Increasing kidney cancer incidence and survival in Estonia: role of age and stage

Figures & data

Table 1. Incident cases of kidney cancer in adults (age ≥15 years) in Estonia, 1995–2014.

	Total		1995–1999		2000–2004		2005–2009		2010–2014
	No	%	No	%	No	%	No	%	No	%	p-value^a
Total	5326	100	1178	100	1186	100	1373	100	1589	100
Microscopic verification	4302	80.8	940	79.8	954	80.4	1092	79.5	1316	82.8	p = .043
Death certificate only	218	4.1	35	3.0	59	5.0	75	5.5	49	3.1	p = .865
Autopsy	78	1.5	7	0.6	25	2.1	21	1.5	25	1.6	p = .017
Gender
Men	3091	57.7	669	56.3	697	58.3	812	58.9	913	57.1	p = .661
Women	2271	42.4	520	43.7	498	41.7	567	41.1	686	42.9
Age at diagnosis (years)
15–44	234	4.4	58	4.9	53	4.5	53	3.9	70	4.4	p = .521
45–54	687	12.9	172	14.6	175	14.8	172	12.5	168	10.6	p = .001
55–64	1374	25.8	340	28.9	323	27.2	329	24.0	382	24.0	p = .004
65–74	1768	33.2	412	35.0	397	33.5	473	34.5	486	30.6	p = .015
75–84	1066	20.0	164	13.9	198	16.7	302	22.0	402	25.3	p < .001
≥85	197	3.7	32	2.7	40	3.4	44	3.2	81	5.1	p = .002
Morphology
Renal cell carcinoma	4022	75.5	843	71.6	890	75.0	1039	75.7	1250	78.7	p < .001
Other specified	230	4.3	68	5.8	56	4.7	44	3.2	62	3.9	p = .022
NOS	1074	20.1	267	22.7	240	20.2	290	21.1	277	17.4	p < .001
TNM stage at diagnosis^b
I/II	2320	46.1	413	36.4	521	47.3	606	47.5	780	51.5	p < .001
III	701	13.9	196	17.3	173	15.7	141	11.0	191	12.6	p < .001
IV	1369	27.2	374	32.9	324	29.4	333	26.1	338	22.3	p < .001
Unknown	640	12.7	153	13.5	84	7.6	197	15.4	206	13.6	p = .923
Surgery done^b	3768	74.9	826	72.7	823	74.7	947	74.2	1173	77.4	p = .005

^aComparing proportions for 1995–1999 and 2010–2014; ^bdeath certificate only and autopsy cases excluded.

Figure 1. (A) Observed (dashed line) and modeled (solid line) age-standardized (World) rates and annual percentage change (APC) with 95% confidence intervals for kidney cancer incidence (1970–2014) and mortality (1995–2014) trends in Estonia; (B) Age-specific kidney cancer incidence trends by five-year birth cohort and period of diagnosis in Estonia, 1970–2014; (C) Observed (dashed line) and modeled (solid line) age-standardized (World) rates and annual percentage change (APC) with 95% confidence intervals for stage-specific kidney cancer incidence trends in Estonia, 1970–2014. *The APC is significantly different from zero at alpha =0.05.

Table 2. Five-year relative survival ratios (RSR) for all kidney cancers and renal cell carcinoma in Estonia, 1995–2014.

