i981) teĺ ultľazvočne pľeiskave tĺebuha (1984)' Pĺeiska- vi omogočata natančnejšo določitev stadijev' StlKA 3: Relatlvno petletno pľeživetje bolnlkov s Hodgkinovim limfomom, zboleľhv letfü 1993-1997 po staľosti. FlGURf, 3l Relatfue five-year suľvivď of Hďgkln Ęmphoma patients diagnosed ln the peľiod 199}1997 by age. Paediatĺics, UMC in Ljubljana, in 20/o in the Generai Hospital in Maľiboĺ, andin10/o in the Geneľal Hospital in Celje. The ľelative five-year suruival ľate was 8% higher in the years1993_97 than in the years1983_87 (Figuľe 1). The majoľ changes in survival occuned in the disease stages III and IV in both sexes (Figuľe 2).The suĺvivalwas the highest in children and adults uĺder 54 (87_9Iw (Figuľe 3). The estimated sur- vival ľate of patients aged over 55 is not ľeliable because of a small numbeľ of cases in each individual age gľoup (Table 1)' According to the EUROCARE-3 study ĺesults ťoľ the peľi- od 1990_9 4 in Euĺope, the age-stand ar dtzed relative suruival rate of the patients with Hodgkin lymphoma was 73.50/o 01_76.2) in male patients and in ĺemale patients 80.2% O 8.1-82.2), while in Slove nia, it" w as 7 5.60/o (65 .7 -56.8) in male patients and76.2o/o(70.7Ą2.2) in ĺemale patients. The high- est Íates of 89 .50/o in ma\e and oÍ 90 .90/o in female patients weľe obserued in Tyrol in Austria and Switzerland (only ĺegistľies Basle and Geneva), ľespectively. - I)4+ - 45_54 - ))-04 b>- /4 - 75+ Skupaj -All ,-1997 PREŽNETJE BoLNlKoV Z RAKoM V SLoVENUI ĺ 983-ĺ 997 101 HoDGKĺN LYMPHoMA S postopnim p rcpoznavanjem pĺognostičnih dejavnikov (sta- dij, velikost tumorske mase, sedimentacijo eľitĺocitov, B simp- tomi itd.) so se v 80. in 90. letih dopolnjevalamerilazaizbor načina zdravljenja, ki upošteva prognóstične ďe1avnike. Że znano učinkovito kombinacijo citostatikov po shemi MOPP z veliko poznih sopojavov smo zamenjaliz enako ali bolj učin- kovitimi kemoteĺapevtskimi shemami z manj poznihsopoja- vov: AB\D (1980), MOPP/AB\D (1985), MOPP/ABV (1987) in kasneje BEACOPP (1997). Vse doslejnašteto je omogoči- lo uvedbo kombiniľanega zdravljenja v poznih 80. in začeĺ ku 90. let, kar pomeni začetek zdĺav\jenja s kemoteľapijo, nadaljevanje z obsevanjem pľizadetih ľegij pĺi začetnemsta- diju (I ľr II) in obsevanje eventualnega ostanka pľi napľedova- nem stadiju (III in IV)' obsevalna doza je odvisna od učinka kemoteľapije. ZdrĄenjeHodgkinovega limfoma samo z obse- vanjem z velikim obsevalnim poljem in dozo je preteklost. Naštete spľemembe v diagnostiki, osnovnem in podpoĺnem zdľavljenju so vzrok dobľim ľezultatom tudi pľi napredova- nih stadiiih (1). VIR Dalla - Faveza R, Gaidano G, !ľeinstein HJ, Taľbell NJ, AĺmitageJo, Mauch PM et al. Lymphomas. In: deVita \ĄJĺ, Hellman S, Rosenbeĺg SÁ, eds' Canceľ: principles and pľactice of oncology' 6th ed' Philadelphia: Lippincott, 2001: 2215-387. Mar1eta Vouk, Institute of oncologt ĹjubĘana Computeľ tomography of the chest and abdomen intľo- duced in 1981 and US examination of the abdomen in 1984 aľe tvvo important landmaĺks in the diagnostics of Hodgkin lymphoma. Both methods allow an accLlrate deteĺmination of the disease stage. Estab1ishing gľadually the prognostic factors, uiz. sÍage, stze of tumoľ mass, erythrocyte count, B-symptoms, etc., the guide- lines for tĺeatment choice, taking into account also the prog- nostic factors, weľe being updated in the 1980s and 1990s. An effective and most functional combination of cytostatics accoĺding to MoPP schedule that was known to have a high numbeľ of 1ate toxic effects, was replaced by a similaľ, yet moľe effective treatment schedules with less late toxic effects. These aľe ABV (1980), MOPP/ABVD (1985), MOPP/ABV (1987), and later oĺ, ín 1997, also BEACOPP. The above treatment schedules facilitated the application of combined treatment in the late 1980s and eaľly 1990s. The tľeatment of the disease stages I and II is staľted with chemotherapy and continued by inadiation of the affected ĺegions. In more advanced stages (III and tV), eventual residual disease is treated by irľadiation. The iĺradiation dose depends on the eťficiency of chemother- apy' The tÍeatrnent of Hodgkin lymphoma by raďotheľapy alone, applying large inadiation fields and hĘh doses, is out-of'date. The advances in diagnostics, primary and supportive treatrnent contľibuted consideľably to the betteĺ treatment ľesults also in more advanced stages of the disease (1). r02 cANcER PATIĹNIľS suRVlVAL lN sLoVE'NlA 1983-1997 HOMA AKUTNA LIMFOBLASTNA LEVKEMUA intľo- 1984 lgkin ntion AI(UTNA LIMFOBLASTNA LEVKEMUA ACUTE LYMPHOBLASTIC LEUIGMIA MKB 8/lCD 8: 2040 V obdobju 1983-97 je zboielo za akutno limfoblastno levke- mijo (ALL) 168 moških in 159 žensk' odtegav1etih1993_97 57 moških in 50 žensk. Y aĺalizo nista bila vključena 2(Iw bolnika, keĺ je bila pľi njiju levkemija ugotovljena šele ob smľti. Y opazovanem 15łetnem obdobju se incidenca akutne lim- foblastne levkemije ni pomembno spľemenila. Vletih 19B}B7 je bila gľoba incidenčna stopnja 1,2/100,000 moških in 0,9/100.000 Žensk, v Ietihl993_97 pa1',2/1,00'000 moških in 1/100.000 žensk. Staľostna porazdelitev v analizo zajetih bolnikov se je spĺe- menila (tabela 1). V zadnjih letih je bilo odkritih več bolni- kov v staľosti 65_74let. V starosti 0ł let se število novih bo]nikov ni povečalo, povečala pa se je Staľostno specifična stopnja incidence. v Ie/ĺh 19%_97 je bilo specifično zdravIjenih7L\/obolnikov . Prvo zdravljenje je bilo v največjem odstotku (62Vo) samo cito- statsko, v 370/o citostatsko in obsevalno.y 780ń so pričeli s prvim zdravljenjem na Pediatrični kliniki KC vL1ubIjaru,v 1,40/o na Kliničnem oddelku zahematoIogijo KC, v70/onaonko- loškem inštitutu v Ljubljani inv L0/o v SB v Maĺiboľu. V letih 1993_97 je bilo ľelativno tľi in petletno preżivetje za 4 0/o v ečje kot v letih I9B3_B7 . Enoletno pr eżiv etje je biIo za 4\/omanjše (slika 1). Spľemembe v pľeŽivetju so bile večje pri otĺocih (1993_97) in pĺi mladih odraslih (obdobje I98u92) kot pri staľejših (slika 2). TABELA ĺl Akutna limfoblastna levkemlia. Bolnfü vkliučeni v aĺallzo po staľosti in obdobju opazovanja. TABIE l: Acute lymphoblastic leukemla. Patients included in the analysis by age and periođ of obseľvatlon. Starost ob diagnozi/Age at Lliagnosis Obdobje/ Skupai/ Period All -14 1544 45-54 5544 65:74 75+ 83Ą7 8U92 - 93-97 012345 letalyears S'IJI(A l: Relativno pettetno pľeživetje bolnikov z alĺutno llĺnfoblastno levkemijo, zbolelih v letih 1983-1997 po obdobju diagnoze. tlGURE l: Relative five-yeaľsuĺvivalof acute Ęmphoblastic leukemia patients diagnosed tn the period 1983_|997 by peľiod of diagnosis. In the peľiod 1983_97, a total of 168 male and 1'59 ťemale patients weľe diagnosed with acute lymphoblastic leukemia (AtL); of these, 57 males and 50 females weľe diagnosed with this canceľ in the period 1993_97.In 2 patients (1%), acute lymphoblastic leukemia was diagnosed at death; theľefore, they weľe not included in the analysis. In the obseľved 75-year period, the incidence of acute lym- phoblastic leukemia did not significantly changed. In 19BlB7, the crude incidence ĺate WaS 1.2/100,000 in males and 0,9/100,000 in females, wherea s n 7D3-97, it was 1.2/100,000 in males and 1/100,000 in females. The age distĺibution of patients included into the analysis has changed (Table 1) In the observation peľiod 1993_97, a high- eľ numbeľ of patients was observed in the age group of 65_74years.In the age gľoup of 04years, the number of newly detected patients did not incľease, whereas the age-spe- cific incidence rate did. In the peľiod t993_97 ,720/o of pauens undelwent specific tĺeat_ ment. In most cases (6Ż0/o), pľimary treatment was chemotheľ- apy alone; 370/o of patients weľe tľeated by radiotherapy and chemotherapy. Prlmary tľeatment was started at the Depaľtment of Paediatľics, UMC, Ljubljana in 78% of patients, in140ń at the Department of Haematlogy, UMC, Ljubljana, in 7o/o at tl-rc Institute of Oncology Ljubljana, and in 1% in the Geneľal Hospital in Maĺibor' The relative five-yeaľ survival rate was 4% higheľ in the years7993_97 than in the yeaľs 19B3_B7. The one-yeaĺ suĺ- vival decreasedby 40Ä (Figuľe 1). Biggeľ changes in suruival were obseĺved in childĺen (1993_97) and in young adults (198u92) than in elderly (Figuľe 2). Accoĺding to the EURoCARE-3 study ľesults for the peľĹ od 1990_94 in Euľope the age-stand aĺdized ĺelative suľvival ĺate of adult patients with ALL was 27 .2Vo(22.9_32,3) inmale patients and in female patients 24,9V0 (19,9-31.1), while in Slovenia, it w as 1.6.30/o (7 .3-36.4) in male patients and 36.10/o (23.2_56.I) in female patients. The highest rates of 45,40/oiĺ adult male and of 55.90/o in female patients weĺe observed 100 80 ä60 .F o ;Ň 40 o, 20 ize of ;uide- pľog- )s. An tatics Lhigh mofe fects. L9B7), .ment .ment SCASC nued ;tages ation. ltheľ- rlone, -date. ment ; also 97 123 105 Skupai All 198ffi7 1988-92 1993-97 56 62 52 1 5 12 5 7 1 27 38 23 -1c)97 ľnrŽvĺ1r BoLNlKoV z RAKoM V sLoVENUl l98Tl997 103 ACUTE LYMPHOBLASTIC LEUKEMIA TABELA 3: Akutna llmfoblastna ĺevkemlja. OpaŻovarLo iÍ|ľelativno petletno preživetje po spolu in obdobju opazovania s 95 0/o inteľvalom zatpanja(IZ). TABLE 3: Acute lymphoblastic leukemia. obseľved and ľelatlve Íive-yeaľ suľvíval by sex and peľiod of obseľvation wlth 950/o conÍldence inteľval (CI). op.rzor'ĺno/Ohserved (0ô Moški/Males leta/\taľs Zenske/ ľemalcs Ĺeta / \'ears 0bdobje/ Pcľiod 1 ru/CI 3 IZ/U 5 VlCI 1 IZICI 3 IZIU 5 IZICI 1983-87 198U92 1993-91 45 40 48 52 49 50 ó1 72 6() 47 57 50 51 64 58 76 73 t5 (65-87) (61-85) 6Ł86) $844) $1-77) (4G72) ę4_60i) (4Ł70) 3743) $242) (ó1_8) (4G74) 3747) 3741) 3G64) (3M0) (2&5Đ $442) Relativno / Relative (96) Moški/Males Leta / \'eaľs Ženske/Females leta /Years Obdobje/ Period 1 tzlcl 3 tzlcr 5 tzlct I rulCI 3 IZ/ü 5 IZ/CI 1983J7 1988-92 1993-97 47 41 50 \4 50 51 tJl 72 61 49 59 52 t2 65 59 71 74 76 (65-8Đ (62-86) (ó5-87) (]8jó) 62:78) (4G12) 3143) (45-73) (]8{ó) $Ż_82) (ó1-8) (41-75) (3&70) $842) 3Á6) (j1-ó3) (29-13) 05-65) 100 100 0-14 -- Ď44 80 .Ę ř a60 'Đ o iŇ 40 Ě o. 20 80 'ě ;Ó0 'Đ o .e 'fi 40 Ě o. 20 1973-77 197ffi2 1983-87 obclobje/peĺiocl 198U92 1993-97 0 23 leta/years 4 SLll(A 2: Re]atfuno petletno pľđivetje bolĺrlkovz akutĺro liĺnfoblastno levkemijo' zbolelih vletiłll973-|997 po staľosti in obdobju diagnoze. I|GURL 2: Relative five-yeaľ suľvival of acute Ęmphoblastic leukemia patients diagnosed in the period 197T1997 by age and period of diagnosis. Izsledkištudije EUROCARE-3 każejo, da je bilo v Evľopi pov- p ľečno staľostno standar diziÍ ano f e1ativno p etletno p Í eźiv et- je odľaslih bolnikov z ALL pri moških 27,20/o (22,9_32,3) in pĺi ženskah 24,90/o(I9,9_31,1), v Sloveniji pa pľi moških 16,3%o 0 ,3_36,4) in pri ženskah 36,1'0/o (23,2_56,1). Največie pÍeŽi- Vetje pri lnoških je bjlo 45,40/ov Nemčiji (samo Posaĺje) in pĺi Ženskah 55,90/o v Śpaniji V pľovincah: Baskija, Malloľca, Navaĺĺa inTaľĺagona. Jožica Anžič, Pediatrična klinika KC Motna Íaz|aga za višje tľi in pe tletno pľeživetje je razvoj novih diagnostičnih metod in doslednejša upoľaba kriteĺIjev za boljše ľazlikovanie podskupin bolezni glede na njihovo bio- 1oško agľesivnost in stopnji rízika za ponovitev bolezni pri- rejena intenzivnost zdľavljenja. 704 SLIKA 3: Relatlvno petletno pľežlvetje bolnikov z akutno limfoblastno levkemijo, zboleľh v letlh l99Tt997 po staľostl. F|GURE 3l Relative five-year suľvival of acute lymphoblastic leukemia patlents diagnosed in the period 199T1997 by age. respectively in Germany (Saaľland only) and Spain (only regions : Basque Country, Mallorca, Navaĺĺa and T arragona) . Jožica Anžič, Depanment of Paediaĺrics, UMC, Ljĺłbljana A possible explanation foľ the impľovement in thĺee- and five-year survival rate is the progress made in diagnostics and Consistency in following the guidelines foí a moĺe exact dif- feĺentiation of the disease subgĺoups by the gĺade of bio1ogical aggressiveness, and the intensiry of the theĺapy adjusted to the ľisk of ľelapse. A decline in one-yeaľ survival may be attributed to a moľe aggressive therapy that, the first yeaĺ afteľ the diagnosis or soon after the beginning of the theľapy, incĺeases the death risk in patients with unfavorable pľognostic factors' These patients o-14 .-^". 1544 - vsi/all Skupaj - All CANCER PATIEMS SURVIVAL IN SLOVENIA 198T1997 AKuTNA LĺMroBLASTNA LEVKEMUA EMIA üom ence 0) z) 2) Nižje enoletno preživetje pa gľe lahko na ľačun intenzivnej- šega zdľavljenja, ki pľi bolnikih z bolj neugodnimi pľogno- stičnimi kazalci poveča umľljivost V pľvem letu po diagnozi oz, začetkuzdravljenja' Ti bolniki so veľjetno pĺejvplivali na večjo umľljivost v obdobju do pet 1et (1, 2). Siceľ pa se načini zdravljenja: kombinacija citostatikov, način zaščite centľalnega źivčnega sistema v pľoučevanem obdob- ju niso pomembno spreminjali in zato verjetno niso vzrok spľe- membam v pĺeživetju. Jože Pretnar, Kĺ'inični od.delek za hematoĺogijo KC Y zadnjihletih je vse več bolnikov staľejših od 65 let, vendaĺ jih je še vedno malo, V obdobju odI989 do 2000 Smo opľa- vili 13 alogeničnih pĺesaditev kostnega mozga' pĺi njih pľi- čakujemo okrog7\\/o 1OJetno pľeživetje (3)' VIRI 1' AntičJ,ZaIeteI-I{ĺageljL.Akutnalimfoblastnalevkemijaotľok.ZdravVestn 1995;64:6134. 2. Ma|iP,JazbecJ. Preživetje otľok in mladostnikov z akutno levkemijo v Slo- veniji v obdobju 1990-1999' Slov Pedatľ 2002; 9: 8Ĺ9. 