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Two-year survival of low-grade and high-grade glioma patients using data from the Swedish Cancer Registry

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Abstract

Background

Swedish health care legislation requires equal, high-quality health care for all inhabitants, while regional differences of medical availability and treatment potentially allow for different outcomes. This study was undertaken to evaluate whether glioma survival differed between the Stockholm region and the other Swedish regions since the Stockholm region has easier mean access to regional care and had started a specialized neuro-oncology service for all inhabitants of the region.

Material and methods

The Swedish Cancer Registry was searched for all gliomas in the neuroepithelial tissue, aged 16–79 years, and diagnosed between 1996 and the end of 2001. Survival analysis was performed using the Kaplan–Meier method. Survival rates from the Stockholm Regional Cancer Registry area was compared to the other areas in Sweden combined.

Results

For high-grade glioma, the 2-year survival was 25% in Stockholm and 14% in the other areas. For low-grade glioma, the 2-year survival was 82% and 72%, respectively. The largest 2-year survival difference was detected for glioblastoma patients aged 16–54 years, with 27% survival in the Stockholm area compared to 12% in the other areas.

Conclusion

We cannot rule out all possible bias in our study, but results indicated higher 2-year survival for patients with glioma in the Stockholm region than in other regions of Sweden. These data are incompatible with the legislation of equal health care.

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Acknowledgment

The authors acknowledge the Swedish National Cancer Registry for providing data.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Clinical Neuroscience, Karolinska Hospital, 171 76, Stockholm, Sweden

    Tiit Mathiesen & Inti Peredo

  2. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Stefan Lönn

Authors
  1. Tiit Mathiesen
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  2. Inti Peredo
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  3. Stefan Lönn
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Corresponding author

Correspondence to Tiit Mathiesen.

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Comment

The authors searched the Swedish Cancer Registry for all gliomas (ICD10 C71.1-9), aged 16–79 years, diagnosed in 1996–2001 (i.e., before temozolomide) and histologically verified during life. The 2-year survival rates by the Kaplan–Meier analysis were compared between the Stockholm Regional Cancer Registry and the five other regional registries of Sweden combined. The follow-up time was too short for meaningful survival analyses for grades II to III gliomas. But the GBM data were devastating—if valid (or in scientific terms reproducible), which I somewhat doubt.

Stockholm: 263 GBMs (70% of HGGs), median age 59 years, 2-year survival 13% (95% CI 10–18).

Rest of Sweden: 847 GBMs (52% of HGGs), median age 60 years, 2-year survival 7% (95% CI 5–9).

Now the devil’s advocate suspects that the GBM diagnoses by the Stockholm neuropathologists had been more liberal than in the rest Sweden, which would explain the difference in the GBM survival. Anyway, these data raise the nagging doubt that GBM patients are ignored for this or that reason (including ignorance) in some part of any EU country. And that should be cleared out by national surveys.

Juha E Jääskeläinen

Kuopio, Finland

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Mathiesen, T., Peredo, I. & Lönn, S. Two-year survival of low-grade and high-grade glioma patients using data from the Swedish Cancer Registry. Acta Neurochir 153, 467–471 (2011). https://doi.org/10.1007/s00701-010-0894-0

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  • DOI: https://doi.org/10.1007/s00701-010-0894-0

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