	5–year RSR (95% CI)
	All kidney cancers					Renal cell carcinoma
	1995–1999	2000–2004	2005–2009	2010–2014	Change^a	1995–1999	2000–2004	2005–2009	2010–2014	Change^a
Total	54 (51–58)	62 (58–65)	63 (59–66)	66 (62–69)	12	64 (60–68)	73 (69–77)	75 (72–79)	77 (74–81)	13
Total (age–standardized)	53 (48–57)	60 (56–64)	63 (60–66)	65 (62–69)	13	63 (57–69)	72 (67–77)	76 (72–80)	78 (74–81)	15
Morphology (age–standardized)
Renal cell carcinoma	63 (57–69)	72 (67–77)	76 (72–80)	78 (74–81)	15
NOS/other specified	30 (24–36)	19 (14–25)	24 (19–29)	19 (14–25)	–11
Gender (age–standardized)
Men	52 (45–58)	55 (49–60)	61 (56–65)	63 (58–67)	11	64 (55–71)	68 (59–75)	74 (68–80)	76 (70–81)	12
Women	56 (50–61)	67 (62–72)	66 (61–71)	69 (65–73)	13	64 (56–71)	78 (71–84)	78 (72–83)	81 (75–85)	17
Age at diagnosis
<55	64 (56–70)	63 (56–69)	74 (67–80)	81 (75–86)	17	66 (59–73)	73 (65–80)	80 (73–86)	86 (80–91)	20
55–64	59 (52–65)	66 (60–72)	64 (58–70)	71 (66–77)	12	67 (60–74)	75 (68–81)	75 (68–81)	79 (73–84)	12
65–74	48 (42–54)	63 (56–69)	60 (54–65)	63 (57–68)	15	60 (52–67)	74 (67–81)	72 (65–78)	71 (65–77)	11
≥75	46 (36–57)	49 (39–59)	56 (48–64)	53 (46–60)	7	63 (47–79)	67 (53–80)	79 (68–89)	81 (71–91)	18
TNM stage (age–standardized)
I/II	88 (78–94)	85 (78–90)	89 (84–93)	93 (87–96)	5	89 (77–95)	88 (80–93)	91 (85–95)	94 (87–97)	5
III	63 (52–71)	70 (59–79)	65 (54–74)	69 (59–77)	6	66 (54–76)	74 (61–83)	72 (59–81)	70 (59–79)	4
IV	13 (9–18)	13 (9–19)	14 (9–19)	13 (9–18)	0	19 (11–28)	23 (15–33)	23 (15–31)	20 (13–27)	1
Unknown	48 (39–58)	63 (48–75)	63 (54–71)	55 (46–62)	15	56 (40–69)	79 (46–93)	91 (72–97)	83 (68–92)	20
Surgery done (age–standardized)	69 (63–74)	78 (72–82)	79 (74–83)	81 (77–84)	12	70 (63–75)	78 (73–83)	81 (76–85)	82 (78–86)	14

^aChange from 1995–1999 to 2010–2014 in percent units (statistically significant findings in bold).

Table 3. Excess hazard ratio (EHR) of death within five years of diagnosis among patients with kidney cancer in Estonia, 1995–2014.

	All kidney cancers^a					Renal cell carcinoma^a
	Crude EHR	95% CI		Adjusted^b EHR	95% CI	Crude EHR	95% CI		Adjusted^b EHR	95% CI
Gender
Men	1.00			1.00		1.00			1.00
Women	0.76	0.68–0.86		0.91	0.81–1.02	0.74	0.63–0.87		0.95	0.81–1.12
Age at diagnosis (years)
15–54	1.00			1.00		1.00			1.00
55–64	1.25	1.05–1.49		1.23	1.03–1.46	1.13	0.91–1.41		1.20	0.97–1.49
65–74	1.47	1.25–1.74		1.35	1.14–1.59	1.23	0.99–1.52		1.19	0.97–1.47
≥75	1.69	1.40–2.05		1.46	1.21–1.76	1.03	0.77–1.39		1.09	0.82–1.45
Period of diagnosis
1995–1999	1.00			1.00		1.00			1.00
2000–2004	0.77	0.66–0.90		0.96	0.82–1.12	0.67	0.54–0.83		0.82	0.67–1.02
2005–2009	0.74	0.64–0.87		0.95	0.81–1.10	0.67	0.54–0.82		0.85	0.69–1.04
2010–2014	0.55	0.47–0.65		0.79	0.68–0.93	0.51	0.40–0.64		0.71	0.57–0.89
TNM stage
I/II	1.00			1.00		1.00			1.00
III	3.64	2.71–4.88		3.37	2.53–4.49	3.79	2.75–5.23		3.56	2.59–4.90
IV	29.36	23.16–37.23		26.62	21.14–33.53	23.21	17.75–30.34		21.90	16.78–28.59

^aUnknown stage excluded (statistically significant findings in bold); ^badjusted for all variables in the table.