3' Pretnaĺ J, Pľeložnik Zupan L Allogeneic stem cell tľansplantation for patients with acute leukemia. In: New tľends in the treatment of acute leu- kemia. Programme and abstĺact book of the óth seminaľ Dubľovnik' Zagĺeb: Univeĺsity hospital, 2001: 109-14' might have had an effect on the rise of five-yeaľ moĺality rate (1,2). Treatment modalities have not considerably changed, com- bining more oľ less the Same Cytostatics and protection meth- ods ťoľ the centľal neľvous System; they theĺefoľe could not have any impact on the changes in the suľvival. Jože Pretnar, Departnxent of Haenatologl, UMC, Ijubĺ;jana In recent yeaĺS' more patients with AlL fall into the age gĺoup ovęĺ 65 yeaľs, though they aĺe still not so many. In the peri- od 1989_2000, 1J allogeneic bone maffow tľansplantations weľe performed. The 10-year survival of these patients is expected to be about 70Vo(Đ. 3) 3) t ltno ;ti. utic rnly na). 1A and and dif- ,rical dto )oĺe oon kin 3nts 1997 nru'Žlvĺ1r nolľĺIKoV Z RAKoM V sLoVENłl 1983-t997 105 ACUTE NON'LYMPHOBLASTIC LEUKEMIA AI(UTNE NELIMFOBLASTNE LEVIGMIJE ACUTE, NON- LYMPHO B LASTIC LE.UIG,MIAS MIG B/IcD 8: 2050' z060,Ż070 V obdobju I9B3-97 je zbolelo za akutro nelimfoblastno lev- kemijo 310 moških in 300 Žensk, od tega v letih 1993_97 127 moških in 102 ženski. Y analizo ni bilo vk1jučenihz9 60/o) bolnikov, keľ je bila pľi njih levkeĄa ugotov1jena še1e ob smĺi. Y opazovanem l5Jetnem obdobju se je incidenca akutne nelimfob1astne levkemije pľi moških večaIa' V letih 19B3_B7 je bila gľoba incidenčna stopnja 1,4/100.000 moških in 2/1'00'000 žensk, v leljh 19%-97 pa 2,6/1,00.000 moških in 2/100'000 žensk' Starostna poľazdelitev v analizo zajetih bolnikov se je spľe- menila (tabela i). V letih 1993_97 je bilo več moških, staĺih 55 let in več, ter več Žensk, staľih 65 1et in več. Y letih 1993_97 so v B40/o pĺičeli s pĺvim zdravljenjem na Kli- ničnem odde1kLr za hematologijo KC v Ljubljani,v )o/onaPedia- tĺični k1iniki KC, v 4o/o v SB v Maľiboru. Po en bolnik je bil zdĺaÚen v SB v Celju, Muĺski Soboti in Šempeüu pľi NoVi Goľici. Y opazovanem obdobju je bilo ľelativno petletno preživetje največje v letih I98u92 Glika 1). PĺeŽivetje se je v 1etihl993_97 povečalo samo pĺi otľocih (na 40 %). V vseh drugih staĺostnih skupinah je bilo manjše od200Á' Najmanjše je bilo po ó5. letu Staĺosti in pľi mladih odľaslih, staľih od 1544Iet (slika 3). Izsledki študije EUROCARE-Jkażejo, da je bílo v Evľopi pov- pľečno Staľostno standar dizirano ĺelativno petletno pr eźiv etje TABEIA ĺl Akutne nelimfoblastne levkemłe. Bolntki vključent v analizo po spolu' starostí ln obdobjuopazovanJa' TABIE ll Acute non-lymphoblastic leukemias. Patients included in the analysis by sex, age and peľíod of obseľvation. Staroĺ ob dia8nozj /Age at di:rgnolis Obdobje/ Skupal/ Peľiod All -1.4 1544 45-54 5544 65-74 75+ 100 83Ą7 q&92 - 93-97 o 1 'rrr^,r"rr3 4 5 SIIKA l: Relativno petletno p"ezĺv"q" bolnlkov z akutno nelimfoblastno levkemijo, zbolellh v letlh 1983-1997 po obdobju diagnoze. IIGUR"E' l: Relatlve ftve-yeaľ suľvival of acute non-lymphoblastíc leukemia patients diagnosed in the peľiod t983_|997 by peľiod ofdlagnosis. In the peľiod 1983_97, a total of 310 male and 300 female patients weľe diagnosed with acute non-lymphob1astic 1eukemia; of these, I27 malesandl)Zfemales weľe diagnosed in the peĺiod 1993_97 ' In 2ý patients (50/o), acllte nonłym- phoblastic leukemia was diagnosed at death; therefore, they weľe not included in the analysis. In the obserued 15-yeaľ peľiod, the incidence of acute non-1ym- phoblastic leukemia was incľeasing in men. In 1983-87, the crude incidence rate was 1.4/100,000 in males and 2/100,000 in females, wheĺeas in 1993_97 , ĺtwas 2.6/100,000 in males and 2/100,000 in females. The age distľibution of patients included into the analysis has changed (Table 1). In the observation peľiod 1993-97,therc Weľe moĺe male patients aged oveĺ 55 and moľe female patients aged oveľ 65 yeaľs' In1,993_97 , primary treatment was started at the Depaĺtment oĺ Haematology, UMC, Ljubl jana iĺ 840/o of patients, in 90/o of patients at the Depaftment oĺ Paediatľics, UMC, Ljubljana, in 40/o in Genęĺal Hospital in Mariboľ; in each of Geneľal Hospitals in Ce1je, Murska Sobota and Šempeteľ pľi Novi Gorici, pľimary tleatment was staľted in one patient. In the whole observation peľiod, the ľelative ĺive-yeaľ survival ĺate was the highest in the years 198u92 (Figure 1). In the years 1993-97, the suruival increased only in children (by 4070). In all otheľ age gľoups, it dropped and was less than 200/o.The poorest sulvival was obserued in the patients oldeľ than ó5 yeaľ and in young adults aged 1544years (Figure 3). According to the EUROCARI-3 study ĺesu1ts foĺ the peĺi- od 1990_94 in Europe, the age-standaľdizedľe1ative suruival ľate of the adult patients with acute non-lymphoblastic leukemia was9.30/o (7.8-11.1) in male patlents and in female patients 10.6Vo G.9_12.ó), while in Slovenia, iÍ was 9'2o/o G 6-18,4) in male patients and 7.60/o (3.3-17.4) in female patients. The highest ĺates of 1'5'7o/o in male and of 2L20/o in female patients weĺe observed in Switzeľlan-/4 - 75+ \ t997 ľnr,Žlvrĺ;r. nolxlKov z RAKoM V sLoVENUI 1983-1997 r07 ACUTE NON-LYMPHOBLASTIC LEUKEMIA Pĺeseneča ugotovitev, da je preŽlvetje najslabše pľav V Staľost- ni skupini 15441et", to je v skupini, ki ima po podatkih iz liteĺa- tuľe najboljše rezultate zdrĄenjaz alogenično tľansplantacijo peľifeľnih krvolvoľnih matičnih celic, kakoľ tudi s konven- cionalno kemoteľapijo. VIRI 1' Pretnaĺ J, Preložnik Zupan I. Allogeneic stem cell tľansplantation for patients with acute leukemia' In: New tĺends in the tfeatment of acute leu- kemia' Progĺamme and abstľact book of the 6th seminar Dubĺovnik' Zagľeb: Univeĺsity hospital, Ż001: 109-14. 2' PfetnarJ. Allogeneic BMT for acute leukemía and chronic gĺanulocytic leu- kemia in UniveľsĘ Medical Centre Ljubljana _ Slovenia. Bone Manow Tľans- pIant1998 22: suppl 4:S77-Ż. 3' Ma|1P,JazbecJ. Preživetje otrok in mladostnikov z akutno levkemijo v Slo- veniji v obdobju 1990_1999, Slov Pedatr 2002; 9: 8Ĺ9. 4' Andoljšek D, Preložnik Zupan I et al' Cell maĺkers in the fecognition of acu- te myeloblastic leukaemia subtypes, Cell Mol Biol Lett 2002; 7:343-5. 108 CANCER PATIEMS SURVIVAL IN SLOVENIA 1983-1997 KRoNIČNA LIMľoctTNA LEVKEMUA NIIA KRONICNA LIMFOCITNA LEVIG,MUA CHRONIC LYMPHOCNC LEUIG,MIA MKB 8/IcD B:Ż041 V obdobju 1983-97 je zbolelo za kľonično limfocitno levke- mijo (KLL) 559 moških in 460 žensk, od tega vletih1993-97 210 moških in 152Źensk'V analizo ni bilo vključenih 626w bolnikov, keľ je bila pri njih levkemija ugotovljena šele ob smĺi. V opazovanem 15łetnem obdobju se je incidenca KLL večala. Vletih 198}87 je bila gĺoba incidenčna stopnja 3,8/100.000 moš- k1h in 2,7 / 1'00. 00 0 žensk, v Ietih 1993_97 pa 4, 4 / I00,00 0 moš- kih in 3/100.000 žensk. Staľostna porazdelitev v anaIizo zajetih bolnikov se je spľe- menila (tabela 1). V zadnjih 1etih je bilo odkľitih več moških v staľosti 65 let ĺn več Žensk v starosti 55_641et. v Ietjh1993_97 je bilo specifično zdľavljenih samo 38 %o bol- nikov. Ptvo zdravljeĺjeje bi1o v največjem odstotku (B27o) samo citostatsko, v 10 % samo obsevalno, v 4 %o obsevalno in citostatsko. Y 330/o so pĺičeli s prvim zdĺauljenjemna onko- loškem inštitutu v Ljub1jani, v IB,/ov SB v Sempetru pľi Novi Gorici, v I30/o v SB v Celju, v I20/o v SB v Mariboru, v 7 0/o na Kliničnem odde]ku zahematologijo KC v tjubljanĺ,v 7 o/ov SB v Slovenj Gradcu, v 60/ov SB v Muľski Soboti, po 1% v SB na Jesenicah, v SB v Novem Mestu in v Trbovljah. V letih 1993_97 je bilo ľelativno petletno pľeživetje za I00/o večje kot v letih 1983-87 (slika 1). Pľeživetje se je največ pove- čalo v staľostnih skupinah 45_541etinveč kot 75 let (slika 2). TABELA l: Kľonlčna llmfocitna levkemlja. Bolniki vključenl v aĺallzo po spolu, staľosti in obdobju opazovania. TABIE l: Chľonic lymphocytic leukemia. Patlents included in the analysls by sex, age and peľiod ofobseľvation. Starost ob diagnozi/Age at diagnorrs Obdobje/ Skupaj/ Period Áll _14 15]'4 45-54 554Ą 65-74 75+ 83-87 -.-'- 8U92 - 93-97 012345 IeÍa /years SLI|(A l l Relativno petletno pľeživetje bolnikov s kronično llmfocltĺro levkemijo, zboleľh v letih 1983_|997 po obdobju diagnoze. IlGllRE l: Relatfue five_yeaľ suĺvivď of chĺonic ýnphocytic leukemia patlents dĘnosed in the peľiod 198T|997 by peľtod of dĘnosis' In the peľiod 1'983-97, a total of 559 male and 460 female patients were diagnosed with chronic lymphocytic leukemia; of these, 210 males and I52 females weľe diagnosed in the peľiod 1993_97. In 62 (60/0) pat1ents, chronic lymphocyic leukemia was diagnosed at death; these patients were theľe- foľe not included in the analysis. In the obseruedl'5-yeaĺ peĺiod, the incidence of chľonic lym- phoq,tic leukemia was incľeasing. In the peľiod 1983Ą7,the crude incidence ľate Was 3.8/100,000 in ma1es and 2.7/100,000 in females, wheĺeas inl993_97 , itwas 4.4/100,000 in males and 3/100,000 in females. The age distribution of patients included into the analysis has changed (Table 1). In the observation period 1993-97 , more chronic lymphocytic leukemia cases were detected in the male patients older than 65 years and female patients in the age group 55_ó4. In the peľiod 1993-97,38%o of patients underwent speciÍic treat- ment. In most cases (82%o), primary tľeatment was chemotheľ- apy alone, 10%o of patients were tĺeated by ľadiotheĺapy alone, and 40/oby radiotheľapy and chemotheľapy. Pľimary treatment was staľted at the Institute of oncology Ljubljana in 330/o of patients, in 18%o in the General Hospital in Sempeteľ pľi Novi Goľici, in1'30Áin the Geneľal Hospital in Celje, ĺn1'20/ointhe Geneľal Hospital in Mariboľ, jn 70/o at the Department of Haematology, UMC, Ljubljana,inT\/o in the General Hospital in Slovenj Gradec, in 6o/o in the Geneľal Hospital ln Muľska Sobota, in 1% in each of Geneľal Hospitals inJesenice, in Novo mesto and in Tľbovlje. The relative five-year survival rate was 10% higher in the yeaĺsl993-97 than in the years1'983Ą7 (Figuľe 1). The high- est increase in survival was observed in the age gľoups of patients oť 45_54 years and in those oldeĺ than 75 years (Figure 2)' In the age group oť 45_54 yeaľS the suľvivalwas 290/o higher than in the group of patients over 75 yeaľs old (Figuĺe 3). In allthree obseruation periods, the survivalwas higheľ in female than in male patients. Accoľding to the EUROCARE-3 study ĺesults foĺ the peĺi- od 1990-94 in Euĺope, the age-stand ardizedre1ative survival 100 80 G .Ę ř ä60 'Đ q ;Ň 40 o. s 20 Moški Meles 198347 198&92 1993-97 172 1ó0 194 ?o 21. 14 50 41 64 51 49 ó1 36 41 50 Żenske Females 1983-87 198U92 1993-97 130 163 138 0 0 0 56 63 45 40 54 47 22 32 34 9 10 11 )97 ľRľ'Žľĺĺ1ĺ BoLNlKoV Z RAKoM V sLoVtNUI 198}1997 109 7 CHRONIC LYMPHOCYTIC LEUKEMIA IABľ,LA 3: Ifuonična limfocltna levkemlja. opazovano ln relativno petletno pľežlvetje po spolu ln obdobju opazovanja s 95 0/o inteľvalom zaupanja(IZ), TABIE 3: Chľonic lymphocytic leukemlja. obseľved and ľelative five-yeaľ survival by sex and períod of obseľvation with 95o7o "o'1r- dence inteľval (CI). Obseľed (0/o) Moški/Males Ĺeta / Yelrs /Females 0bdobje/ Ĺeta/Years Period 1 IZ.|CI 3 IZ/U 5 Żlcl 1 tzlu 3 rzlct 5 n/c\ 1983-87 1988-92 1993-97 (óŔ0) (71-8t 63-17) (40-56) (4(Á2) ęu52) (23-37) (3Mó) 3M4) (ó7-8) (ó&8Đ (7i-8t (4341) $147) $Ł70) 0Ł52) 07-53) (4341) 43 Ą5 52 52 59 62 75 75 78 J(] 38 37 48 54 45 73 78 70 Relativno / Relative (9ó) Moški/Nĺales letalYeaľs Zenske/ ľemales Leta /\tars obdobje/ Period 1 rzlq 3 rzlu 5 wcl 1 1zlÜ 3 IZ/u 5 IL/CI 1983-87 198U92 1993-97 0o-81) (7Ł88) (67-81) (49-ó7) $5-73) (4ó114) (31-51) (4M0) (4242) (71-87) (72-86) (75-89) (50-70) (ó0-78) (ó3-81) (4547) (49-69:) $G76) 56 59 66 6o 69 72 79 79 82 41 50 52 i8 64 55 77 81 74 100 100 65-74 - 75+ 80 ä0o 'Đ o .Ż 'Đ 4í) o. z0 80 E 'Ł ;60 'Đ o :Ň 40 ř o. 20 1973-77 1978-82 1983-87 obdobje/period 198U92 1993-97 0 23 leta/years 4 SIIKA 2: Relativno petletno prežlvetje bolnikov s kľonično limfocitno levkemijo, zboleľh v letth 1973-1997 po staľosti in obdobju diagnoze. I|GURE 2: Relative five-yeaľ suľvival of chronlc lymphocytic leukemia patients diagnosed in the perlod t973-|997 by age anď peľiod of diagnosis. V staľosti 45_54\etje bilo petletno pÍeživetie za2)0/ovečje kot pĺi staĺejših od75Iet Glika 3). V vseh tľeh opazovanih obdobjih je bilo pľi ženskah pľeŽivetie Večje kot pĺi moških. Izsledkištudiĺe EUROCARE-3 katejo, da je bilo v Evropi pov- pľečno staľostno standardizirano relativno petletno pľeŽivet- je bolnikov s KLL pĺi moških 64,80/0(62,147 ,6) inprĺ ženskah 69,2 o/o (66,5_72), v Sloveniji pa pľi moških 43,9 0Á (3G53,5) in pri Ženskah 580/0|,4),I_68,5). Največje preŽivetie pľi moš- kih je bilo 82,20/o v Śpaniji v pĺovincah: Baskija, Mallorca, Navaľľa lnTarragona in pľi Ženskah 85,20/ovFranciji v okľož- jih Bas-Rhin, Calvados in Cote d'oľ. Barbara Jezeľšek Nouakouič, onkološki inštitĺlt Ĺjtłbĺjana Naľaščanja incidence KLL na osnoví doslej znanih podatkov ne moľemo zadovoljivo poiasniti, kajti etiologija osÍaia nez- S[ll(A 3: Relativno petletĺro pľežíve$e bolĺrlkov s kľoĺúčno limfatíčno levkemijo, zbolelih v letih 1993_7997 po staľosti. ľ|GURE 3l Relative Íive_yeaľ suľvlval of chľonic lymphocytlc leukemia patients dlagnosed in the peľiod 199T1997 by age. ĺate of the patients with chľonic lymphocytic leukemia was 64'BVo (62.1'47 .6) in ma\e patients and in female patienÍs 69'20/0 (66.5_72), while in Slovenia, it'was 43'90/o (3G53Đ in male patients and580/o(49.I-68.) in female patients. The highest rates oť 82,20/o in male patients and of 85 ,20/o in female patients weľe obseffed in Spain (only regions: Basque Country, Mallorca, Navaľra and Tarragona) and in three ĺegions in France: Bas-Rhin, Calvados and Cote d'Or, respectively. Barbara Je zeršek Nouakouič, Institute of oł'l.cologl Ljĺłbljana The increase in incidence of chronic lymphocytic leukemia is not explicable fľom the available data because the etiolo- gy of the disease remains unknown. In general, the occunence SkLrpaj - All _ 75+ - vsi/all - 45_54 - >>-o4 o>- /4 110 CANCER PATIEMS SURVIVAL IN SLOVENIA 1983-1997 KEMIA KRoNÉNA LIMFoCľTNA LEVKEMI|A valom confi- 1CI nana, Siceľ pa pojav ne-Hodgkinovih malignih limfomov, kamoľ uvľščajo tudi KLL, na splošno povezujejo z nekateri- mi genetskimi boleznimi, dejavniki iz oko\ja in inťektivnimi agensi. Spľemenjeno staľostno poľazdelitev v analizo zajetih bolni- kov, pľedvsem pomik v višje staľosti, lahko razlożimo z bolj- šo diagnostično obdelavo starostnikov in posledično večjo možnostjo za odkritje bolezni v tei populaciji. Glede teĺapevtskega pristopa k bolnikom s KĹL še vedno velja pravilo opazovanja, dokleľ je bolezen stabilna. Kasneje ob napľedovanju bolezni zdľavimo stopenjsko: spva z neagÍe- sivno monokemoterapijo, v pľimeĺu neuspeha pa z agtesiv- nejšo polikemoterapiio. Novost v zdravIjenju je predvsem upoľaba fludaĺabina (v monoteľapiji ali kombinacijah), s kate- ĺo dosežemo večje število objektivnih odgovoľov, Kljub bolj- šemu odzivu pa se z upoľabo fludarabina celotno pľeŽivetje ni izboljšalo. Boljše ľelativno pľeživetje v zadnjihletih lahko v večji meľi pľipisujemo le izboljšanemu podpornemu zdľav- ljenju (1, 2,3,4). Tudi upoľaba kladĺibina' pentostatina teľ monoklonalnih pľotiteles V tem obdobju na preživetje bolnikov ni imela vpliva. VIRI 1. Canellos GĘ ListerTA, SklalJL, eds' The lymphomas. Philadelphia: 'WB Saun- ders, 1998. 