State of the Russian Oncology Service: malignant neoplasms of the tongue C01, 02 (mortality rate and median survival of patients, taking into account the stage of the disease and histological structure of the tumor) Part 2

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ABBREVIATIONS:

PCR – Population-based Cancer Registry;

NWFD RF – Northwestern Federal District of the Russian Federation;

ICD – International Statistical Classification of Diseases and Related Health

INTRODUCTION

Malignant tongue neoplasm is a rare visual localization with the highest mortality rate.

More than 3000 primary cases of tongue cancer are registered in Russia (3416 in 2018) each year, in the Northwestern Federal District of the Russian Federation – 300 (374 in 2018) [1].

In the general structure of cancer cases diagnosed in Russia, tongue neoplasms occupy 0.55 % (both genders, 2018), in males – 0.8 %, in females – 0.3 %. In the NWFD – 0.6%, 0.9%, 0.3%, respectively [1]. The structure of the pathology of the malignant tongue neoplasm (C01, 02) in the Northwestern Federal District is close to the national average. The levels of standardized incidence rates are also close to it (Table 1) [1–4].

 

Table 1. Standardized rates of tongue cancer incidence in Russia and the Northwestern Federal District (NWFD). 2018 [1, 2] / Табл. 1. Стандартизованные показатели заболеваемости ЗНО языка в России и СЗФО. 2018 г. [1, 2]

	Both sexes	Males	Females
Russia	1,43	2,43	0,71
NWFD RF	1,57	2,64	0,82
Saint Petersburg	1,70	2,95	0,89

 

In Russia, there is practically no population-level research on the calculation of analytical indicators of the effectiveness of tongue cancer measures, including the survival rates. The only exception is our studies conducted in Saint Petersburg [5–9]. Prior to that, a general idea of the tongue cancer treatment effectiveness could be obtained from the clinical guidelines by Professor R.I. Wagner and Professor A.I. Paces [10–12].

Over the decades, we have gained vast experience in the development of Cancer Registries in the Russian Federation and disseminated it to the whole Northwestern Federal District territory and to other Russian administrative territories which work according to our program.

The database developed for the Northwestern Federal District (more than a million observations) provides voluminous and high-quality information on the state of the Russian Oncology Service to study malignant neoplasms prevalence and analyze in detail rare tumor localizations. For example, malignant neoplasms of the heart, eye, etc. [13, 14].

A large number of studies have been devoted to techniques in survival rate calculation of cancer patients [7–9, 15–23].

Let us consider the effectiveness of the anti-cancer measures taken in Russia in relation to tongue cancer.

One–year mortality rate of patients

Reliability assessment of the registration of patients with malignant neoplasms is carried out using accuracy index of calculation, that is, the death-to-case ratio. This calculation is one of the main criteria for the information published in the IARC series “Cancer Incidence in Five Continents” [24]. This value should not exceed 1.0, i.e. the number of deaths should not be more than the number of cases. The technique of calculation this criterion has been outlined before [7–9].

Unfortunately, no data on the number of deaths related to tongue cancer in Russia has been provided. Thus, the severity of the cancer might be identified by the other criteria – mortality or survival rates.

The mortality of patients in the first year of observation (or one-year mortality) for tongue cancer is significant. To study the dynamics of the structure and, subsequently, the survival rate of the patients by histological types of tongue cancer, 5188 observations were selected in the period from 1999 to 2018.

Most of the histological types were squamous cell carcinomas: M-8070/3, M-8071/3 and M-8072/3, which accounted for 78.5% of all histological findings. Adenocarcinoma NOS (M-8140/3) accounted for 1.3%. M-8000/3 (malignant neoplasm without histological confirmation) accounted for 1.5%.

The main histological structure of tongue cancer remained stable over the period.

The one-year mortality rate is one of the most important indicators for determining the effectiveness of anti-cancer measures. It is closely linked to cancer localization.

The most important thing to consider here is how to calculate it. It makes no sense when calculated on the basis of summary tabular data from district and regional oncologists by January 20 for the past year – the mortality data have not been collected [25]. In the other case, using updated PCR information a year later, the data might be quite reliable to reflect the problem.

Unfortunately, to date, the Ministry of Healthcare of the Russian Federation relies on the routine reporting data (by January 20), not on PCR database. We have already drawn attention to the fact that there are no analytical indicators for the all-Russian level analysis of malignant neoplasms of the tongue.

