Standard cancer patient population for age standardising survival ratios
Abstract
Standard adult cancer patients populations are derived in this paper as a tool for the calculation of age-standardised cancer survival figures. Previously used standards in survival analysis have been site- and/or study-specific. Here, multivariate methods have been used to define the smallest possible number of general standard cancer patient populations which are simple to use and provide standardised survival values close to the raw ones for the largest possible number of cancer sites. The analysis was based on data for over 1.1 million cancer patients included in the EUROCARE-2 study. The proposed standard populations consist of three age distributions, appropriate for cancers with incidence patterns: (1) increasing with age - the vast majority of cancers; (2) broadly constant with age and (3) mainly affecting young adults. The three standard distributions are presented by both broad and five-year age classes. The latter can be used to determine which of the three standards would be used for sites not included in the cluster analysis because their survival is generally calculated in unusual age groups. Overall, standard 1 is appropriate for over 91% of cases, standard 2 for just over 7%, and standard 3 for less than 2%. The proposed standards were tested on European (EUROCARE-2 and EUROCARE-3) and US (Surveillance, Epidemiology and End Results Program, SEER) relative survival data. There was very good correspondence between the raw (population weighted) and age-standardised survival figures.
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For children, survival was estimated for age groups 0-4, 5-9 and 10-14 years, and age-standardised estimates were obtained by assigning equal weights to the three age-specific estimates.
“For children, we estimated survival for the age groups 0–4, 5–9 and 10–14 years; age-standardised estimates were obtained by assigning equal weights to the three age-specific estimates.41,42”
For adults, ICSS weights were used with age at diagnosis categorised into five groups, and group 2 weights were used for melanoma, cervix and brain, group 1 for oesophagus, stomach, colon, rectum, liver, pancreas, lung, breast, ovary and prostate, and both groups for haematopoietic malignancies.
“For adults, we used the International Cancer Survival Standard (ICSS) weights,41 in which age at diagnosis is categorised into 5 groups: 15–44, 45–54, 55–64, 65–74 and 75–99 years and, for prostate cancer, 15–54, 55–64, 65–74, 75–84 and 85–99 years. Of the three sets of ICSS weights, we used group 2 (cancers for which incidence does not increase steeply with age) for melanoma of the skin, cervix”
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“Adjustment was done by deriving weighted averages of modelled age-specific 5-year relative survival estimates, with weights from the International Cancer Survival Standards [11].”
Survival of patients with skin melanoma in Europe increases further: Results of the EUROCARE-5 study
Crocetti, E., Mallone, S., Robsahm, T. E., Gavin, A., Agius, D., Ardanáz, E., López, M. C., Innos, K., Minicozzi, P., Borgognoni, L., et al. (2015) · European Journal of Cancer · doi:10.1016/j.ejca.2015.07.039 · Cited by 109 · see citing works
“Both age-specific and age-standardised [13] RS were obtained by using the Ederer II method for expected survival [14].”
MethodSelf-citationColonna, M., Uhry, Z., Guizard, A., Delafosse, P., Schvartz, C., Belot, A., & Grosclaude, P. (2015) · Cancer Epidemiology · doi:10.1016/j.canep.2015.04.015 · Cited by 107 · see citing works
“Ageadjusted net survival estimates at 5 and 10 years were calculated using the International Cancer Survival Standard weights [22] for three periods of incidence: 1989–1993, 1994–1998, and 1999–2004.”
MethodJansen, L., Eberle, A., Emrich, K., Gondos, Á., Holleczek, B., Kajüter, H., Maier, W., Nennecke, A., Pritzkuleit, R., Brenner, H., et al. (2013) · International Journal of Cancer · doi:10.1002/ijc.28624 · Cited by 106 · see citing works
Sengayi‐Muchengeti, M., Joko-Fru, W. Y., Miranda‐Filho, A., Egue, M., Akele‐Akpo, M., N’Da, G., Mathewos, A., Buziba, N. G., Korir, A., Manraj, S. S., et al. (2020) · International Journal of Cancer · doi:10.1002/ijc.33120 · Cited by 106 · see citing works
“Direct age-standardisation was done using International Cancer Survival Standard-2 weights for cancer sites with broadly constant incidence by age.(20)”
MethodIs England closing the international gap in cancer survival?