2. DaI|a -FavezaR, Gaidano G, !ŕeinstein HJ, Taĺbell NJ, AĺmitageJo, Mauch PM et al. Lymphomas' In: deVita VTľ, Hellman S, Rosenberg SA, eds. Can- ceľ: principles and pĺactice of oncology' 6th ed, Philadelphia: Lippin- cott, 2001: 2215-387 3. Monserĺat E. Chronic lymphoc}'tic leukemia' In Annual of lymphoid malig- nancies. Cavalli Ę AÍmitage Jo, Longo DL, eds. London, Martin Dunitz Ltd,,2001: 117-Ż9. 4. Jezeľšek Novaković B. Smeľnice za zdĺavljenjebolnikov z ne-Hodgkino- vimi limfomi in Hodgkinovo boleznijo' In: LindtnerJ, Bešić N, Budihna M et al, eds' Doktrini Żdľavljenja bolnikov z maligniĺrľ limfomi in bolnic z rakom rodil. Zboľnik 1ó' onkološki vikend. Ljubljana: Slovensko zdravniško drušwo, Ż00Ż: Ż3_30, of non-Hodgkin malignant lymphomas, which include also chronic lymphocýic leukemia, is ľelated to Certain genetic dis- eaSes' enviľonmental factoľs, and infectious agents. The changes in age distľibution of the patients included into the analysis' particulally a shift towards oldeĺ age, may be explained by the impĺovements in the diagnostic pĺocessing of eldeľly patients, thereby increasing the chances for the detection oĺ the disease in this population. Conceľning the theĺapeutic appĺoach to the patients with chľonic lymphoc1tic leukemia, the rule oť the thumb is fol- low-up in the peľiod in which the disease seems to be in ľemis- sion. Lateĺ on, when the disease pĺogÍesses' the tľeatment is fol1owľlg a step-by-step appľoach: firstwe staftwith non-aggĺes- sive monochemotherapy; if it fails, we apply instead a moľe aggressive polychemotheĺapy. The most ľecent therapeutic improvement is the application of f]udaĺabine as monother_ apy oľ in combinations; its application helps to obtain a high_ eľ numbeľ of objective treatment ľesponses' but has not had any influence upon the overall survival, which has not impĺoved. Better relative survival in the recent years is attributable to more efficient Suppoltive tľeatrnent (I, 2, 3' 4), In this observation peľiod, the use of cladĺlbine, pentostatíne and monocional antibodies did not have any efĺect on the suľ- viva1. -52) -53) 41) ,Cl ^ JÔ l) 49) -76) ie. Úično rcytlc r was j9.zvo male ghest tients lntry, ns in emla liolo- :ence -1997 nnĺŽtvr,r;r, BoLNIKoV z RAKoM V sLoVENUl 198ý1997 111 CHRONIC MYELOID LE,UKEMIA KRoNlČN I(RONICNA MIELoIČľĺn LEVKEMUA CHRONIC MYELOID LEUKEMIA MlG 8/IcD 8:Ż051,Ż061 V obdobju 1983_97 je zbolelo za kľonično mieloično levke_ mijo 1B1 moških in 167 žensk, od tega V \etih 1993_97 55 moških in 54 žensk. Y analizo nista bila vključena 2 bol- nika, keĺ je bila pľi njiju levkemija ugotov1jena šele ob smrti. Y opazovanem 15łetnem obdobju je bi1a incidenca kĺonič- ne mieloične levkemije ustaljena. V letih 1983_87 1e bila gĺoba incidenčna stopnja 1,3/100.000 moških in 1,2/100.000 Žensk, v \etlh 1993_97 pa I,1 / I00,000 moških in 1, 1/1 00. 000 Žensk' Staľostna poľazdelitev v analizo zajetih bolnikov se je spľe- menila (tabela 1). V letih 1993_97 je bilo več bolnikov, staľej- ših od 55 let. Y \eljh19%_97 sov 340/o pľičeli s prvim zdĺavljenjem na Kli- ničnem oddelku za hemato1ogijo KC v tjubljani, po 17 %o v SB v Maĺiboĺu in v Celju, po 10 % v SB Šempetĺu pľi Novi Gorici in po Slovenj Gľadcu. Po en bolnik je bil zdravljen v SB v Muĺ- ski Soboti, na Ptuju in v Bolnišnici Golnik. Na onkološkem inštitutu v Ljubljani sta bila zdľav\jena 2 bolnika. V opazovanem obdobju je bilo ľelativno petletno pľeživetje največje v letihl9&u9z (slika 1). Zaradimajhnega števila pĺi- meĺov ĺazlike v preživetju g1ede na staĺost teŽko ocenjujemo' Daljše opazovanje in opazovanje v letih 1'993_97 kaŹe, da je TABEIA l: Kľonična mieloična levkemlja. Bolniki vklučeni v artallzo po spolu, starostl in obdobju opazovanja. TABLE l: Chĺonlc myeloid leukemia. Patients lncluded in the anďysls by sex, age and peľiod of obseľvation. Srarost ob tliagnozi. Age at diagnusis obdobje/ Skupaj/ Peĺiod Áll Males Ą4 1544 45_54 5544 65:14 75+ 83-87 .-'*. 88-92 - 93_97 012345 leta/years SIIKA l: Relativno petleürc pľeživetje bolnikov s kľonično mieloično levkemljo, zboleĽh v letfü 19E3-1997 po obdobju diagnoze. tlGURL l: Relative five-yeaľ suľvival of chľonic myelold leukemia patients diagnosed in the peľiod 1983-|997 by peľiod ofdtagnosis. In the períod 1983_97, a total of 181 ma]e and 767 female patients weľe diagnosed with chľonic myeloid leukemia; of these, 55 males and 54 females were diagnosed in the peri- odl993_97 .In 2 patients, chľonic myeloid leukemia was diag- nosed at death; these patients weľe therefoľe not included in the analysls. In the obseĺved l5-yeaĺ peĺiod, the incidence of chľonic myeloid leukemia was steady. In the peĺiod l98ffi7, the crude incidence rate was 1.3/100,000 in males and 1.2/100,000 in ĺemales' wheľeas inl993_97 , it was 1.1/100,000 in males and 1. 1/i00,000 in ťemales' The age distĺibution oľpatients included into the analysis has changed (Table 1). In the obseĺvation period 1993-97 , more chronic myeloid leukemia cases weľe detected in the patients o1deľ than 55 years. In the peľiod 1993_97, pĺimary tleatment was staľted at the Department of Haematology, UMC in Ljubl jana in 340/0, in 770/o of patiens in each of GeneralHospitals in Maribor and in Ce1je, in 107o in each of GeneralHospitals in Sempeter pn Novi Goĺici and in Slovenj Gradec. One patient was admitted to primary treatment in each of the General Hospitals in Muĺska Sobota, Ptuj, and Golnik, and 2 patients to the Instltute of Oncology, Ljubljana. In the obseruation period, the relative five-yeaľ survival ľate was the highest in the yeaĺsl9&8_9}(Figure 1). Due to a small numbeĺ of cases, it is not possible to evaluate the survival ĺate in ĺelation to the age distľibution' Fľom the data oĺ a longeľ obseruation period and oĺ the obseruation period 1993_97 iÍ is evident that the survivalwas the highest in the patients of the age gľoup of 45_54 yeaĺs and the lowest in the patients oveĺ75 yeaľs (Figuľes 2,3). According to the EUROCARI-3 study resu1ts ĺoĺ the peĺi- od 1'990_94in Euľope, the age-standardizedĺelative suruival rate of the patients with chronic myeloid ieukemiawasł8.3}/o (24,5-32.7) in male patients and in female patients 35.30/o GI. Ł39'6), while in Slovenia, iÍ. w as 75,7 o/o (64l .z) in male patients and 330/o(19.ť5) in female patients. The highest rates 100 80 G .ł ř äó0 'Đ :Ń 40 20 TABEIA zaupanl TABTE 3 tnterval Obdobje/ Peľiod 198j-87 r98U92 1993-97 obdobje/ Period 1983-87 r98U92 r99T97 STIKA IIGURE 75let 100 80 .ž ä ('0 'Đ o 'Ň 40 o. z0 198T87 198U92 199T97 64 63 53 15 18 12 17 9 9 6 1ó T3 12 6 8 13 12 11 le iih Jože Females 198!87 1988-92 1993-97 58 54 l4 8 11 16 17 9 12 5 T5 5 10 10 9 18 8 12 712 CANCER PATIEMS SURVIVAL IN SLOVENIA 1983-1997 ša1o TMIA KRoNIČNA MIELoIČNA LEVKEMIIA IABEIA 3: Ifuontčna mieloična levkemlja. opazovano in relativno petletno pľežlvetje po spolu in obdobju opazovanja s 95 0/o lnteľvalom zaupaĺJa(IjZ)' TABIE 3l Chĺonlc myeloid leukemla' obseľved and ľelatíve five_year suľvivď by sex and peľiod of obseľvatlon wíth 950/o confldence tnterval (CI). (o/o) Moški/Males leta / Years /Females ktalYears obdobje/ Period 1' lzlÜ 3 |zlCI 5 V|CI 1 IZIU 3 TZIU 5 TZICI 198H7 198U92 1993-97 $o-14) (6H5) 6T79) (1u2) (2549) (1tuo) (7-27) (13-35) (G26) 63 16 63 11 24 16 30 37 28 tJl 74 66 60-76) (64-8Đ 61-75) (2248) 3Á2) (3c58) (10-32) (2248) (1tuo) 35 48 44 21 35 28 I 5 Relativno / Relative (0/Đ Moški/Males Leta i Years Ženske/Females letalYears )rcno 0bdoble/ Peĺiod 1 Izlü 3 lzl] 5 |ZlCl I Żlq 3 lzlg 5 lzlcI eÍľúa LOSIS. 198347 198U92 1993-97 62-78) (óŔ8) (55-8t (2147) (2u56) (1Mó) (1ýl2) 6H9) (óG90) 61-79) (2G54) ęÁ6) 3343) (13-39) (2Ę54) (18-48) 21 ]Ô 20 34 42 )t 65 77 69 ot3) (7-33) 66 78 o) 40 51 48 26 39 33 nale a; oť )eľi )iag- :d in onlc rude )0 in and ; has nofe ients I the 17Vo )elje, onci \4ry )ota, oBY' rute mall fate nger 97 it ts of ents )eÍi- ĺivaI 1.30h ).30/o nale rates -1997 100 1973_77 1978Ą2 100 80 ś aó0 'Đ o 'd 40 o. 20 80 F 'Đ I iŇ 40 o. 20 1983-87 obdobje/peĺiod 198u9Ż 199347 0 2 4 5 SIIKA 2: Relativno petletno pľežlve$e bolnikov kĺontčno mieloično levkeĺntjo, zboleľh vle.till197Tt997 po starostt ln obdobju diagĺroze. IIGURI' 2: Relative five-year suľvlvď of chľonic myelold leukemia patlents diagnosed in the perlodl)73-1997 by age and peľiod of diagnosis. |eÍa/yeaĺs SĹll(A 3: Relatívno petleün pľežtve$ebolnikovs kronlčno mielolčno levkemijo' zbolellh v letíh l99Tl997 po staľostl. ľIGURI' 3: Relative five-yeaľ suľvlval of chĺonic myeloid leukemla patlents diagnosed ln the pedod 1983-1997 by age, preživetie največje v StaÍosti 45_54let in najmanjše pľi staľih 7 5 let inveč (slika 2, slika 3)' Izsledki šĺ"ldije EURoCARE-3kaźejo, da je bilo v Evropi pov- prečno Starostno stan dardizirano ľelativno petietno preživetie bolnikov s kľonično mieloično levkemijo pľi moških 2B,3% (24,5_32,7) in pľi Ženskah 35,3Vo(37,Ę39,6), v Sloveniii pa pri moških 15 ,7 0/o (G4I ,2) in pĺi ženskah 33Vo (19 ,B_55) . Največ- je pľeŽivetje pľi moških in pľi Ženskah je bilo v Fĺanciji v okĺož- jih Bas-Rhin, Calvados in Cote d'or:37 ,80/o oziÍoma 4),1,0/o, Jože Pretnar, Klinični od'delek za hematologijo KC Podatek o tem, da se v zadnjih petih letih pľeživetje ni izbolj- šalo, oziroma se je celo nekoliko poslabšalo, je presenet- of 37 .B0/o and of 49.I0/o ln ľespectively male and in female patients v/ere observed in thĺee ĺegions in Fĺance: Bas-Rhin, Calvados and Cote d'oľ. Jože Pretnaľ, Departnxent of Haematologl, UMC, Ljubĺ;jana, The data showing that, in the last five yeaľs, the suľvivalhas not improved but ľatheľ declined is tľuly most suĺpľising (1). In this peĺiod, the tľeatment with alpha-interfeľon was intro- duced and we also stated with the pľogľam of allogenic bone-maľrow transp1antation. In the period 1989:2000, we perfoľmed 22 allogenlc bone-maľ- ľow tľansplantations' The 10-yeaľ survival oľ disease'fľee inteľ- val is expected to be 707o. This tľeatment moda1ity was Skupaj - All -*"- 1544 - +>->4 - )'-JÔ4 o>- /+ _ 75+ Skupal - All PREŽNETJE BoLNIKoV Z RAKoM V sLoVENłl 1983-1997 11,3 CHRONIC MYELOID LEUKEMIA ljiv (1). V tem obdobju smo pĺičeli zdľavljenje z inteľfeľo- nom alfa inzačeli s pľogĺamom alogenične presaditve kosĺ nega mozga. V obdobju odl989 do 2000 smo opľavili 22 alogeničnih pľe- saditev kostnega mozga - pľičakovano 10 letno pľeživetje ozlroma pľosti interualbľez bolezni je okĺog 700/o,To zdrav- ljenje smo izvajalipraviloma pľi bolnikih, starih do 55let' očit- no majhno število presaditev kostnega mozga ni vplivalo na celotno pĺeŽivetje vseh bolnikov. VIR PretnarJ. Allogeneic BMT foľ acute leukemia and clľonic granulocytic leu- kenĺa in UniversĘ Medical Centre Ljubljana - Slovenia' Bone Marow Tľans- plant 1998; 2Ż: slppl 4: 377-2' applied in the patients aged less than 55 years. Such a low num- beĺ of bone maľľow tľansplantations appafently did not have any influence on the overall survival of all patients, 1,1.4 CANCER PATIT,MS SURVIVAL IN SLOVT,NIA 1983-1997 MuLTĺPLI MIELoM T,MIA rum- not t. MUNIPLI MIELOM MULTIPLE MYE,LOMA MKB 8/lCD 8: 203 V obdobju I9B3-97 je zbolelo za multiplim mielomom 368 moških in 430 Žensk, od tega v letih 1993_97 141 moških in172Žensk'Y analizo ni bi1o vključenlh37 60/o) bolnikov, keľ je bila pľi njih bolezen ugotovljena šele ob smrti, V opazovanem 15-letnem obdobju se je incidenca multiplega mieloma večala. V letih 1983_87 je bila gľoba incidenčna stop- nja2,1'/700,000 moških in2,2/I00,000 žensk, v letih 1993_97 pa2,9/I00,000 moških in 3,3/100.000 Žensk. odstotek mikľoskopsko potrjenih pľimeľov se je povečal s 960/o v letih 19B3-B7 na 990/o v IeÍth 1993_97 . Starostna poľazdelitev v analizo zajetih bolnikov se je spľe- ĺnenila (tabela r).Y zadnjlh letih je bilo odkľitih več bolnikov, staľih 55 1et in več. Y \etlh 1993_97 je bilo specifično zdľav1jenih samo 69 7o bol- nikov. Pruo zdravljenje je bilo v največjem odstotku (51%o) samo citostatsko,v 260/oobsevalno in citostatsko, v 750/osamo obsevalno, v 50Á jebila zdrav\jenju dodana