Let us consider the dynamics of mortality of patients with malignant tongue neoplasm according to the NWFD RF PCR database in one the first year of observation. (Table 2).

 

Table 2. Dynamics in one-year mortality rate of tongue cancer patients in the NWFD. NWFD RF Population-based Cancer Registry database / Табл. 2. Динамика показателя одногодичной летальности больных со ЗНО языка в СЗФО. БД ПРР СЗФО РФ (в % от числа учтенных больных).

	2000	2005	2010	2015	2018	decrease %
Both sexes	59,5	55,6	51,3	47,7	43,1	-27,6
Males	62,4	57,2	52,5	54,9	47,0	-24,7
Females	46,8	50,0	48,8	35,2	34,8	-25,6

 

One should pay attention to the fact that tongue cancer belongs to the group of cancer with a high mortality rate. At the same time, there was a significant treatment progress. Over 18 years, the mortality rate of patients with tongue cancer decreased in the Northwestern Federal District of the Russian Federation by almost 1/4.

We emphasize that this indicator calculated on the basis of Form No. 7 for many other tumor localizations has no right to exist, since it is incorrect. The data cannot be generalized by January 20 over the past year since a significant number of death certificates have not been received by oncological dispensaries [25]. This indicator should be calculated only on the PCR DB and not by summing up the data collected in the region, no earlier than 1-2 years and only after careful control of all received registration cards and a complete set of medical death certificates.

Year-by-year lethality

Year-by-year mortality (mortality of patients throughout each year of observation) is the most important indicator for the assessment of performance of the oncological service and fundamental study of the patterns of an increased mortality risk in patients at various stages of the ongoing complex of preventive and curative measures.

To study the characteristics of the risk of death in patients over a long period (10 years), 1122 patients diagnosed with tongue cancer in 2000–2004 were selected, according to the PCR database of the Northwestern Federal District of the Russian Federation (Fig. 1, Table 3).

 

Fig. 1. Year-by-year lethality of tongue cancer (C01, 02) patients in the NWFD. NWFD RF PCR database (2000–2004) / Рис. 1. Погодичная летальность больных со ЗНО языка (С01, 02) в СЗФО. БД ПРР СЗФО РФ (2000–2004 гг.)

 

Table 3. Year-by-year lethality of tongue cancer (C01, 02) patients in the NWFD. NWFD RF PCR database (2000–2004 – 10-year follow-up of patients) / Табл. 3. Погодичная летальность больных со ЗНО языка (С01, 02) в СЗФО. БД ПРР СЗФО РФ (2000–2004 гг. – десять лет возможности прослеживания судеб больных) 

Observation period	Males		Females		Both sexes
	Abs. number	Lethality	Abs. number	Lethality	Abs. number	Lethality
1	858	62,0	264	50,6	1122	59,4
2	323	40,7	126	27,1	449	36,9
3	190	19,5	91	13,2	281	17,5
4	152	17,8	79	10,2	231	15,2
5	124	10,6	70	11,4	194	10,9
6	109	11,1	62	4,8	171	8,8
7	96	9,4	59	5,1	155	7,8
8	86	9,4	56	1,8	142	6,4
9	77	10,4	53	5,7	130	8,5
10	69	0,0	50	6,0	119	2,5

 

The highest mortality rate during the first year of treatment was noted: 62% of 858 male patients, 50.6% of 264 female patients. Among the survivors, only 40.7% of males and 27.1% of females died during the second year of observation. By the tenth year of observation all men had died, only 50 women (18.9%) survived. A leap in lethality was noted: among male patients – in the sixth and ninth year, among female patients – in the fifth, seventh and ninth year.

The same patterns of year-by-year lethality are characteristic for most other localizations of malignant neoplasms.

Figure 2 and Table 4 present the data on the year-by-year lethality of tongue cancer patients only for a five-year period of observation. 1503 patients registered in 2010–2014 were selected.

 

Fig. 2. Year-by-year lethality of tongue cancer (C01, 02) patients in the NWFD. NWFD RF PCR database (2010–2014) / Рис. 2. Погодичная летальность больных со ЗНО языка (С01, 02) в СЗФО. БД ПРР СЗФО РФ (2010–2014 гг.)