Walters, S., Majano, S. B., Muller, P., Coleman, M. P., Allemani, C., Butler, J., Peake, M. D., Guren, M. G., Glimelius, B. L. G., Bergström, S. N., et al. (2015) · British Journal of Cancer · doi:10.1038/bjc.2015.265 · Cited by 103 · see citing works
Pinheiro, P. S., Morris, C. R., Liu, L., Bungum, T. J., & Altekruse, S. F. (2014) · JNCI Monographs · doi:10.1093/jncimonographs/lgu016 · Cited by 103 · see citing works
Long-term survival expectations of cancer patients in Europe in 2000–2002
Brenner, H., Francisci, S., Angelis, R. D., Marcos‐Gragera, R., Verdecchia, A., Gatta, G., Allemani, C., Ciccolallo, L., Coleman, M. P., & Sant, M. (2008) · European Journal of Cancer · doi:10.1016/j.ejca.2008.11.005 · Cited by 102 · see citing works
Pulte, D. D., Redaniel, M. T., Jansen, L., Brenner, H., & Jeffreys, M. (2012) · Haematologica · doi:10.3324/haematol.2012.063602 · Cited by 102 · see citing works
“An analysis with age adjustment according to the International Cancer Survival Standards using the age groups 15-44, 45-54, 55-64, 65-74 and over 75 was performed in order to evaluate the effects of variation in age on apparent overall changes in survival.(25)”
MethodSurvival patterns in lung and pleural cancer in Europe 1999–2007: Results from the EUROCARE-5 study
Francisci, S., Minicozzi, P., Pierannunzio, D., Ardanáz, E., Eberle, A., Grimsrud, T. K., Knijn, A., Pastorino, U., Salmerón, D., Trama, A., et al. (2015) · European Journal of Cancer · doi:10.1016/j.ejca.2015.07.033 · Cited by 99 · see citing works
“Age-standardised relative survival (RS) at 1 and 5 years after diagnosis [11] was calculated by applying the complete approach [12] to 917,568 and 34,146 patients diagnosed with lung and pleural cancer respectively in 2000–2007, and followed up to 31st December 2008 (Figs.”
MethodSelf-citationJiang, Y., Yuan, H., Li, Z., Ji, X., Shen, Q., Tuo, J., Bi, J., Li, H., & Xiang, Y. (2021) · Cancer Biology and Medicine · doi:10.20892/j.issn.2095-3941.2020.0634 · Cited by 96 · see citing works
“We distinguished between the age standardization RSRs and the overall RSRs in the outcomes to obtain better international comparisons 9 .”
The effect of multiple primary rules on population-based cancer survival
Weir, H. K., Johnson, C. J., & Thompson, T. (2013) · Cancer Causes & Control · doi:10.1007/s10552-013-0203-3 · Cited by 94 · see citing works
“All cancers and cancer-specific survival estimates were age-standardized to the International Cancer Survival Standards (ICSS) [31] by using five age-groups (15–44, 45– 54, 55–64, 65–74, and 75+).”
MethodPulte, D. D., Jansen, L., Castro, F. A., Emrich, K., Katalinic, A., Holleczek, B., Brenner, H., & the GEKID Cancer Survival Working Group (2015) · British Journal of Haematology · doi:10.1111/bjh.13537 · Cited by 92 · see citing works
“Ageadjusted survival estimates were derived by computing weighted sums of age-specific survival estimates using weights according to the International Cancer Survival Standard (Corazziari et al, 2004) for four age groups (15–44, 45– 54, 55–64 and 65–74 years).”