še imunoteľapi- ja. P rl 20/o način zdľav\jenja ni bil sporočen. Y 37 0/o so pľiče- li s pĺvim zdravljenjem na onkološkem inštitutu v Ljubljani, v 1'70/o na Kliničnem oddelku za hematologijo KC v Ljublja- ni,v 140/o v SB v Maľiboru,v IJ\/o v SB v Sempetru pľi Novi Goĺici, v 10 %o v SB v Celju, po 4 % SB v Novem mestu in v SB v Murski Soboti, v 30/ov SB v Slovenj Gľadcu, y 20/ov SB na TABELA l3 Multipli mielom. Bolntkt vključeni v anaľzo po spolu, staľosti in obdobju opazovanJa. TABLE ĺ: MultĘle myeloma. Patients included in the analysis by sex' age and period of obseľvation. Staľoĺ ob diagnozi/ Áqe at diagnosis obdobje/ 83-87 88-92 - 93-97 012345 leta/years SIIKA l: Relativno petletno pľeživetje bolnikov z multiplim mielomom, zbolelih v letlh 1983-1997 po obdobju diagnoze. IIGüRI' ĺ : Relative five-year suľvíval of multiple mye loma patients dlagnosed in the peľiod 1983_|997 by peľtod ofdiagnosis. In the peĺiod 1983_97 , a total of 3óB ma1e and 430 fema1e patients weľe diagnosed with multiple myeloma; of these, 141 males and 172 females weľe diagnosed with this cancer in the peľiod 1993_97 ,In 37 patients (57o), multiple myelo- ma was diagnosed at death; theľefoľe, they weĺe not includ- ed in the analysis. In the observed 15-year peľiod, the incidence of mu1tip1e myeloma did not significantly change .In1983-87, the crude incidence ĺate was 2.1/100,000 in males and2.2/100,000 ĺn females, wheľeas in 1993_97, it w as 2.9 / 100, 000 in males and 3.3/100,000 in females. The age distĺibution of patients included into the analysis has changed (Table 1). In recent yeaľs, a higheľ number of multi- ple myeloma cases was observed in the patients oveľ 55years. In the peľiod 1993_97 ,6)0/o of patients underwent specific tĺeat- ment. In most cases (51%o), primary tĺeatment was chemother' apy alone,260/o of patients weľe tľeated by ľadiotherapy and chemotherapy, 7j0/o by ĺadiotheĺapy alone and 50/o received also immunotherapy, The tľeatment modality applied ln 20/o of multiple myeloma patrents was not repofied to the Registry. Prímary treatment Was staľted at the Institute of onco1ogy in 370/oof patiens,n7ll/ooťpatients itwas Staĺted at the Depatment of Haematology, UMC, Ljubllana, in I40/o in the General Hospital in Maľiboľ, in I30/o in the Geneľa1 Hospital in Sempeter pĺi Novi Goĺici, in 107o in the General Hospital in Celje, in 40/o in each of the Geneľal Hospitals in Novo mesto and Muĺska Sobota, in30/oin the GeneralHospital in Slovenj Gradec, andinl\/o in the GeneĺalHospital in Ptuj. Some indi- vidual patients weľe admitted to primary treatment in Geneľal Hospitals inJesenice, Izola and Trbovlje. The ĺelative five-yeaľ survival ĺate WaS 3% loweľ in the years 1993_97 than in the yeaľs 198}87 (Figuľe 1) and was sim- llaľ to that in the obseruation peľiod 1973Ą2 (Figure 2). In the observation petod1993-97 , the suruival of female patients was worse than that in men (Table 3). The diffeĺences in suruival by the age gľoups are significant only within the peĺiod of fouľ 100 80 E .a äó0 .F o 'Ł 'H 4l) Ě o" 20 Period Skupaj/ AII -14 1544 45_54 5544 ś5_74 75+ Moški ]\'ĺales 198!87 1988-92 199T97 16 25 35 3' 31 41 29 42 11 12 13 0 0 0 95 124 134 22 Ą0 35 33 53 60 34 31 45 10 21. 12 4 5 3 0 0 0 103 150 155 4 2 3 Zenske 198|87 Fernales 198&92 199T91 1997 PREŽNETJE BoLNlKoV z RAKoM V sLoVĹNUl l98}1997 11.5 MuLIIPLE MYĹLoMA TABEIA 3: Multipli mielom. opazovano in relativno petletno pľeživetje po spolu ln obdobju opazovanja s 95 0/o inteľvďomzallpaĺ|a(IZ). TABtt 3: Multiple myeloma. obseľved and ľelative five-yeaľ suľvivď by sex and period of obseľvatlon with 950lo confidence intervď (CI). Opazovano/Observed (%) Moški/Males IľtalYears Ženske/Females [eta/Yeaľs obdobje/ Period I Żlcl 3 |ZlU 5 |zlCI 1 IZ|U 3 lzlü 5 vlCI 1983-87 198U92 199Ť97 (4949) (4543) $7-73) (2343) (2r-37) 3147) o-25) o-21) (11-25) (61-79) (ó0_7ó) (ó0-7ó) 01-51) (2945) (2T37) (rG32) (r5-?9) (12-24) 24 22 18 37 37 30 70 ó8 66 17 15 18 33 lo 39 t9 54 65 Relativno / Relative (ľo) MoškilMales leta/Years Ženske/Females [etalYeaľs obdobje/ Period 1 VICI 3 IZICI 5 IZ/CI 1 IZII 3 IZIU 5 IZICT i98!87 1988-92 199T97 62 56 ó8 (t1-73) (4145) 69-77) (2749) (2u2) 3G56) (12-32) (11-27) (1G34) (ó}81) (62-78) (ó0-76) ot-51) 32-50) (2541) (1y39) (1u34) (1Ł28) 38 33 46 22 19 25 29 26 21. 41 41 33 72 70 6B 100 100 - 45_54 -))_04 65-74 - 75+ 80 G 'Ł ä ĺro 'Đ o ;Ň l'^ o. Ż0 80 E .: aou Ř 'Đ o ;Ň 40 o. s 20 1973-77 197U82 1983-87 obdobje/period 198u92 1993-97 0 23 leta/yeas 4 5 SIIKA 2: Relativno petletno prežlvetje bolnikov z multiplom mlelomom, zbolellh v letth 1973-1997 po staľosti in obdobju d7agĺoze' FIGURI' 2l Relative ťĺve-year suľvivď of multiple myeloma patients diagnosed ín the periodĹ973Ą997 by ageandperiod of diagnosis. SLIKA 3: Relatlvno petletno pľeživetje bolnikov z multiplim ĺnlelomom, zbolelih v letih 1993-|997 po stafosti. tlGüRE 3: Relatlve five-yeaľ suľvival of multiple myeloma patlents diagnosed in the period 199F1997 by age. Pfuiu. Posamezni bolniki so pričelizzdravljenjem še v SBJese- nice, Izola in Trbovlje. v leĺh 1993_97 je bilo ľelativno petletno pre źiy et)e za 3 0Á many še kot v Ietih1'983-87 (slika 1) in je bilo pĺibliŽno enako kot V letih 1973-82 (slika 2),Weżivetjeje bilo v 1etihl993_97 pľi Ženskah manjše kot pľi moških (tabela 3). G1ede na Staľost se preživetie ĺazIikujevse do štiĺih 1et po diagnozi, pet let po diagnozi pa med staľostnimi skupinami ni pomembnih ľaz- lik Glika 3). Izsledki študije EURoCARE-3 kažejo, da je bilo v Evropipov- prečno staľostno standardizirano ľelativno petletno pľeŽivet- je bolnikov z multiplim mielomom pri moških 30,6o/o(28,8_32,6) in pri ženskah 34,60/0 (32,7_36,6), v Sloveniji pa pľi moških 20,2 0/o (73,I_3I,2) in pĺi Ženskah 2I,3 0/o (I 5,2-29, 8)' Največj e pľeživetje pľi moških in pľi ženskah je bi1o v Francijiv okľožjih Bas-Rhin, Calvados in Cote d'or: 47 0/o oziÍoma 49,80/o, yeaľs afteľ the diagnosis, while in the fifth yeaľ aťter the diag- nosis, these diffeľences aľe not significant any more (Figuľe 3). According to the EURoCARE-3 study ľesults foĺ the peĺi- odI99o-94 in Europe' the age-standardtzed ľe1ative survival rate of the patients withmultiple myeloma was29.60/0(27.711..7) in male patients and in female patients 34.60/0(32.7-36.6), while in Slovenia, itwas20,20/o(1,3,1-3].}) in male patients and2l30/o (1'5.2_29,B) in female patients. The hĘhest ratesoť 470/oín male and of 49,80/o ln female patients weľe obserued in thľee ľegions in Fľance: Bas-Rhin' Calvados and Cote d'oľ. Radka Tomšič, Institute of oncologt Ljubljana Multip1e myeloma is haľdly ever detected in localized stage, e, g. as solitary medullary oľ extľamedullary plasmacytoma. The Skupaj - A1l o)- /4 _ 75+ - vsi/all 1,1,6 CANCER PATIEMS SURVIVAL IN SLOVENIA 1983-1997 MT]LTIPLI MIELOM .OMA Gz). (cD. CI Radka Tomšič, onkološki inštitut Ĺjubljana Multipli mielom je pĺaviloma diseminiľanabo\ezen,le redko se pojavlja kod lokaliziľana oblika - solitaľni medulaľni in ekstĺamedulaľni plazmocitom. Slednji obliki zdĺavimo z obse- vanjem, razširjen mielom pa s citostatiki. Znjimizmanjšamo simptome, podaljšamo preŽivetje, ozdľaviťve pa običajno ne dosežemo' Vľsto let je bilo standaľdno zdravljenje kombina- cija z melfalanom in koľtikosteľoidi (mediano pľeŽivetje 2_J leta, 5 letno preživetje pa 20_)0 0/o, odvisno od razv ojne stopnje bolezni, staľosti, pľognostičnih faktoľjev, odziva na zdrĄenje), Tudi novejše kombinacije citostatikov VAD in podobne sheme, kakoĺ tudi vzdĺŽevalno zdravIjenje z inter- feľonom, niso bistveno izboljšale pĺ eŽiv etja. Če pľimeľjamo naše podatke z izsledki iz literatuľe, so ti v gľo- bem pĺimeľljivi |n zato tudi ne pľeseneča dejstvo, da je pet- letĺro pľeživetje V opazovanem obdobju v glavnem enako (1, 2). Ugodnejša je prognoza pľi solitaĺnem medulaľnem in ekstra- medularnem plazmocitomu' Daljše pretivetje pa imajo tudi bolniki z začetno ĺazvojno stopnjo in mlajši bolniki (intenziv- nejšaterapija). Danes se pľi bolnikih mlajših od 65let (vendar je teh le pĺib- ližno polovica vseh bolnikov) odločamo zazdľav\jenje zviso- kodozno teľapijo in pĺesaditvijo avtolognih peľifeľnih krvotvoľnih matičnih celic (3). To zdravljenje po raziskavah v tujini bistveno podaljša pľeživetje. Tega zdravljenja je bilo deležno do leta 1997 še zelo malo bolnikov, tako kakor tudi podpoľnega zdrav\1enja z bifosfonati. Jože Pretnar, Klinični oddelek za hematologijo KC Dejstvo, da se pľeživetje v zadnjem obdobju ni bistveno izbolj- šalo, je nepľičakovano, saj zadnjih 10 let upoĺabljamo vľsto zdravIjen1, ki bisrveno podaljšajo pľeŽivetje - "VAD like" kemoteľapijo. Poleg tega od \eta 1996 izvajamo pľi bolnikih do 60. leta staľosti presaditev avtolognih peľifeľnih kruotvoľ- nih matičnih celic, ki po raziskavah v tujini bistveno podalj- ša preživetje bolnikov. Relativno majhno število pľesaditev avtolognih peľifernih krvotvornih matičnih celic v obdobju opazovanja ni vplivalo napreżivet1e vseh bolnikov (3)' latter two are usually tĺeated by iľradiation. Diffuse myeloma is tľeated with cytostatics in oľder to suppľess symptoms and to prolong suľvival; complete ľemission is almost impossible to obtain' The tľeatment modaliry that has long been con- sidered as standaĺd tľeatment is a combination of melphalan and cofticosteĺoids (median suľvival 2-3 years;five-yeaĺ sur- viva120_300Á). The treatment outcome depends on the stage ofthe disease' age ofthe patients, prognostic factoĺs and tĺeat- ment response. The latest combinations of q'tostatics, e,g. VAD or similar schedules, together with the Suppoĺtive tľeatment with interferon did not exceptionally improve the survival. ouľ ĺesults aĺe comparable to those in the liteľature; it is theľefoĺe not suľpľising that the five-yeaĺ sulvival ľate in this observa- tion peľiod was ľatheĺ stable (1, 2)' The prognosis of solitary medullary and extramedullary plas- macytomas Seems moĺe ťavorable. Better survival was observed in the patients with the disease in its initial stage and young adults (moľe aggĺessive therapy)' Today, the treatment of choice applied in the patients under 65 years (this is ľoughly one half of al1 patients) is high-dose therapy in combinationwith the tĺansplantation of autologous peripheľal hematopoietic stem cells (3). Accoľding to the ĺesearch studies caľľied out abľoad, this combination signif- icantly improves the survival. Until 1997, very few patients underwent this treatment or received suppoltive theľapy with biphosphonates. Jože Pľetnar, Departrnent of Haematologl, UMC, Ljubljana The data showing that, in the last five years, the survival has not impľoveđ are truly most sulpĺising because, in the last decade, a seĺies of new tĺeatment modalities, all significant- ly impĺoving the survival, weľe introduced, e. g. "VAD like" chemotheľapy. In addition to that, since 1996, the patients undeľ 60 yeaľs of age have been undeľgoing autologous peľipheľal hematopoietic stem celltĺansplantation; this is an inteľvention that' accoľding to the ľeseaľch ľesults obtained abroad, radically pľolongs the suľvival. Because a relatively small number of tĺansplantations of autologous peripheral hematopoietic stem cell weľe perfoľmed in this observation period they could not influence the obtained survival rate (3). \2) t9) t4) :I i9) \4) r8) .age, The VIRI 1 . The Myeloma Trialiss' Collaborative Gĺoup : Inteľfeĺon as therapy for mul- tiple myeloma: an individual patíent data overview of Z4randomizedtĺia|s and 4012 patients; BĺJ Haematol 200;113:1020-34. 2. Combination chemotherapyversus melphalan plus pĺednisone as treatment foľ multiple myeloma: an overyiew of 6ó33 patíents fĺom27 randomized trials' Myeloma Tĺialists' Collaborative Gruop; J Clin oncol 1998; 16: 383242. J. PĺetnaĺJ, PrelotnkZlpaĺI,Zveĺ S et al' Naše izkušnje pľi zdravljenju dise- miniranega plazmocitoma s presaditvijo ar'tolognih perifeľnih krvotvoĺnih matičnih celic. Med Razgl Ż000;39: sľlppl' 5:129-32. 4 ,4 '4 -1997 nnr'Žvľ1n' nolľĺIKoV z RAKoM V sLoVENuI 198T1997 TT7 ALL SITES, INCLUDING SKIN VSI RAKI, VIquČNo s noŽľrunn ALL SITE.S, INCLUDING SKIN MKB Bi IcD B: 140-Ż09 V obdobju 1983_97 je zbolelo za rakom 50.814 moških in 48'690 źensk, od tega v letih 1993-97 19.