 

Table 4. Year-by-year lethality of tongue cancer (C01, 02) patients in the NWFD. NWFD RF PCR database (2010–2014 – 5-year follow-up of patients) / Табл. 4. Погодичная летальность больных со ЗНО языка (С01, 02) в СЗФО. БД ПРР СЗФО РФ (2010–2014 гг. – пять лет возможности прослеживания судеб больных)

Observation period	Males		Females		Both sexes
	Abs. number	Lethality	Abs. number	Lethality	Abs. number	Lethality
1	1018	51,3	485	38,9	1503	47,3
2	460	35,5	276	25,0	736	31,6
3	295	22,2	201	14,4	496	19,1
4	226	16,1	161	10,8	387	13,9
5	163	12,9	119	9,3	282	11,4

 

Special attention should be given to a significant decrease in the lethality of patients in the first year of observation compared with the previous years. Thus, the entire complex of anti-cancer measures taken in the period from 2000-2004 to 2010-2014, by the fifth observation period had saved 85 lives of tongue cancer patients in the Northwestern Federal District of the Russian Federation.

Median survival

The median survival is the period of time during which half of the registered patients die. The methodology for calculating the median survival rates was published by us earlier [7–9]. For the period from 2000 to 2016 median survival (for both sexes) increased from 9.5 months to 1.4 years. Among males – from 9 to 10.3 months, among females – from 1.2 to 2 years.

The median survival is expressed in months for cancer localizations with high lethality. The possibility of calculating it makes it possible to obtain the rates close to our time.

When calculating the rates for localizations with low lethality, its value for 2016 can be obtained no earlier than 2033 or even 2035.

One-year and five-year cumulative observed and relative survival of tongue cancer patients

The system of Population-based Cancer Registers developed in Russia allows calculating the survival rates of cancer patients. This is the most important criterion for the assessment of the effectiveness of all anti-cancer measures, unfortunately, little used.

If for a certain period we do not see any improvement in the level of this indicator, then it makes no sense to use the indicators actively promoted in the country (beyond PCR), such as an increase in the proportion of the early stage, a decrease in the neglect rate or one-year lethality (calculated beyond PCR). Inevitably, the entire data analysis system must be based on international standards and the PCP database.

Tables 5 and 6 show the one-year and five-year cumulative survival rates of tongue cancer patients in the Northwestern Federal District for the period from 2000 to 2017. All survival rates increased in both males and females (the latter have a higher level of indicators).

 

Table 5. Cumulative observed survival of tongue cancer (C01, 02) patients in the NWFD. NWFD RF PCR database / Табл. 5. Кумулятивная наблюдаемая выживаемость больных со ЗНО языка (С01, 02) в СЗФО. БД ПРР СЗФО РФ

Both sexes
Year of diagnosis		2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017
Abs. number of patients		253	212	200	254	206	208	238	232	236	281	270	293	308	229	320	387	404	429
Observation period	1	41,6	36,5	43,2	46,1	38,1	46,1	43,6	44,6	55,3	51,6	48,9	43,7	52,9	54,8	57,6	54,0	60,4	54,1
	2	27,4	23,4	28,9	26,5	25,9	27,2	28,0	25,1	35,3	32,6	33,7	26,7	33,3	39,8	39,5	37,3	36,8
	3	22,9	18,6	25,8	21,7	20,8	18,6	19,4	18,9	31,2	28,5	27,2	22,8	28,1	31,5	31,7	27,8
	4	20,0	14,7	22,7	19,3	18,3	16,1	16,2	17,0	26,1	24,4	24,9	19,7	26,2	26,3	22,2
	5	18,7	12,7	19,6	18,1	16,7	14,1	14,3	16,5	25,1	21,8	23,2	17,3	24,5	25,1
Males
Year of diagnosis		2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017
Abs. number of patients		206	160	157	193	145	160	185	174	172	179	187	194	213	148	221	238	248	279
Observation period	1	39,0	34,6	38,7	44,4	36,3	44,7	40,3	41,5	55,4	44,8	47,9	38,5	48,7	49,1	51,8	47,4	56,4	47,1
	2	25,6	21,1	25,7	22,5	22,4	25,4	25,0	22,6	31,0	26,1	31,7	23,0	31,6	32,0	31,8	31,4	30,0
	3	21,1	15,4	21,7	19,3	17,5	16,3	15,2	17,6	27,8	22,3	22,6	19,8	26,3	23,7	26,2	22,8
	4	17,5	11,5	18,4	17,2	15,4	13,7	12,3	15,1	22,1	18,6	19,8	16,6	25,0	18,5	18,2
	5	16,5	10,2	16,5	16,2	13,9	11,7	9,9	15,1	21,4	15,9	18,8	15,2	22,7	16,8
Females
Year of diagnosis		2000	2001	2002	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017
Abs. number of patients		47	52	43	61	61	48	53	58	64	102	83	99	95	81	99	149	156	150
Observation period	1	52,7	42,3	60,0	51,7	42,4	51,1	55,3	54,1	55,2	63,5	50,9	54,3	62,7	65,0	70,4	65,2	67,2	67,3
	2	35,1	30,5	40,8	39,6	35,0	33,3	38,9	33,3	46,8	43,9	38,0	34,3	37,3	53,4	56,6	47,5	49,3
	3	30,7	28,5	40,8	29,3	29,5	26,6	34,7	22,9	40,1	39,5	36,6	28,8	32,3	45,3	43,9	37,0
	4	30,7	24,4	38,4	25,8	25,8	24,4	30,4	22,9	36,8	34,6	35,1	26,0	28,8	40,3	31,4
	5	28,5	20,3	31,2	24,1	23,9	22,2	30,4	20,8	35,0	32,0	32,0	21,7	28,8	40,3