MethodColorectal cancer survival in the USA and Europe: a CONCORD high-resolution study
Allemani, C., Rachet, B., Weir, H. K., Richardson, L. C., Lepage, C., Faivre, J., Gatta, G., Capocaccia, R., Sant, M., Baili, P., et al. (2013) · BMJ Open · doi:10.1136/bmjopen-2013-003055 · Cited by 91 · see citing works
“The overall (all ages) net survival estimates were age standardised with the International Cancer Survival Standard (ICSS) weight.(17) We used a logistic regression model to estimate the odds of patients with colorectal cancer in each area being resected with curative intent, the odds of patients”
MethodSelf-citationRecent Trends in Survival of Patients With Pancreatic Cancer in Germany and the United States
Sirri, E., Castro, F. A., Kieschke, J., Jansen, L., Emrich, K., Gondos, Á., Holleczek, B., Katalinic, A., Urbschat, I., Vohmann, C., et al. (2016) · Pancreas · doi:10.1097/mpa.0000000000000588 · Cited by 92 · see citing works
“Patients were categorized into 4 major age groups (15–44, 45–54, 55–64, and 65–74 years) following the International Cancer Survival Standards for age standardization of survival estimates for cancer sites with a steeply increasing age distribution.(19) Standard weights were recalculated to add up to 100% (15–44 years…”
MethodKlint, Å., Tryggvadóttír, L., Bray, F., Gislum, M., Hakulinen, T. R., Storm, H. H., & Engholm, G. (2010) · Acta Oncologica · doi:10.3109/02841861003691945 · Cited by 92 · see citing works
“Age-standardisation of relative survival used the ICSS-standard cancer patient populations [12].”
MethodExamining the gastric cancer survival gap between Asians and whites in the United States
Jin, H., Pinheiro, P. S., Callahan, K. E., & Altekruse, S. F. (2016) · Gastric Cancer · doi:10.1007/s10120-016-0667-4 · Cited by 91 · see citing works
“Five-year age-standardized overall survival, as well as survival stratified by anatomic site and stage at diagnosis, was calculated using the life table method [25].”
MethodIversen, L. H., Green, A., Ingeholm, P., Østerlind, K., & Gögenür, I. (2016) · Acta Oncologica · doi:10.3109/0284186x.2015.1131331 · Cited by 90 · see citing works
Sex differences in lymphoma incidence and mortality by subtype: A population‐based study
Radkiewicz, C., Bruchfeld, J. B., Weibull, C. E., Jeppesen, M. L., Frederiksen, H., Lambe, M. P., Jakobsen, L. H., El‐Galaly, T. C., Smedby, K. E. E., & Wästerlid, T. (2022) · American Journal of Hematology · doi:10.1002/ajh.26744 · Cited by 90 · see citing works
“The 5-year RS in men and women was age-standardized according to the International Cancer Survival Standard (ICSS) 1, except for in young ageonset lymphomas; cHL, PMBL, BL, and NLPHL, where ICSS 3 was used.(22) The age-standardized RS in men and women was plotted over”
MethodSurvival from common and rare cancers in Germany in the early 21st century
Hiripi, E., Gondos, Á., Emrich, K., Holleczek, B., Katalinic, A., Luttmann, S., Sirri, E., & Brenner, H. (2011) · Annals of Oncology · doi:10.1093/annonc/mdr131 · Cited by 89 · see citing works
“estimates were calculated with age adjustment according to the International Cancer Survival Standards using the following age groups: 15–44, 45–54, 55–64, 65–74 and 75+ years [14].”
MethodRecent improvement in survival of patients with multiple myeloma: variation by ethnicity
Pulte, D. D., Redaniel, M. T., Brenner, H., Jansen, L., & Jeffreys, M. (2013) · Leukemia & lymphoma/Leukemia and lymphoma · doi:10.3109/10428194.2013.827188 · Cited by 89 · see citing works
“Due to diff erences in the age distribution between patients from diff erent ethnic groups, we employed age adjustment of overall survival according to the International Cancer Survival Standard [21] for relative survival analyses.”
MethodComparison of liver cancer incidence and survival by subtypes across seven high‐income countries
Rutherford, M. J., Arnold, M., Bardot, A., Ferlay, J., De, P., Tervonen, H. E., Little, A. L., Bucher, O., Jacques, N. S., Gavin, A., et al. (2021) · International Journal of Cancer · doi:10.1002/ijc.33767 · Cited by 89 · see citing works
“All survival estimates were age-standardised using International Cancer Survival Standard (ICSS) weights.(20) This also resulted in data from Quebec being excluded from the survival analysis as they only provided data for 2000-2011.”