ó28 moških in 19.06l źensk. Y analizo ni bilo vključ enih 5843 (ó 7o) bolni- kov' Pľi njih je bilľak ugotovljen še]e ob smrti. V opazovanem l5letnem obdobju se je incidencarakave- čala' V 1etih 1983-87 je bila gľoba incidenčna stopnja 311,8/100'000 moških in 279,2/1'00,000 žensk, v letih 1993_97 pa ż'e 407 ,7 /1'00.000 moških in 372,4/1'00.000 žensk. odstotek mikĺoskopsko potĺjenih primeĺov se je povečal z 89 0/o v letih 1983-87 na 920/o v letih 1993-97 . Staľostna poľazdelitev v analizo zajetihbolnikov se je Spľeme- nila,v zadnjihletihl993_9l je bilo zajetih več staĺejših bolni- kov (tabela 1). Razšiĺjenost bolezni ob diagnozi se je ugodno spľemenila le pľi Ženskah (tabęlaz), YIeĺh1993_97 je bilo specifično zdľavlienih 79% bolnikov. Prvo zdrĄenje1eblov 430/osamo kiruľško, v 14% obsevalno, v 10% obsevalno in kiruľško, v 4% samo s citostatiki, v 20% so bili cito- statiki vključení v shemo kombiniranega zdravljenja, samo s hormoniv3%, v kombinacijiz opeľacijo in obsevan1empav 60/o' V letih 1993_97 je bilo ľelativno petletno preŹivetjeza8\/oveč je kot v letih 1983_87 (slika 1)' Pľeživetje se je povečalo bolj pľi ženskah kot pĺi moških (tabela 3). Povečalo se je v vseh starostnih skupinah (slika 2). Povečanje za80/ose moľda ne sli- TABELA l: Vsl rakl' Bolniki vključeniv aĺallzo po spolu, staĺosti in obdobiu opazovaĺja. TABIE I r All sites. Patients included ln the analysis by sex, age and period ofobseľvation. Staľoĺ ob diagnozi/ Age at diagnosis obdobje/ skupai/ Peľiod All _14 1544 45-54 '544 65-74 15+ 83-87 88-92 - 93-97 012345 leta/years SIIKA ĺ: Relativno petletno pľeživetje bolnikov z vseml raki, zbolelih v letih 198T1997 po obdobfu diagnoze. tlGURE l l Relative five-year suľvival of patients with cancers of all sites diagnosed in the perlod l98Tt997 by peĺiod of dlagnosls. In the period 1983_97 , a total of 50,81 4 malę and 48,690 female patients weĺe diagnosed with Canceľ; of these, 19,628 males and 79,061 females weĺe d1agnosed with Canceĺ in the peĺi- od1993_97.In5,843 patients (6%o), canceĺ was diagnosed at death; theľefoĺe, they weľe not included in the analysis. In the observed 15-yeaľ peĺiod, the canceľ incidence was incľeas- ing' In 198H7, the cĺude incidence rate was 311.8/100,000 in malesand279.2/100,000 in females, wheľeas in 199}97' it was 407,7/100,000 in males and372.4/100,000 in females. In comparison to 198}€7, the incľease of micľoscopically con- ĺirmed cases in the observation peľiod 1993-97 was30/o,i.e. ľrom 897o to920/0. The age distľibution of patients included into the analysis has changed. In the observation peľiod 1993_97, more elderly patients were included into the analysis (Table 1). The stage distribution at diagnosis changed too, yet favorably only in women (Table2). In the period 1993-97 ,790/o of patiensunderwent specific treat- ment. Surgery alone was applied as pľimary treatm ent in 430/o oĺ patients, in anotheľ I40/o oť patients, the primary tleatment was ľadiotheĺapy alone,10% weľe tľeated by ľadiotehrapy and Suľgeľy' 40/o by chemotheľapy alone, 20% undeĺwent chemotheľapy in combination with otheľ tľeatment modali- TABELA 2l Ysi ľaki. Bolntkt vključeni v analizo po spolu, stadíju bolezni in obdobju opazovanja. TABIE 2: AII sites. Patients included in the analysls by sex, stage and period of obseľvation' Stadij/Stage Obdobje/ Skupaj/ oĺrejen/ Razšiľjen/ Razse1an/ Neznan,/ Period All Localized ľo Regional % Distant 0/0 Unknown 9'o 100 80 E .Ę áeo 'Ě o ;Ň 40 o. 20 31,2 3387 25,1 1014 7,5 31,5 4048 25,8 1179 7,5 31,2 4681 21,3 1166 6,3 2216 3791 3419 2815 Moški z24z 4942 3863 3183 Males 241ś 5327 5893 3213 Moški Nĺales 198|87 1988-92 199T97 198|87 1988-92 1993ł7 13472 4870 15682 5510 18527 6891 36J 4201 35,1 4945 37,2 5189 13472 15682 18521 151 127 124 1080 1325 1554 118 1983-87 198U92 1993-97 CANCE,R PATIEMS SURVIVAL IN SLOVENIA 1983-1997 12915 5184 40,1 j869 30,0 3078 23,8 iB[ 6,r 14939 ó090 40,8 4473 29,9 3582 24,0 794 5,3 '18122 8021 44,3 53Ż1 29,4 3936 21,7 844 4,7 1411 1922 3201 3084 3162 1809 2090 3587 3648 3703 2109 2502 3935 5321 4138 Ženske Fcnulcs 198|87 198&92 1993-97 12919 14939 18122 Ženske Iremales 99 102 1r7 iKIN Vsl RAKI, VKLluČNo s KoŽNM TABELA 3: Vsi ľaki. opazovano iln relativno petletno ptež,ivetJe po spolu tn obdobiu opazovanias 950lo inteľvaloĺnzaupan|a(IŻ), TABIE 3l All sites. obseľved and ľelative Ílve-year suľvival by sex and perlod ofobseľvation with lJolo conÍidence inteľvď (CI). Observed (70) Moški/Males [etalYears Females Leta/Years 0bdobje/ Period 1 rulU 3 IZlÜ 5 IL/CI 1 rzlct 3 rzlu 5 rulcr 198H7 198U92 1993-97 (4&50) $1-53) 65-57) (29-31) 02-34) 37-39) (2T25) (25-27) (17-19) (6M6) 6749) (70-72) (4749) 61-53) 65-57) 0941) (4345) (4749) 49 ,2 56 48 52 56 o) ó8 71 40 44 48 30 33 38 24 26 31 Relativno/Relative (%) Moški/Males [etalYeaĺs Żenske/Females LetalYears J 5 AH, 0bdobje/ Peľiod I ]ZICI 3 TZICI 5 TZ/CI 1 tzlct 3 Izlcl 5 rulcr 1983-87 1988-92 199T97 $0-52) $T55) (58{0) 3Ę36) 37-39) (4244) (29-31) 02-34) 3749) (óffi8) (69-71) 0T75) $2-54) (5Ĺ58) (6143) (4749) 61-53) (5Ĺ58) 35 38 43 5T 54 59 67 70 74 53 57 62 30 33 38 48 52 57 fall ris. nle úes eľi- 7at )as- lin VAS 100 80 G60 .E s40 'F 60 )N o o- 100 80 20 z0 on- i. e. has rrly 1ge ĺln 1983-87 1988-92 obdobje 1993)7 1983-87 198U92 period 1993-97 '-at- 3Vo ent lnd ent ali- liju age r96 7,5 7,5 6,3 6,1 5,3 4,7 997 S[ll(A 2: Relativno petletno pľežlvetje bolnlkov z vsemi ľaki, zbolellh v letih 1973-|997 po staľosti in obdobju dlagnoze. ši veliko. Če pa vemo, da se za tem odstotkom skĺiva 1'4B2boI- nikov, pomeni to več. V vseh obdobjih je bilo ĺelativno petletno pľeživetje najbolj- še pĺi otľocih,v zadfijemobdobju 700/oprifantih in 760/opri deklicah. Pľi moških, mlajših od 45 \et, je bi\o za 21' 0/o večje kot pľi staľih75let in več, pľi ženskah pa za2B0/o (slika 3), Pĺi razlagi preźivet)a in trendov preżivetja vseh bolnikov zrukomskupaj moľamo upoštevati' da je odstotek preżivet- ja odvisen od deleŽa posameznih rakavih bolezni glede na spol in starost. Zenske zbolevajo v večji meľi ua prognostično ugod- nejšimi ľaki. Na povečanjé preživet1a vseh bolňkov v zadň1em obdobju v primeĺjavi s pĘšnjimi, večji delež bolnikov z neme- lanomskim kožnim ľakom, ki je le v izjemnih pľimeľih lah- ko vzľok smľti, ni imelvečjega vpliva (1). Verjetnost pľeŽivetja posameznegankavega bolnika pa je odvi- sna od tega, zakateĺo rakavo boleznijo je zbolel, od narav- nega poteka te bolezni' od ľazšiľjenosti v času diagnoze in od vseh drugih številnih dejavnikov, ki smo jih navedli že v uvo_ dn in v razpravljanjl o posameznih rakavih boleznih. FIGURI' 2: Relative ftve_year suĺvival of all canceľ patients dlagnosed ln the peľiod |973-1997 by ąe and peľiod of dĘnosis' ties, 3% ľeceived hoľmonaltherapy and in 6%o of patients com- bined tľeatment oľ suľgery and ĺadiotheľapy was applied. The re]ative five-yeaľ surviva] rate WaS B% higher in the yeaĺs 7993_97 than in the yeaľs I9B3ą7 (Figuľe 1). The incľease was higher in female patients than in male patients (Table 3). Actually, the suruival impľoved in allage gĺoups of patients (Figure 2). An B-peľcent increase may not Seem to be indicative, but it would ceľtainly be more illustrative, if it was explicitly cleaĺ that this peľcentage covered 1,482 patiens' In all observation peľiods, the relative five-year survival ĺate was the highest in childľen; in the last observation peĺiod it was700/oand760/oin boys and girls, ľespectively. The survival rate in male patients below 45 years was Zl\/ohigher than in those older than75yeaÍs,whereas in female patients, this dif- feľence was280/o (Figuľe 3). The inteľpretation of survival and trends in suruival of all can_ ceľ patients should allow foľ the fact that the suľvival rate depends on the pÍopoľtion of individual canceľs by sex and age. It should be noted that, in compaĺison to men, women Moški _ Males 0-r4 1544 - ))-o4 _ 75+ - vsi 0-14 1544 _ 45_54 - >>_Jr4 b>-/4 _ 75+ - all PREŽIVETJE' BoLNIKoV z RAKoM V sLoVENIJl l 983-1 997 7rg ALL s[Ĺs' INCLuDING sKlN 80 100 Ż0 100 80 có0 ř s40 Eb0 >N o Ô- s40 K1 0 20 ) 2 3 4 5 0 3 4 5 SIIKA 3l Relativno petletno prežlvetje vseh bolnikov z ľakom' zbolelihv letih 199T1997 po starosti. VIR 1. Pompe Kirn V, Zakotnik B, Volk N, Benulič T, ŠkľkJ. Preživetje bolnikov z ĺakom v Sloveniji - Canceľ patients survival in Slov enia 1963-1990 . Ljub- ljana, onkološki inštitut 1995. years IIGURI' 3: Relattve flve_yeaľ suľvivďof ďlcancer patlents dtagnosď ln the perlod 199T1997 by age. are affected with pľognostically moľe favorable Cancers. The improvement of survival in the ľecent observation period in comparison to earlier peÍiods, can harďly be attributed to non-melanoma skin cancer that is lethal only exceptionally (1). The pľobabilĘ ofsurvival ofindividual canceĺ patient depends on the site and type of the disease, of its natuĺal Course' Stage at diagnosis, and of many other factoľs that have been men- tioned in the Introductionaĺd dealt with in the discussions on individual canceľ sites. leta V 0-14 1544 - 45_54 - ))_{4 - ot_/4 - 75+ Moški - 1544 4t-t4 -'-')r-JÔ4 _ 75+ Ženske - Females r20 CANCER PATIENTS SURVIVAL IN SLOVE,NIA 198T1997 SKIN ZAKLJUCE,K 5 Dsd ZAKLIUCEK Ali smo lahko zadovoljni s pľeživetjem bolnikov, zbolelih za ľakom v letih I9B3_97 v Sloveniji? Za vse bolnike z ľakom, ki so zboleli v letih1993-97, smo ugotovili, dalihie pet let po diagnozipľeživelo nekaj manj kot polovica (vsi v 4B%, moš- kiv 380/o in ženske v 57 W. opaźamo, da se preživetje izbolj- šlje, Zaĺadivečanja incidence pa število umľlih zaradi raka vsako leto še vedno narašča, vendarv zadnjem obdobju manj kot incidenca (slika 1), V obdobju 1997-2000 je bilrak kot vzľok smrti naveden povpľečno letno pľi 4760 umľlih (1), Kakšne spľemembe so se dogodile v Sloveniji v 1etihl983_97 , koliko se je povečala incidenca, za koliko se je povečalo pľe- tivetje,je bila bolezen odkĺita v zgodnejšem stadiju, se je spre- menila staľostna struktuľa zbolelih, je razvidno iz prikazov in komentaľjev v tei knjigi. Katerapaso tista podľočja, nakate- ĺa bi moľaii biti še posebej pozoĺni v naslednjem obdobju, pĺi celostni obľavnavi rakavih bolezni? Ali je to uvajanje źe pĺiz- nanih načinov zdravljenja, ki se pri nas zaradirazIičnihĺaz- logov še niso uveljavili, ali pľesejanje alipľimarna pĺeventiva aIi moľda ĺak pĺi staľejših? Če smo v prvi knjigi zak\jučevali z opisom skupin ľakavih boleznigléde na śp-remembo preŹivetjav obdobju 1963-87 in jih primerjali le s Škotsko in z Dansko (2), bi v tej, naši dru- gi kniigi, Želeli v zaključku izpostavititiste ľakave bolezni,pri kateĺih je neglede na ugodne spľemembe v letih 1983_97 pre- živetje bolnikov še vedno pomembno nižje od povprečjaizbta' nih Ź0 evľopskih drżav,vključenih v študijo EURoCARE-3 (3). V študiji EUROCARE-3 ima Slovenija Statistično značilno niź- je staľostno sÍaĺdaĺdizjrano ľelativno petletno preŽivetje od povpľečja v študijo vključenih drŹav pri: kaľcinomu ustne Vot- line' ustnega źreIa, ŹeIodca,dojke, malĘnem melanomu, karci- nomu debelega čĺevesa in danke, kaľcinomu sečnega mehurja, pÍostate in pĺi kĺonični limfocitni levkemiji, Pľi večini drugih iakavlh bolezni smo nekje med povprečjem zahodnih in vzhodnih evropskih dľžav' CONCLUSION May we possibly be satisfiedwith the survivalof cancer patients in ślovénia in'the observation peľiod 1983_97? Afteľ the analysis of all cancer sites, we maý conclude that only half of patiénts diagnosed in1993_97 survived foľ five years from the äiagnosis (ř[ patients 48o/o, males 38%, femalés 5'7o/o) , Ithas bee_n observeä that the survivalis impľoving despite the fact that the mortality rate Continues to incľease, though in the last observation period, much less than the incidence ľate (Figuĺe 1)' In ťhe yeaĺs 1997_2000, Cancer was ľeported to be thďcause of death on average in 4,760 cases peľ yeaľ (1). This publication, containing the pĺesentations of suruivai data and ćommentaries of clinicians, iś an illustĺation of the changes that occurred in Slovenia in the years1983_97, and are ľesumed in the following issues: How much did the incidence increase? How much diđ the survival impľove? \ŕas canceľ detected in an early stage? Did the age patteÍnof canceľ patients at diag- nosis change? \ľhich cańcér sites should be paid particulaľ attention tďin the next obseruation period? Wheĺe should we look foĺ the causes of pooľ impľovement in some canceĺ sites? In the treatment moda]ities that aľe widely recognized as most effective' but for various ľeasons not yet applied in Slovenia? In lacking scľeening progÍams oĺ pľimary prevention? oÍ in Canceľ in the eldeĺly? !üe concluded the fiľst ĺeport with an outline of cancer sites fľom the viewpoint of the changes in survival in the peĺi- od 1963_87 ańd compaľed them only with the data fľom Scotland and Denmaľk (2). In the conćlusion of our second report, we would like to expose those canceľs with the suľ- viiral ĺates thaÍ arc, ľegaĺdleśs of a numbeľ of most favorable changes in the observátion period 1983-97 , diffeľent from the 'u"'a"ge ľate obtained fronizo Euĺopean countľies included inro EUROCARE-3 study (3). Fľom the EUROCARE-3 study, it is obvious that Slovenia has significantly low er age-standárdized ľelative five-year suľvival ĺaÍes in the carcinoňas of the oral cavity, pharynx, stomach, bľeast, in ma\ignant melanoma, in coloľectal, bladder and prostate canceiand in chľonic lymphatic leukemia than the áverage rates of other countfies included in the study. The sur- vival řates in other cancers aľe moľe or less close to the aveľ- age rate obtained fľom 20 European countľies included into EUROCARE-3 ĺudy (3). Living standaľd is an impoľtant deteĺminant of life expectancy as wěll as of the obseľved suľvival. I am theĺefoľe certain that a positive tľend in five-yeaĺ survival ľates in three ĺecent con- secutive observation peľiods aľe moľe impoľtant indicators of improvement than the comparison with otheľ Euĺopean coun_ triés' The changes in suĺvivđ rates are shown in Figure 1 of each chapteĺ. It is eňcouĺaging to see that the survivalis improving in tńe majoľiry of malĘnánt diseases, in some of them remaľk- ably, in others less notably. Regrenably, this same tľend has not been observed in bladder canceł multiple myeloma, acute nonJymphoblastic leukemía, and clľonic myeloid leukemia. In this publication, the clinicians who had been foĺ yeaľs involved in the tľeatment of paľticulaľ cancer sites commented on the maiorlty of reasons foĺ pooľ suľvival in some of cancers in Slovenía thät is below the'European aveÍage ĺate and for almost no impľovement in the last fifteen years. In these con- cluding pages, I wish to make a Summary of their obseľva- tions and aäd to them further claľification. The din Jto (1). :nds .age Ien- ons 500 450 400 3g 350 9Ŕłoo ě;= - FE zso IlÉ ^i Ebrso Đ 100 50 0 - umĺljivost moški,/moĺaliry males - inqidęn62 Ínoški/incidence males - x61ljiv6s1 lenske/mortaliry females . incidencaženske/incidencefemales 2000 obdobje/period SL|KA t: Incldenca in umĺlilvost za takom v Sloventjl po spolu, 1980-2000. ľlGURf, ĺ: Cancer incidence and mortality in Slovenia by sex, 1980-2000. 