  

Table 6. Cumulative relative survival of tongue cancer (C01, 02) patients in the NWFD. NWFD RF PCR database / Табл. 6. Кумулятивная относительная выживаемость больных со ЗНО языка (С01, 02) в СЗФО. БД ПРР СЗФО РФ 

Both sexes
Year of diagnosis					2000			2001			2002			2003			2004			2005			2006			2007			2008		2009		2010			2011			2012		2013			2014			2015			2016				2017
Abs. number of patients					253			212			200			254			206			208			238			232			236		281		270			293			308		229			320			387			404				429
Observation period	1				43,2			37,9			45,2			48,0			39,5			47,8			45,1			46,1			57,2		53,0		50,4			45,0			54,3		56,1			59,1			55,2			61,7				55,5
	2				29,5			25,3			31,5			28,6			27,9			29,0			29,8			26,7			37,7		34,3		35,7			28,3			35,0		41,7			41,6			39,0			38,5
	3				25,5			21,0			29,0			24,3			23,3			20,5			21,2			20,7			34,3		30,6		29,4			24,8			30,2		33,9			34,4			29,7
	4				23,1			17,4			26,3			22,4			21,3			18,2			18,2			19,1			29,8		26,8		27,5			22,1			28,8		28,9			24,8
	5				22,5			15,7			23,4			21,9			20,2			16,3			16,4			19,1			29,5		24,4		26,2			20,1			27,8		28,3
Males
Year of diagnosis			2000			2001			2002			2003			2004			2005			2006			2007			2008			2009		2010			2011			2012					2013			2014			2015			2016		2017
Abs. number of patients			206			160			157			193			145			160			185			174			172			179		187			194			213					148			221			238			248		279
Observation period	1		40,6			36,0			40,5			46,4			37,8			46,2			41,8			43,0			57,3			46,2		49,5			39,6			50,1					50,3			53,3			48,6			57,8		48,3
	2		27,7			23,0			28,2			24,5			24,2			27,1			26,7			24,2			33,1			27,8		33,7			24,3			33,3					33,7			33,6			33,1			31,6
	3		23,8			17,6			24,7			22,0			19,6			18,0			16,8			19,6			30,7			24,3		24,6			21,6			28,5					25,7			28,5			24,6
	4		20,6			13,9			21,8			20,5			17,9			15,6			14,1			17,4			25,2			20,8		22,1			18,7			27,8					20,6			20,4
	5		20,2			13,0			20,1			20,1			16,9			13,7			11,7			18,0			25,1			18,2		21,7			17,7			26,0					19,4
Females
Year of diagnosis				2000			2001			2002			2003			2004			2005			2006			2007			2008			2009			2010			2011			2012		2013			2014			2015			2016		2017
Abs. number of patients				47			52			43			61			61			48			53			58			64			102			83			99			95		81			99			149			156		150
Observation period		1		54,4			43,7			62,2			53,0			43,7			52,9			56,7			55,8			57,0			64,8			52,6			55,8			63,9		66,4			72,1			66,4			68,4		68,9
		2		37,2			32,4			43,7			41,5			37,4			35,5			40,4			34,8			49,9			45,6			39,9			36,3			38,8		55,7			59,3			49,3			51,1
		3		33,1			31,3			44,5			31,5			32,7			28,9			36,6			24,2			44,0			41,6			39,3			31,3			34,1		48,2			47,1			38,9
		4		33,9			27,9			42,7			28,6			29,9			27,0			32,5			24,5			41,8			37,1			38,1			29,1			31,1		43,6			34,5
		5		32,2			24,1			35,3			27,7			28,7			25,1			32,9			22,4			41,3			34,9			35,3			25,1			31,7		44,5