MethodTrends in incidence, mortality and survival of penile squamous cell carcinoma in Norway 1956–2015
Hansen, B. T., Orumaa, M., Lie, A. K., Brennhovd, B., & Nygård, M. (2017) · International Journal of Cancer · doi:10.1002/ijc.31194 · Cited by 88 · see citing works
“Overall survival estimates were age-standardized using the International Cancer Survival Standard weights.(27) When the standard weighting could not be used due to sparse data, age-standardized estimates were obtained by the alternative weighting method proposed by Brenner.”
International trends in oesophageal cancer survival by histological subtype between 1995 and 2014
Morgan, E., Soerjomataram, I., Gavin, A., Rutherford, M. J., Gatenby, P. A. C., Bardot, A., Ferlay, J., Bucher, O., De, P., Engholm, G., et al. (2020) · Gut · doi:10.1136/gutjnl-2020-321089 · Cited by 87 · see citing works
Urinary tract cancer survival in Europe 1999–2007: Results of the population-based study EUROCARE-5
Marcos‐Gragera, R., Mallone, S., Kiemeney, L. A. L. M., Vilardell, L., Malats, N., Allory, Y., Sant, M., Hackl, M., Zielonke, N., Oberaigner, W., et al. (2015) · European Journal of Cancer · doi:10.1016/j.ejca.2015.07.028 · Cited by 87 · see citing works
“Both age-specific and age-standardised (according to International Cancer Survival Standards [6]) RS were computed using the Ederer II method for expected survival [4].”
MethodSelf-citationSurvival with nonmelanoma skin cancer in Germany
Eisemann, N., Jansen, L., Castro, F. A., Chen, T., Eberle, A., Nennecke, A., Zeißig, S. R., Brenner, H., Katalinic, A., & the GEKID Cancer Survival Working Group (2015) · British Journal of Dermatology · doi:10.1111/bjd.14352 · Cited by 86 · see citing works
Comparison of different approaches to estimating age standardized net survival
Lambert, P. C., Dickman, P. W., & Rutherford, M. J. (2015) · BMC Medical Research Methodology · doi:10.1186/s12874-015-0057-3 · Cited by 85 · see citing works
“The usual external reference population uses weights in five age groups as shown in Table 1 [8].”
MethodInfluentialRoche, L., Danieli, C., Belot, A., Grosclaude, P., Bouvier, A., Velten, M., Iwaz, J., Remontet, L., & Bossard, N. (2012) · International Journal of Cancer · doi:10.1002/ijc.27830 · Cited by 84 · see citing works
“Age-standardized net survival estimates were obtained with the International standard for cancer-survival weights.(25) Estimations carried out with Ederer I,(10) Ederer II(10) and Hakulinen methods(11) were performed as usual and used individual data.”
MethodSurvival of European patients with central nervous system tumors
Sant, M., Minicozzi, P., Lagorio, S., Johannesen, T. B., Marcos‐Gragera, R., Francisci, S., & the EUROCARE Working Group (2011) · International Journal of Cancer · doi:10.1002/ijc.26335 · Cited by 83 · see citing works
“To account for differences in the age structure of the different populations, relative survival was adjusted for age using the international standard for cancer survival analysis.(17) For time trends, we estimated the 5-year relative survival of patients diagnosed in five consecutive 3-year periods (1988–1990, 1991–19…”
MethodSurvival from colorectal cancer in Germany in the early 21st century
the GEKID Cancer Survival Working Group, Májek, O., Gondos, Á., Jansen, L., Emrich, K., Holleczek, B., Katalinic, A., Nennecke, A., Eberle, A., & Brenner, H. (2012) · British Journal of Cancer · doi:10.1038/bjc.2012.189 · Cited by 83 · see citing works
“To allow for comparisons between subgroups or populations with potentially different age distribution, age adjustment was done using the International Cancer Survival Standards proposed by Corazziari et al (2004).”
MethodWeir, H. K., Johnson, C. J., Mariotto, A. B., Turner, D., Wilson, R. J., Nishri, D., & Ward, K. C. (2014) · JNCI Monographs · doi:10.1093/jncimonographs/lgu018 · Cited by 82 · see citing works
“Survival estimates were age-standardized to the International Cancer Survival Standard using five age groups (29).”