1995 1990 '1985 r980 1997 ľnĺŽlvqr, nolľĺIKoV z RAKoM V sLoVENUI 198T1997 L21 coNcLustoN Življenjski standaľd je pomembna deteĺminanta tako pľičako- vanega kot opazovanega ptetiveÍja, Zato se mi zdi izboljša- nje petletnega pľeŽivetja v tľeh zapoĺednih petletnih obdobjih pomembnejši kaza\ec kot primerjava z drugimi evľopskimi drżavami. Te spľemembepreźivet1a so pľikazane v sliki 1 pľi vsakem posameznem poglavju. Spodbudno je, da se preživer je izboljšuje pľi večini ľakavih bolezni (nekje bolj, drugje manj). Tega trenda paźa|ne opatamo pinaslednjih ĺakih: kaľcinomu sečnega mehuĺja, multipiem mielomu, akutni nelimfoblastni levkemiji in kroničnl mieloični levkemiji. Kljub temu, da so o večini razlogov,zakaj je pĺi naštetih ĺakih preżivetje pod evľopskim povpľečjem aIizakaj se ni v zadnjih petnaistih letih izboljšalo, vĘ knjigiżerazpravljali k1iniki, ki se s posameznimi boleznimi ukvaĄajoŹevľsto\et, Želim v nasled- njih odstavkih to na kľatko povzeti in dodatno pojasniti. KARCINOM USTNE VOTLINE IN USTNEGA ZRELA Pľi ľaku ustne votline (btezraka jezika) in ustnega Žĺela v Slo- veniji statističn o značlno zaostajamo za aĺľopskim povprečjem, ki je pľi ĺaku ustne votline za moške 39,90/o, prinas pale21,50/o in pĺi ľaku ustnega źreIa za moške 25,30/o pri nas pa 1'J,1'0/o. Kljub temu, da je tĺend ozdĺavitve pľi teh bolnikih pľi nas ugo- den, saj se jih pozdĺaviv zadnjempetletnem obdobjukar za tretjino več, je stanje še vedno slabo (slika 1' stĺan 16)' Inci- denca te socialne bolezni je v Sloveniji velika in bolniki pľi- hajajo na zdľavljenje v napľedovanem stadiju. Keľ pľesejanje ni izvedljivo, vztokipa so dobľo znani,bibila pĺi ľeševanju pľoblema te bolezni še najbolj smisel na primarna pľeventiva. Upam, da bo z novimi zakonio kajenju in alkoholu in z večjo skbjo za obľobne skupine prebivalcev, pĺišlo v slovenski druž- bi do pozitivnih pľemikov pÍaY na podĺočju pľepĺečevanja. V samem izidu zdravljenja te bolezni pa pričakujem v nasled- njih obdobjih še nadaljne pľibliževanje drugim evĺopskim dĺža- vam, saj bo večji odstotek bolnikov kot je bil v pľeteklosti, zdĺ av\jen komb inirano. ZELODCNIRAI( Kljub temu, da je incidencaźelodčnegaraka v ľahlem upada- nju, je še vedno veiika sajje v letih 1993_97 zbolelo 2365bo\- nikov. Le petina jih je imela ob diagnoziomejen stadij(T1,,2, N0, M0), pĺi katerem je odstotek s kirurgijo ozdľavljenih bol- nikov velik. Pľoblem je podoben povsod v Evľopi, saj je bilo povpľečno petletno Staľostno standaľdiziĺano relativno pĺe- Živetje komaj 24Vo.Y Sloveniji je bilo slabše (I50/o za moške in 790/o za źenske). Pľimeľjava po stadiju z ostalimi dĺżava- mi, vključenimi v EUROCARE-) nimoźna,tako, da glavnega raz\oga za te ĺazlike ne moremo ugotoviti. V obdobju 1990_94, ki ga EURoCARE-3 obľavnava, standardov kiruľgije (način opeľacije, opeľacija v ustanovi, ki obĺavnava večje število bol- nikov) in patologije pri nas še ni bilo. Uvedeni pa so bíli, kot navajav svojem komentaľju pľoĹ dr Repše, kmalu zatem,Tako menim, da se bomo lahko kmalu pĺibližali evľopskim dĺžavam. K temu bo pĺipomogla tudi večja dostopnost do endoskop- skih pĺeiskav in do dopolnilnega zdravljenje tistih bolnikov, pĺi kateľih je to indiciľano (4). CANCE,ROF THE ORAL CAVITY AND PHARYNX In the survival oĺ patients with the Cancef of the oľal cavity (with the tongue excluded) and pharynx, Slovenia is signif- icant1y lagging behind the Euľopean aveÍage rate. In male patients with oľal cavity canceľ, the ĺates in Euĺope and in Slovenia aĺe 39,90/o and only 21.50/o,respectively' while in those with mesopharyngeal canceq these ľates are 25.30/o and 1,5'10/o, ľespectively. Though the tendency to cuľe seems favoľable in Slovenia, as a thiľd more patients were cured in the last obser- vation penod, the ciĺcumstances continue to be desolate. (Fig. 1, p. 1ó). The incidence ľate of this disease with a strong social stigma iS very high ín Slovenia. The patients aĺe coming foľ tľeatment when the disease is in its advanced stages. As scľeen- ing is not possible and the causes oť this disease are well known, the most sensible stĺategy to fight against this canceľ is pĺimary pĺevention. Hopefully, the new law, restĺicting the alcoholand cigaľette abuse and paying moľe attention to the socialwelfare of the poorest and marginalgľoups of people' willbľing about the changes foĺ the betteľ in the pľevention endeavoľs ofSlovenian people. I also honestly hope that the tľeatment ľesults will get closeĺ to those in otheľ European countľies because, in the futuĺe, a higheľ pľopoľtion of oľa1 Cancef patients will be ľeceiving combined theľapy. STOMACH CANCER Though the incidence of stomach canceľ is modeĺately decľeas- ing, it is neveĺtheless high; in the peľiod 7993_97 ,2,365 patients were diagnosed with stomach cancer. In less than one fifth of them, the disease was detected in localized stage (TI, 2, N0, M0). Localized disease is manageable by suľgery, yielding the cure ofa high peľcentage oťpatients. The European coun- tľies aľe ťacing a similaľ pľoblem as the aveÍage Íive-year age-standardized ľelative survival is haľdly ľeaching the ľate of 240/o.InSlovęnia, it is even worse, haĺdły 160/oinmenand190/o in women. A compaľison by stage disľibution with otheľ Coun- tries included into EUROCARE-3 is not possible. This is why we cannot provide any definite explanations foľ these differ- ences. In the peľiod 199o-94, analyzed in the EURoCARE-3 study, no suľgicalstandaľds (suĺgical method, surgery to be peľ- formed in a health care institution that treats a gľeater numbeľ of stomach cancer patients) neither pathological ones weľe elaborated in Slovenia. Accoĺding to Pľofessoľ Repše's com- ments, such standards weľe introduced soon afteľ that period' To my view, we will soon be able to catch up with otheĺ Euĺopean countries' ľates. Betteĺ accessibility to andavailabl|- ity of endoscopy andadjuvant treatment of patients eligible foľ it will ceĺainly help to improve treatment ľesults (4). BREAST CANCER The suruival of breast canceľ patients is gradually impľoving. Accoľding to EUROCARE-3 study, the aveľage five-year age-standaĺdized relative suruival of breast canceľ patients in Euľope is 7 4,8o/o, whereas in Slovenia, it is 65.60/0' The diĺfeľ- ence of a1most 10% means that, in the peĺiod 7993_97, we could have avoided aľound 400 deaths due to breast cancer. All that we could and should have also done is summarized in the commentaries by Pľoľessor Čufeľ and Pľoťessor Lindtner. 122 CANCER PATIT,MS SURVIVAL IN SLOVENIA 1983-1997 ,ION zAKLIuČEK ŕity niť- ale lin ose Io/0, :in ieť- \.1, :ial foľ en- ĺell cer the the ;le, ion the :an >ral, :as- lĺltS lof ) ing tn- eat :of 9Vo Jn- lhY 'eľ- E-3 'ef- ]eľ efe rm- rd. 1eľ ril' foľ RAK DOJIG, Preživetje se s časom izboljšuje. V EUROCARE-3 je povpľečno petletno Starostno standardiziľano ľeiativno pÍeżivetje za żenske v Evĺo pi 7 4,B o/o, v Sloveniji pa 65,6 o/o, skoraj I0 0/o ĺaz- lika. Ta ĺazlika pomeni, da bi se lahko v letih 1993_97 v Slo- veniji izognili pĺibliŽno 400 smľtim. Kaj bi še lahko stoľili, si lahko pĺebeľemo V komentarju pľof. dľ. Cuferjeve in pľoť. dľ. Lindtneľja. Keĺ se pľi nas V Vsem obdobju opazova- njarazmer1e med stadiji bolezni skoĺaj ni spľemenilo (Tabe- la 1, stĺan 35), menim, da je potľebno največ moči usmeľiti pÍav na organiziľano pĺesejanje. Zaradi več dejavnikov (ne šamo flnaněnihl) to ne Ĺo enôstávno. Kotnavajaprof. dľ. čufeĺ, samo povečanje mamogľafskih centľov ni imelo pĺav nobe- nega vpliva na zgodnejšo diagnostiko. Samo opľema toľej ni zadostna, pomembni so kakovostni izvajalcí presejanja, kon- tĺola kakovosti dela, dobľo organiziĺaĺa povezava med diag- nostično in teĺapel'tsko službo in seveda ozaveščene Ženske. V letih 1989-199I ozaveščenost žensk, merjena z odstotkom odzivnosti na ponujeno mamogľafijo, ponekod v Sloveniji še ni bila dovolj velika (v takľatni občini Ljublja na-Centeĺ Ie 560/o in Maĺiboľ-Rotovž le 53 vo) ()' Ponovno se bo morala zbta- ti skupina strokovno podkovanih in motiviľanih zdĺavnikov teĺ ostalih zdľavstvenih delavcev, kooĺdiniĺanih s strani onkološkega inštituta, da bo 1ahko izpeIjala iniciativo, kí sta jo daIa tako Ministľstvo za zdravje kot civilna dĺužba (Euĺo- pa donna). Dokler pa se ne bo našel nekdo, ki se bo temu delu popolnoma posvetil in poizkušal teoľijo spľemeniti v prakso, bo v Sloveniji še vedno vsako leto umľlo po nepo- tĺebnem pľibližno 100 bolnic zaradiĺaka dojke' MALIGNIMELANOM Incidenca se veča. Relativno Starostno standardizirano preżi- vetje ie bilo za zbo\ďle v letih 1990_94 daleč pod povprečjem EUROCARI-3 (Evľopa: 81%, Slovenija: 65Vo). Y zadnjem petletnem obďobju(1993_97) se je pomebno izboljšalo, ven- daľ se je izboljšalo tudi drugod. Preživetje se izboljšuje, ĺaz- like ostajajo (6). Glavnĺ napovedni dejavnik za preźiuetje je debelina pĺimaľnega tumorja. Z dodatnim zdĺavljenjem po opeľaciji preźivetja zaenkrat ne moľemo pomembno izbolj- šati. Rešitev vidim tako pĺedvsem v dobĺi pľimaľni in sekun- daľni pĺeventivi. o bolezni je potĺebno govoľiti v javnosti, da se ljudje z njo sezĺanijo in gĺedo ob sumljivih spĺemembah pľavočasno k zdravniku, Zdravnikipa moľajo imeti ustĺezno znanje za pĺepoznavanje in pĺavilno zdravIjenje bolezni. Najboljši zgledza uspešne tovľstne ukrepe so nam sporoči- Iaiz Avstralije (7). KARCINoM DEBELEGA Čnľvľ,sn N DANKE V obdobju 1985-89 je bilo v ZDA petletno ľelativno pretivet- je bolnikov s kaĺcinomom debelega črevesa in danke stati- stično značilno boljše kot v Evľopi (debelo čĺevo: ZDA600/o, Evopa 4Bo/0, Slovenija 360/0, danka: ZDA570/o,Evropa 440/0, Slovenija 30w 8,9, 10, 11). Ko so analíziľa\i,zakajtakšna razlika, so pĺišli do zak\jučka, da sta glavni vzľok boljšemu ľru'Žlvryĺ BoLNlKoV z RAKoM V sLoVt'NuI ĺ98}1997 As in Slovenia, the stage distribution did not change through- out the observation péľiod, (Table 1, p. 35), I am confident that most of ouĺ endéavoľs should from now on focus on the development and implementation of screenin'g pľogľam although, foľ severalľeasons (not solely financial) it will not be simple at all. As noted by Professoľ Cufeľ, the mere prop- agatioń of mammogľaphy in Slovenia did not have any favor- able impact on eaľlieľ diagnosis of breast cancer. It is obvious that technical equipment alone does not pĺovide the desired ľesults; in fact, moľe important aĺe well-tĺained expeĺts in screening, quality contľol, appľopĺiate and close coopeľation be|ween diagnostic and theľapy departments' and above all' highly conscientious women. In a pilot study in I989-I99I in three regions of Slovenia, we ofťeľed women fľee Scľeen- ing mammography and physical examination; but the com- pliance rate in some communities was low (in Ljubljana-Centeľ on\y 56Vo, and in Maľiboľ-Rotovž onlly 53Vo) (5). Again, we will have to Set up a gĺoup of expefts gatheľing expeĺienced and highly motivated medicai doctors and otheľ health caľe pro- fessiona]s and cooľdinate its activities in oľdeľ to implement the incentive given by the Ministry of Health and non-gov- eľnmental organization,Euľopa Donna". As long as we do not find a person who could be wholly in charge of and committed to these activities and goals, as well as capable of tuľning the- ory into practice, around 100 bľeast canceľ patients will unnecessaľily die of this cancef yearIy. MALIGNANI MELANOMA Malignant melanoma incidence has been incĺeasing. The 1990_94 survival ľate was faľ below the ELIRoCARE-3 aveľ- age Íate (Euľope 817o vs. Slovenia 65w.|nthe ĺecent obseľ- vation peńod 19%-97 ,a sĘnificant impľovement was obseľved in Slovenia; but, it happened also eisewheľe. The suľvival ĺates aĺe impĺoving, but "ihe differences ĺemain wide- (6)' one of the majoľ pľognostic ľactoĺs foľ survivalis pľimary tumoĺ thick- ness. So ťaľ, adjuvant postopeĺative tĺeatment has not proved to be as effective as to improve significantly the suĺvival. The best solution would be a well-designed primary and second- ary pľevention. \ŕe should speak a lot about this disease in pub- lic iń orderto keep people attentive to suspicious changes and advise them to consult the doctoĺ in time. on the other hand, medical doctors should have adequate knowledge and expe- ĺience to identiff the disease and treat it pľopeĺly. To date, the most pĺomising ľeports about successful pľeventive measuÍes have been received fĺom Australia (7). COLORE,CTAL CANCER In the period 1985-89, the five-yeaĺ suľvival of colorectal can- ceľpatients in USAwas significantlymoľe favorable than in ĺg- nifičantĘ Euĺope (colon: USA ó0%, Europe 4B7o, S\oveĺia 360/o; ľectum: USA 57%, Euľope 440/o,Slovenia 30%) (8, 9, 10, 11). AĺÍter ana\yzing these diffeľences, it was concluded that ber teľ survival in USA is laĺgely due to loweľ disease stage at diag- nosis andto a moľe favoĺable histologic fype. The disease stage ľemains one of the majoľ pľognostic factors for the suľvival if the canceľ is pĺopeľly tľeated. And the majoĺ diffeľence beNveen colorectal cancer patients in Slovenia and those in Noľtheľn and \ľesteĺn Euľope is precisely the disease sage (10). ng. ?aÍ ;in 'eĺ- WC ler. :ed ter. 997 r23 CONCLUSION V 1 z v V V pÍęŹivetilv zDA nižji stadiji ob ugotoviwidiagnozein ugod- nejša histološka vľsta. Stadijje ob primernem zdĺavljenju glavni napovedni dejavnik preŹivet1a, Razlika med nami in seveľno teľ zahodno Evľopo je pľedvsem v stadiju bolezni (10)' Vzpodbudno je,dasejev zadnjem opazovanem obdobju tudi v Slovenijipreživetje izboljšalo. Težko je zaključiti, alizaradi tega, keľ je več omejenega stadija (manj veľjetno, če pľimeľ- iamo številke), ali zaradiboIjšega teĺapel,'tskega pĺistopa (12). V začetku 90. let smo v Sloveniji pľičeli uvajati povsem dĺu- gačen pľistop pľi zdravljenju bolnikov z ľakom debelega čre- vesa, Ta pľistop se v naši analizi za\eta 1993_97 še ne kaže v celoti, sajje bilv tem obdobju zdravljenlemanjši delež bol- nikov po pľincipih kot jih opisuje v komentaľju pĺof' Repše. Ali se bomo z uvedbo takšnegazdrav\jenja pľi večini bolnikov pľibliŽali evropskemu (kaj šele ameriškemu) povpľečju, bodo pokazale bodoče analize, Verjetno pa to ne bo dovolj, keľ bo stadij še vedno ostalglavni napovedni dejavnik zapreźivetje. Pľi ľaku debelega črevesa sem optimist, sajupam' da se bomo z zastavl)eniÍni standaľdi, z boljšo iďoľmiľanost|o prebivalcev, boljšim dostopom do modeľnih diagnostičnih metod, z njihovo ĺacionalno upoľabo in uvajanjem novosti v zdĺavljenju kmalu pĺ ibllŽali zaho dni Evľop i. Pĺi kaĺcinomu danke, kjeľ glede preżivetja še bolj zaostajamo za evropskim povpľečjem, je sľvaľbolj zapletena,sajso se stan- daľdi, ki smo jih uvajali v začetku 90. let spĺemenili' To velja tako za podĺočje kiruĺgije (nove tehnike opeĺacije) kot ĺadio- teľapije, ki sta poleg stadija glavnanapovedna dejavnika pľe- Źivetja. Moľda bi bilo pľi ĺaku danke smiselno po vzoru iz preteklosti (13) ponovno zastavitiraziskavo ali pa se pľiklju- čiti kakšni dobro zastavljeni mednaľodniraziskaviin se na ta način kar najhitľeje pľibližati evľopskemu povpľečju. Ker je pĺi večini bolnikov z ľakom debelega čľevesa in danke ob diagnozi stadljŹenapredovan in pĺeživetje slabo, je potľeb- no na osnovi novih spoznanj tudi v SlovenijirazmišIjati o oľga- niziĺanempľesejanju teh dveh bolezni. RAK PROSTATE, PreŽivetje bolnikov z rakom pľostate v Sloveniji Statistično značilno zaostaja za povprečjem v študijo EURoCARE-3 zajetihdrźav (Evľopa: 6l,5o/o, Slovenija 47 ,3w. Razlog je veľ- jetno zelo kompleksen, vĺeden natančne analize. Po podat- kih o pĺičetku prvega zdrav\jenja lahko sklepamo, da so se skoľaj vsi bolniki v Sloveniji pričeii zdľaviti v ľegiji, kjeľ sta- nujejo. V onkologiji naj bi veljalo načelo, da pruo zdravlje- nje maligne bolezni načĺtuje multidisciplinaľni konzilij. Bojim se, da 1ele majhen odstotek bolnikov z rakom pľosta- te, v Sloveniji jih je letno več kot 400, pĺedstavljen urološke- mu konziliju' kjer naj bi bila poleg uľologa pĺisotna tudi za ľaka pľostate specializirana onkolog-ľadioteľapevt in onko- log-inteľnist. Največ ,za in proti- razprav po kongľesih je ĺav- no o zdľavljenjllĺakapľostate, Kolikšno je najmanjše število bolnikov, ki bi ga moľal določeni centeĺ zdĺaviti letno, da bi si pľidobil dovolj izkušenj? Ali lahko s šiľoko uporabo PSA kaj pĺispevamo k izboljšanju preźivetja? Moĺda se stvari izboljšujejo, vendar ostaja v Sloveniji pľeživetje slabo. Kot ugo- tavlja prim. Maľolt, je stanje pľi nas enako kot v 80, letih. It is however most encouľaging that, in the last observation peĺiod, the survivalimpĺoved also in Slovenia, though it is not easy to asses whether this impľovement ľesults from more cases of localized disease (which is, with regard to the figuľes, 1ess likely) oľ fľom better theľapeutic appfoach to coloľectal cancer patients (12). In the early 1990s, a completely new tľeat- ment approach to the colon canceĺ patients was initiated in Slovenia, but its impact on the survival foľ the perio d1993_97 cannot be seen yet because, in this period, only a minoľ pľo- poľtion of colon Canceľ patients wefe tĺeated accoľding to the standards as descľibed by Pĺď Repše. Vłletheľ oĺ not this most recent tľeatÍnent modality will bľing us closer to the Euĺopean avenge ľate (let alone the Ameĺican one) will be readily demonstĺable only by futuľe analyses. \ŕe may expect that this new approach alone will not be sufficient because the disease stage wiil continue to be the most impoľtant pľognostic fac- tor for suľvival. I allow myself to be optimistic about the colon canceľ as there is hope foĺ Slovenia to meet the \ŕest-European aveľage rates by setting up new standaľds, higheľ awareness of people in geneľal, easier availability and sensible application of up{o-date diagnostic methods and introducing of innovations into our practice. In the suruivai of ľectal cancer patients, we afe considerably lagging behind the Euľopean average rate because the situ- ation is ľatheľ more complex since the standaľds that were introduced in the eaľly 1990s have changed. This is as much true in suľgery (new techniques|) as in ľadiotherapy that are both, beside the disease stage' the majoľ prognostic factoľs foĺ suľvival' At this point, we should look back and ĺeconsideľ the possíbility of dľawing up a new study or to join a well-designed inteľnationalstudy and through it reach the level of Europ ean average rate. Since the main reason foĺ the pooľ suľvival of patients is the advanced stage, it would be appropriate to intľoduce an organ- ized scľeening program in Slovenia also. PROSTATE CANCE,R The survival ĺate of pľostate canceľ patients in Slovenia is sta_ tistically significantly loweľ thanthe averuge rates of the coun- tĺies included into the EL]ROCARE-3 srudy (Europe 61''5o/o, S\ovena 47 .3Vo). The ľeason may be complex and multfaceted, deseľving a detailed analysis. Fľom the data on primary tľeaĹ mentwe may Conclude that almost allpatients ľeceived it inthe district of theiľ ľesidence . The rule of thumb in oncology is that the primary tľeatrnent of a ma\ignancy should be planned by multidisciplinary advisory team. In Slovenia, a total of 400 of new prostate Canceľ Cases aĺe detected yearly aĺd I am conceľned that a too low percentage oť these patients is refened to the Multidisciplinary Advisory Team ťor Urology, consisting of an urologist, a radiatton oncologist and a medical oncologist, At oncology congľesses, the most buľning 'pľos and cons' debates evolve around the tĺeatment of pľostate Canceľ. Vhat would be the minimum nuńber of pľostate cancer patients treated yeaľly at a certain health caľe institution that could be a gxaÍantee of high pľoficiency and skill of that institution in the pľostate Canceľ treatment? Could we, to any extent, Con- tribute to the impľovement of suľvival by tumoľ maĺker tests 124 CANCER PATIINTTS SURVIVAL IN SLOVENIA 198T1997 zAKtJuČEK RAK SEČNEGA MEHuRJA Pľi raku sečnega mehuľja težko ugotĄamo, kje je naše mesto v Evľopi, saj eni ĺegistľi vključujejo intraepitelijski povľšin- ski ľak mehuľja, drugi ne. Iz podatkov, ki jih imamo na voljo, tako ne moľemo potegnitinajbolj tehtnih zaĘučkov. Rak seč- nega mehuľja izpostavljam zato,ker se pĺeŽivetje v zadnjih 15' letih ni nič izboljšalo (slika 1, stľan 6ĺ). rollko bolnikov zinvazivnimĺakom jebilode janskozdĺavljenihzradikalno cistektomijo, ki je deklaľiĺan standaľdni ĺačinzdravIjenja? Po podatkih Registľa (možnost nepopolne prijave?) zelo malo (13w' ob napĺedovanem stadiju je tudi premajhen odsto- tek radikalno operiľanih lahk o razlogza sIabše pĺeživetje, Vse- kakoľ bo potľebno pri mišično invazivnem ľaku mehuľja v Sloveniji izboljšati pľistop, če želimo, da ne bo tudi pľi nasled- njem pľegledu pľeživetje enako kot v B0. letih' KRoN|ČNA LIMtoclTNA LEVKEMUA Povpľečno petletno staľostno standardizkano ĺelativno pľe- żivetje za obdobje l990_94je biio v Evľopi za moške 64,80/o (pri nas 43,9 W in za źenske 69 ,20/o (pri nas 58 %o). Smo med dĺźavamiz najslabšim pľeživetjem v Evĺopi' Incidenca v drźa- vah, kjeľ ľegistľi pokľiva|o vso populacijo, pa je podobna tisti v Sloveniji, V obdobju 1993_97 je bilo, po podatkih Registľa, ob posta- viwi diagnoze specifično zdľavljenih 38 % bolnikov . Razlog temu ie strategiiazdravl1enjabolezní, ki se zdĺavi šele, ko posta- ne simptomatska, delno pa nepopolna in pomanjklivapĺija- va hematoloških ambulant v Sloveniji. Zakajtorej tako slabi rezultati? A1i so naši bolniki deležni slabšega zdravIjenja, pĺedvsemslabšegapodpoĺnegazdrĄenja?YzdrĄenjebo- nične limfocitne levkemije pĺihajajo nova, draga zdravila. Stľošek bo toliko večji, če smo Že s 'staľimi in poceni' nači- nizdravl)enja oz&avilí manjši odstotek bolnikov kot bi ga lahko. AKUTNE NELIMFOBLASTNE, LEVKEMUE Pľeživetje bolnikov, ki zbolijo zaradi akutne nelimfoblastne lev- kemije, je v okviľih evľopskega povpĺečja. S tem ne moľemo biti zadovoljni, keľ bi bilo lahko pľeživetje bolnikov pľi nas med boljšimi v Evľopi, če se ne bi ĺavno v zadnjem petletnem obdobju poslabšalo (slika 1, stľan 103). Će pozoľno pogle- damo sliko 2, stĺan 104, vidimo, da se je naibolj zniŽa\o ravno pľeŽivetje bolnikov staĺihl544let. Nekateri od teh bolnikov so bili že v tem obdobju deležni bolj agresivne ga zdravI1eĺja (transplantacija kostnega mozga), ki se je ĺavno takĺat pľičelo uvajati ťudi pľi nas. Pľedpostavljam, da so rezultati slabši ravno zaradi obdobja wajanja in da bodo že naslednje analize poka- zale občutno izboljšanje preżivetja teh bolnikov. KRoNIČNA M|ELoIČNA LEVKEMUA Podobno kot za akltno mieloično levkemijo velja verjetno fidiza kľonično mieloično levkemijo (sliki 1 in 2, stan10) foľ PSA? It may seem that the tľeatment potentials are chang- ing for betteľ; nonetheless, the suľvival continues to be pooľ, Asnoticed by Dľ. Maľolt of the Institute of oncology Ljubljana, the situation is currently the same as it was in the 1980s. BLADDE,RCANCER !ľith ľespect to bladdeľ canceľ' we Cannot make a straight- foľwaľd estimation where Slovenia ĺanks in Euľope because some ĺegistĺies in Euĺope include supeĺficial bladdeĺ tumoľS into the anaĘis of bladdeĺ canceľwhile otheľs do not, From the available data, we can haĺdly draw any reliable conclusion. I would like to highlight paĺticularly the bladdeľ CanceÍ because the suruival ĺate in both sexes has not impľoved in the ]ast 15 yeaľs (Figuľe I,p.6I). How many patients with the invasive bladder canceľ weÍe actually treated by ľadical cys- tectomy that is considered as standard tÍeatment modaliry? Accoľding to the data from the Registry, this number is ľatheľ low, only 13% (possibly due to incomplete notification). Among the patients with the disease in more advanced stages, the peľcentage of those who undeľwent ľadicalsurgery is too low' This may also be one of the ľeasons foľ pooĺer suľvival. It is obvious that we will have to make some impľovements in the tľeatment approach to the muscle invasive bladder canceľ if, in the next obseľvation peľiod, we hope foľ the survival that would not match up with that in the 1980s. cHRoNlc LYMPHocn]c LĽuKEM|A In the yeaĺs I99o_94, the average European five-yeaľ age-stan- dardized relative suľvival ľate of male patients with chronic lymphocytic leukemia was64.80/o (in Slovenia 43.9V0) andof female patients 69.zolo(ĺnSlovenia 587Đ. The survivalľate in Slovenia is among the lowest in Euľopean countľies' The inci- dence in the countries with the canceľ registries coveĺing the whole country is similar to the incidence in Slovenia. The Registry data suppoĺ that, in the period 1993_97,380/o patients received specific tľeatment at diagnosis. This low peĺ- Centage may be due to the treatment stĺategy: this disease is often treated on1y afteľ it is confiĺmed to be symptomatic, and partly also due to incomplete notification of the cases by hema- tology departments at various health caľe institutions in Slovenia' \ľhy then such pooľ results? Aľe the patients in Slovenia ĺeceiving less efťective theĺapies, in paĺticulaĺ less effective suppoľtive tľeatment? At pľesent, new and expensive drugs are being developed and will soon be intľoduced into clinicalpľactice. The costs of treatment of patients with chron- ic lymphoqtic leukemia with new drugs willbe much high- er accoĺding1y. ACUTE NON-LYMPHOBLASTIC LEUKEMIAS In Slovenia, the suruival of patients with acute nonJym- phoblastic leukemia is within the aveĺage Euĺopean ľates. Though favoĺable, this comparison is faľ fľom being soothing because, in Slovenia, the survival of these patients could have been among the highest in Euľope if it had not declined in the last five-yeaĺ obseruation peľiod (Fig. 1, p. 103). A closer look r'nľŽvĺr;e BoLNĺKoV z RAKoM V SLoVENUI 198T1997 725 CONCLUSION -t in 110). Posebno zanimivabo analiza za naslednje obdobje, ko se bo, upam, pokazal učinek imatinib mesilata, novega zdravlla za kľonično mieloično levkemijo' MUnlPU MIELOM Kljub novim, bolj učinkovitim zdľavi1om in boljšemu podpoľ- nemll zdravljenju je bilo prcŽivetje v 1etihl993_97 skonj enako (slika 1, stĺan 115). Morda pľi multiplem mielomu bolj inten- zivno zdrav\jenje ne pomenitudi boljše zdravl1enje? RAK PRl STAREJŠH Posebej bi želel opozoľiti še na pĺoblem zdĺavljenja in pľe- Živetja starejših bolníkov z ľakom. Y let1hl993_97 je bilo v Slo- veniji34\/obolnikov ob diagnoziĺakastaľih 70let ali več. Kot je ľazvidno iz príkazov o pľeživetju po Staľostnih skupinah je pĺi teh bolnikih pľeŽivetje v primerjavi z rnlajšimi slabo' Sama staľost V našem pĺikazu ni vplivala narazliko, Relativno pľe- Živetje namľeč upošteva pĺičakovano tra1aĺje Življenja glede na StaÍost. Na pĺoblem staľejših bolnikov z ľakom opozaĄajo údidrugod po svetu in mu v zadnjem času posvečajo tudi več pozor- nosti (14)' Razlogov zato je več. Standaľdno zdravljenje za posamezno ľakayo bolezen je lahko kontraindiciľano zaradi spľemljajočih bolezni; včasih pa je to le naš pľedsodekzara- di same koledarske staľosti bolnika. Vsa standaĺ dna zdravlje- nja, ki so se izkaza\a za učinkovita v kliničnih ľaziskavah, pa veĺjetno ne veljajo za staľejše bolnike. Ponavadi je bil in je še vedno eden od izključitvenih kľiteľijev za vstop v klinično ľazi- skavo prav starost (npr. staľejši od 70 let). Pľipoľočajo, da se moĺajo