Tryggvadóttír, L., Gislum, M., Bray, F., Klint, Å., Hakulinen, T. R., Storm, H. H., & Engholm, G. (2010) · Acta Oncologica · doi:10.3109/02841860903575323 · Cited by 82 · see citing works
Miller, J. W., Smith, J. L., Ryerson, A. B., Tucker, T. C., & Allemani, C. (2017) · Cancer · doi:10.1002/cncr.30988 · Cited by 81 · see citing works
“We obtained age-standardized survival estimates using the International Cancer Survival Standard weights.(24) If 2 or more of the 5 age-specific estimates could not be obtained, then we present only the pooled, unstandardized survival estimate for all ages combined.”
Baili, P., Salvo, F. D., Marcos‐Gragera, R., Siesling, S., Mallone, S., Santaquilani, M., Micheli, A., Lillini, R., Francisci, S., Hackl, M., et al. (2015) · European Journal of Cancer · doi:10.1016/j.ejca.2015.07.025 · Cited by 81 · see citing works
“Cancer survival statistics are usually considered comparable if the original data are: (a) collected in a standardised way (EUROCARE-5 data originate from CRs working to standardised data collection and coding rules), (b) estimated by the same methods (the EUROCARE-5 methods are described elsewhere [12]) and (c) if th…”
MethodSelf-citationAllemani, C., Minicozzi, P., Berrino, F., Bastiaannet, E., Gavin, A., Galcerán, J., Ameijide, A., Siesling, S., Mangone, L., Ardanáz, E., et al. (2012) · International Journal of Cancer · doi:10.1002/ijc.27895 · Cited by 80 · see citing works
Recent cancer survival in G ermany: An analysis of common and less common cancers
Jansen, L., Castro, F. A., Gondos, Á., Krilavičiūtė, A., Barnes, B., Eberle, A., Emrich, K., Hentschel, S., Holleczek, B., Katalinic, A., et al. (2014) · International Journal of Cancer · doi:10.1002/ijc.29316 · Cited by 80 · see citing works
“Age standardization was performed using weights defined by the International Cancer Survival Standard.14 Period survival estimates were obtained through left truncation of the follow-up of contributing cohorts in addition to the usual right censoring at the end.”
MethodTryggvadóttír, L., Gislum, M., Hakulinen, T. R., Klint, Å., Engholm, G., Storm, H. H., & Bray, F. (2010) · Acta Oncologica · doi:10.3109/02841861003702528 · Cited by 80 · see citing works
“Age-standardisation of survival used the weights of the International Cancer Survival Standard (ICSS) cancer patient populations [12].”
MethodStewart, S. L., Harewood, R., Matz, M., Rim, S. H., Sabatino, S. A., Ward, K. C., & Weir, H. K. (2017) · Cancer · doi:10.1002/cncr.31027 · Cited by 80 · see citing works
“We obtained age-standardized survival estimates using the International Cancer Survival Standard weights.(18) If 2 or more of the 5 age-specific estimates could not be obtained, then only the pooled, unstandardized survival estimate for all ages combined was presented.”
- Authors
- Corazziari, I., Quinn, M., & Capocaccia, R.
- Affiliations
- Istituto Superiore di Sanità (IT)
- Office for National Statistics (GB)
- Corresponding author
- Capocaccia, Riccardo
- Venue
- European Journal of Cancer
- Publisher
- Elsevier BV
- Published
- 2004-10
- Volume
- 40
- Issue
- 15
- Pages
- 2307-2316
- ISSN
- 0959-8049 (ISSN-L)
- OpenAlex
- W2077720730
- Cited by
- 589
- References
- 7
- Citations by year
- 2026: 35 · 2025: 47 · 2024: 34 · 2023: 34 · 2022: 42 · 2021: 39 · 2020: 40 · 2019: 24 · 2018: 37 · 2017: 33 · 2016: 35 · 2015: 40 · 2014: 30 · 2013: 21 · 2012: 26
- FWCI
- 1.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Cancer (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
- Keywords
- age adjustment, cancer survival, standard population, age distribution, relative survival, SEER, cancer incidence patterns
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Neoplasms, Reference Standards, Multivariate Analysis, Cluster Analysis, Survival Analysis, Age Distribution
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