zdĺavniki posebej usposobiti za zdrav- Ijenje raka pĺi staĺejših bo1nikih, saj to zahteya še dodatna zna- nja in dľugačen pľistop (15,16,17,IB). at Figule 2 (p' I04) ľeveals that this decline was the biggest in the age gľoup of patients of 1544 yeaľs, Some of these patients undeľWent moĺe aggressive theľapies (e. g. bone maľ- ĺow transplantation) that weľe being initiated into the clinical pľactice in Slovenia right in that observation peĺiod. I pľesume that pooĺer tĺeatment ľesults could be anributed to the initia- tion phase of the new method and that all the subsequent anaĘ ses will show an improvement in the suruival of ouľ patients. CHRONIC MYELOID LEUKEMIA A similaľ assessment as that foľ acute myeloid leukemia can be made a1so foľ chľonic myeloid leukemia (Figs 1 and 2, p. p. 109 and 110). The analysis of the next obseruation peĺi- od, in which the impact of a new dĺug for chronic myeloid leukemia (imatinib mesilata), willhave been felt alľeady, will hopefully show some pľogľess in the survivalof ouľ patients. MUNIPLE MYELOMA Despite new moľe effective dľugs and impľoved supportive tfeatment the survival in the yeaľs 1983_97 was moľe oĺ 1ess steady (Fig. 1, p. 115). We are still not suľe whether a moľe aggľessive theľapy applied foľ multiple myeloma is also more effective theľapy. CANCER IN THE ELDERTY I would like to draw the ľeader's attention to the treatment and suľvival of elderly Canceľ patients, which pľesent a paÍ- ticu1aľ challenge to oncologists. In the period 1993-97,340/o of a1l new1y detected canceĺ patients weľe oldeľ than 70 yeaĺs. The gľaphs showing the survivalby age gľoups indicate cleaľ- ly that the survival of the elderly in comparison to that of youngeľ patients is pooľeľ. In ouľ presentation, the age alone does not affect the diffeĺence in suruival. In efťect, the relative survival ľate takes account the 1ife expectancy with ľespect to the actual age. Cancer in the elderly is a problem woľldwide and has been ĺecently given moľe attention than earlier (14)' Theľe aÍe many ľeasons. Standaĺd tľeatment of the eldeĺly foľ each individ- ua1 canceĺ may sometimes be a contraindication to vaľious accompanying diseases. Yet, sometimes, it could be only ouľ prejudice aľising from the concern for the patients due to their old age. The standaľd tĺeatment modalities that pĺoved to be very eľfective in clinica1 studies, weĺe not always as effective in the e1derly. A ľľequent exclusion cĺiteľíon of the patients fľom a clinical study has been patient's age' e, g. patients aged over 70, It has been ľecently recommended that oncologists shoulc1 specifically specialize in the tľeatment of cancer in the eld' eľly because this requires additionalknowledge and skills as well as diffeĺent appĺoaches (I5,76,77,18)' Branko Zakomik 726 CANCER PATIEMS SURVIVAL IN SLOVENIA 1983-T997 SKLEPNE MISLI SIOE.PNE MISLI Želja uľednikov te kĄrge je, dabipľičujoči podatki in komen- taľji vzpodbudili vse zdľavnike,ki se z zdnv\jenjem ľaka ukvaľ- jajo, k še boljšemu interdisciplinaĺnemu delu. Verjamemo, da bi le tako lahko izboljšali pľeživetje bolnikov z rakomv Sioveniji. Menimo, da je v Sloveniji ľakavih bolezni, kateĺih incidenca jemajhna,zdrĄenjepazapleteno,smiselnozdrayitinaenem mestu (npľ, maligne limfome, saĺkome, ľaka ščitnice, geľmi- nalne tumorje) . Zabo\ezĺi, ki jih je veliko (npľ. ľaka dojk, raka debelega čľevesa in danke, pljučnega ĺaka), je potľebno zdravljenjev nekaj centfih. Ti centľi pa moľajo obĺavnavati dovolj veliko število bolnikov in slediti dogovoľjenim smeľ- nicamzdravljenja, da bo leło lahko kakovostno. Na ta način bomo bolnikom lahko zagotovili tudi hitľejšo dostopnost do zdravnika. SkoĄ v vsakem poglavju poudarjamo, da jezapretivetie bol- nikov še vedno glavni prognostični dejavnik stadij bolezni' K zgodnejšemu odkľivanju lahko pľipomoľe večja ozavešče- nost prebivalstva o zgodnjih znakih bolezni in oľganiziĺani pĺe- sejalni pĺogľami. Pĺesejanje pa je smiselno omogočiti zdĺavjmljudem le, če je dokazano,da zmanjša umľljivost ali incidenco, če so znanaťÝe- ganja in koľisti in če je stľošek v pľimeľjavi s prednostmi spľe- jemljiv. Trenutno tem meľilom zadoščajo: pľesejanje za raka mateľničnega Vľatu s pľegledovanjem celic v bľisu, ki naj se začnenajkasneje po 30. letu starosti in ne pľed 20. letom, pre- sejanje za raka dojk z mamogĺafijo za ženske, staľe 50 let in več in pľesejanje za kolorektalni ľak z iskanjem prikĺite kľva- vitve v blatu za moške in ženske, stare 50_741et. Za zgodnje odkĺivanje ĺaka mateľničnega vĺatu je bil Ž,e leta1998 pilotno zastavljen progľam ZORA na šiľšem območ- ju tjubljane. Zdaj se šiľi na celo dĺźavo, Uveden je bii pose- ben Registeĺ za izpe|javo in sprotno ocenjevanje tega dela(IĐ. Nedvomno je, da bi z učinkovitim pľesejalnim pľo- gramom zaraka dojk pľeživetje lahko še pomembno izbolj- šali, Upamo, da bo načľt Ministrstva za zdravje na tem podĺočju uspešno izpeljan. Podobno upamo za raka đebe- lega čĺevesa in danke. Iĺ ĺe nazadnje, najcenejše zdľavljenje je zdrav\jenje bolezni, ki |e ni - pľimaľna pľeventiva. Za zdravljenje te razyite raka- ve bolezni namľeč prihajajo nova, izredno dľaga zdravila. Največje bľeme pľi moških pľedstavljajo kadilski in pivski ĺaki. Ali se bo z novimi zakoni o omejevanjutehrazsĺad stanje izbolj- šalo? odstotek moških kadilcev v Sloveniji se je zmanjšal, Vpliv na zbolevnost se Žekaźe pľi pljučnem ľaku pri moških. od Ietal995 dalje se je njegova incidenca po 50' letu staľosti usta- ]ila. V bodočností pa se bojimo, dabo zaradi vse bolj zgod- njega pľičetka kajenja mladih vse več tudi mladih bolnikov, starih3049let. Ali bomo lahko s spľemembo prehrambenih navad in večjo gibalno dejavnostjo med prebivalci Slovenije kajvplivali na rake pľebavnegatÍakta in dojk? Zdľavstveno-vzgojno delo je izĺedno pomembno, v ZD A'staI- no objavljajo tudi študije, v katerih izračlnavajo finančni dobľobit preventivnih akcij, npĺ' uspešno izvedenih protika- CLOSING REMARKS we' editoĺs of this book, sinceľelywish that the data and com- mentaries will stimulate allspecialists thatare involved in can- Ceľ tľeatment to get together and staľt with betteľ, more pľoductive interdiscip1inary collaboration. \ľe are most pos- itive that this is the only way to impľove the survival oľ can- cer patients in Slovenia. It is our opinion that in Slovenia cancers that have ľathef low incidence yet ľequiľe highly sophisticated tľeatment, should be tľeated in one Centef only (e. g. malignant lymphomas, sar- Comas' thyroid canceÍ' geĺm cell tumors). The canceĺs with high incidence (e. g. breast canceľ, coloĺectal cancer, and lung cancer) aľe tĺeated in seveľal health caĺe centeľs. However, these centers should have ľeached the highest proficiency through the tľeatment of a sufficient numbeľ of canceľ patients and follow the appľoved treatÍnent guidelines ín oľdeľ to assuľe high quality ľeatment. Such an appľoach could also assuľe a fasteĺ access of patients to medica1 tľeatment. In almost each chapteľ, it was specifically stfessed that the most important prognostic factoľ is the disease stage. Eaĺly detec- tion of cance ľ may be noticeably impľoved by enhancing the awaľeness of eaľly Symptoms of the disease in our popula- tion and by launching scľeening pľograms. Scľeening for canceĺ in healthy population is ľeasonab1e pĺo- vided that it is definitely suľe that it ľeduces mortality oľ inci- dence, and under condition that ĺisks and beneĺits aľe wel1 known and that the costs of a screening pľogľam veľsus its ben- eĺits aľe acceptable. Cuľľently, three cancers meet the above requirements: scľeening foľ cervical cancer in women aged at least J0 years but not 1ess than}} by smeaľ test, scľeening foĺ bľeast canceľ in women aged 50 yeaľs and over by mam- mography, and scľeening for coloľectal canceľ in men and women aged betlveen 50 andT4yearsby detecting occult fecal bleeding. In 1998, a pilot study foĺ eaľly detection of cervical Canceľ named ZoRA Was outlined foľ the Ljubljana ĺegion and its suĺ- ľoundings. Today, this screening pľogľam is being extended all oveľ the country and a special ĺegisteĺ has been estab- lished (19). Theľe is no doubt that we could gĺeatly impĺove the survival by launching an efficient scľeening pĺogľam for bľeast cancer, We sincerely hope that the pľoject set by the Ministry of Health of the Republic of Slovenia will be suc- cessfully implemented. '!ľe also expect that similaľ measuĺes will be adopted also foľ the colorectal Cancer, Eventually, the least expensive therapy is the treatment oĺthe disease that never develops, in otheľ woľds, pĺimary pľe- vention. Ve should be awarethatnew, extĺemely expensive drugs aĺe appeaĺing on the maĺket foľ the tľeatment of the advanced malignancies. In men' the heavlest burden aľe CanCerS due to heavy smok- ing and dľinking habits. \ŕi11theľe be any turn for the better in ľestľicting these habits with the new ]aw? The peľcentage of male smokeľs decreased in Slovenia and its effect has been obserued in the lung canceľ incidence in men. Since 1995, its incidence has become stab1e. But we aĺe anxious that the num- beĺ of young lung cancer patients aged 3049 yeaľs will )97 ľnrŻvĺr;ĺ BoLNIKoV z RAKoM V sLoVĹNUl 198T1997 727 CLOSINC REMARKS dilskih pĺogĺamov med delavci določene tovarne (20). V Slo- veniji je pľeventíVnih pľogľamov vse več in upajmo, da bodo uspešni, VIRI 1. Incidenca ľaka v Sloveniji 1997, 1998' 1999, Ż000. Ljubljana: onkološki inštitul, Register raka za Slovenijo, 2000' 200l, 2001' 200J. 2. Pompe Kirn V, Zakotnik B, Vo]k N, Benulič ! ŚkrkJ' Pĺeživetje bolnikov z ĺakom v Sloveniji - Canceľ patients suĺvivalin Slovenia 196}1990. Lpb- ljana, onkološki inštitut 1995. 3. Beľľino Ę Capocaccia R, Gatta G et al, eds' Survival of cancer patients in Europe; the EUROCÁRE-3 study' Ann oncol; Suppl (in pĺess). 4. MacdonaldJS, Smalley SR, BenedeniJ et al. Chemoľadiotheľapy afteľ suľ- gery compared with surgery alone foĺ adenocaľcinoma ofthe stomach oI gastľoesophageal junction' N EnglJ Med 2001;345:725-30. 5. Pompe Kiľn V, Us J, Jelinčič V et al' Pilotna študija zgodnjega odkĺivanja ĺaka dojk v šestíh občinah SloveĄe; odzivnost in znaćilosti žensk' In: Lindt- neĺ J, Budihna M, Marolt Ę Śkrk J et al, eds' Detekcija ľaka dojk. Detek- cija ginekološkega raka. Zboľnik. Ljubljana' Kanceĺološka sekcija Slovenskega zdľavniškega društva, Zveza slovenskih dnlštev za boj pľo- ti Íakl| 1995,1G2B. 6. Sant M, Capocaccia R, Coleman MP et al. Cancer survival incĺeases in Euro- pe, but inteľnational differences ĺemain wide. Euĺ J Canceľ Ż001;37: 165947. 7, Milne E,Johnston R, Cross D, Giles-Corti B, English. Effect of a school-ba- sed sun-pľotection inteĺVention on the development of melanocýic nevi in children. AmJ Epidemiol 2002;1.55:73945. B' Gatta G, Capocaccia R, Coleman MP et al. Toward a comparison of suĺ- vival in Ameľican and Euľopean cancer patients' Canceľ 2000; 89: 893-900, 9' Beĺľino F' Canceľ patients sulvival and cure in Europe: time tfends and compaľison with the USA. In: Abstĺact book. 18. UICC Inteĺnational can- ceľ congress. oslo, 2002. 10, Gatta G, Capocaccia R, Sant M et al. Understanding variations in survival foľ coloľectal canceľ in Europe; an EUROCARE highĺesolution study' GUT 2000; 47: 533-8. incĺease because theľe are moľe and moĺe youngsteĺS smok- ingatavery ęarly age. Shall we be able to make any step further in the prevention of coloľectal and bľeast canceí by making Slovenian popu- lation aware of the uľge to change their eating habits and to get moľe addicted to physical exeÍCise? Health education is of paľamount importance, In Slovenia, pľevention programs ale incľeasing1y pĺopagated and we honestly hope that they will fulfill theiľ mission. 11. Anon. Diffeĺences in the survival of coloĺectal canceľ patients beMeen Euľope and USA. Final ĺepoľt' Agleement No. s1Ż.117414' Milano, 2001 ' 12. Feinstein ÁR, Sosin DM, \ťells CK. The \ľill Rogers phenomenon| stage migĺation and new diagnostic techniques as a souĺce of rnisleading sta- tistics foĺ sutvival in cancer' N EnglJ Mecl 1985;312:160R. 13' Štabuc B, Zakotnik B, Maĺkovič S, Repše S, Benulič ! Golouh R' Adju- vantno Żdravljenje bolnikov z operabilnim rakom danke' Ljubljana: onkološki inštitul, 1992. (]IGIT -03-92). 14. Veĺcelli M, Capocaccia R, Quaglia A et al. Relative suľival in eldeľly Euro- pean cancel patients: evidence foľ health caľe inequalities: The EURoCARE working group. Crit Rev Oncol Hematol 2000;35:161-79. 15. Yancik R, Ganz PA, Varricchio CG, Conley B' Peĺspectives on comoľbi- dity and cancer in older patients: appĺoaches to expand the knowledge base. J Clin Oncol 2001; 19: 11.47-51.. 1ó. Post PN, Hansen BE, Kil PJ,Janssen-Heijnen ML, Coebeĺghflľ. The inde- pendent prognostic value of comorbidity among men aged > 75 years with localized prosate canceľ: a population-based study' BJU Int 2001; 87: B21-ó' 17. De Maĺco MĘ Janssen-Heijnen ML, van der Heijden LH, Coebeľgh flř. Comoĺbidity and colorectal canceĺ accoĺding to subsite and stage: a popu- lation_based study. Euĺ J Canceľ. 2000; 36: 95_9' 18. Critical Reviews in Oncology/Hematology 2000; 35:147-232. 19. Primic ŽakeljM. Zgodnje odkĺivanje pĺedĺakavih sprememb mateĺnične- ga vratu _ državni Progĺam ZoM. In: LindĺreľJ, Bešić N, Budihna M, Flko- vić G et al, eds' Doktľini zdravljenja bolnikov z malignimi limfomi in bolnic z ĺakom rodil. Zbornik, Ljubljana: Kancerološko zdrużenje Slovenskega zdravniškega drušw a, Ż00Ż: 5642' 20. Colditz GÁ. Disseminating ľesearch findings into public health pĺactice. Canceľ Causes Control 2002; 13:5034. 728 CANCI.R PATIT,MS SURVIVAL IN SLOVENIA 1983-1997