 

The success seems obvious: the mortality rate of tongue cancer patients is decreasing, while the survival rate is increasing.

However, the lack of desire among the health officers to use reliable objective criteria according to international standards makes us pay attention to the state of organization of treatment of patients in this group in the Northwestern Federal District compared to the European program (Eurocare-4).

The average European level of the observed and relative five-year survival rate of tongue cancer patients of the 1990s was not reached even in 2013 [26]. According to the Saint Petersburg PCR database, the survival rates of tongue cancer patients are slightly better. This is easy to explain given the qualification of specialists in Saint Petersburg and the availability of medical care for citizens in scientific medical institutions of the federal level. The factor of the small annual number of registered tongue cancer cases should be taken into account, particularly in a large city of Saint Petersburg, with 21-58 new cases reported each year in 2000–2018. In different years they could differ significantly in age composition and health status. If the data for Saint Petersburg are excluded from the PCR database of the Northwestern Federal District, the territorial indicators would be rather modest. All data on the survival rate of patients were taken only from the PCR database (Saint Petersburg and the Northwestern Federal District of the Russian Federation).

The comparison is shown in Table 7.

 

Table 7. Comparative data on the cumulative 5-year observed and relative survival of tongue cancer patients on the EU average in the NWFD RF and St. Petersburg / Табл. 7. Сравнительные данные кумулятивной 5-летней наблюдаемой и относительной выживаемости больных со ЗНО языка в среднем по Европе, в СЗФО и Санкт-Петербурге 

	Observed (%)		Relative (%)
	Males	Females	Males	Females
Eurocare (1995–1999)	36,8	47,2	41,6	54,4
Northwestern Federal District of the Russian Federation (2013)	16,8	40,3	19,4	44,5
Saint Petersburg (2013)	24,3	39,0	27,4	43,4

 

Dynamics of one-year and five-year survival of patients with cancer of the tongue, taking into account the stage of the disease

Figures 3, 4 and Tables 8, 9 show a complete picture of the effectiveness of treatment of cancer patients in the Northwestern Federal District. Three five-year follow-up periods from 1999 to 2013 have been compared, with the number of patients recorded for each period – about a thousand.

 

Fig. 3. Dynamics in the observed 5-year survival rate of tongue cancer (C01,02) patients (males) in the NWFD, taking into account the stage of the disease, NWFD RF PCR database / Рис. 3. Динамика наблюдаемой 5-летней выживаемости больных со ЗНО языка (С01, 02) (мужчины) в СЗФО с учетом стадии заболевания, БД ПРР СЗФО РФ

 

Fig. 4. Dynamics in the observed 5-year survival rate of tongue cancer (C01,02) patients (females) in the NWFD, taking into account the stage of the disease, NWFD RF PCR database / Рис 4. Динамика наблюдаемой 5-летней выживаемости больных со ЗНО языка (С01, 02) (женщины) в СЗФО с учетом стадии заболевания, БД ПРР СЗФО РФ

 

Table 8. Dynamics in the observed 5-year survival rate of tongue cancer (C01,02) patients (males) in the NWFD, taking into account the stage of the disease, NWFD RF PCR database / Табл. 8. Динамика наблюдаемой 5-летней выживаемости больных со ЗНО языка (С01, 02) (мужчины) в СЗФО с учетом стадии заболевания, БД ПРР СЗФО РФ

Period		Stage					Total
		I	II	III	IV	Unk.
1999–2003	Number	31	175	315	240	129	890
	%	3,5	19,7	35,3	27,0	14,5
	1	80,3	66,4	46,7	16,6	27,1	40,7
	2	53,6	42,6	28,7	7,4	15,4	24,6
	3	43,5	36,6	23,2	5,6	12,8	20,3
	4	40,2	30,6	18,7	5,6	12,0	17,2
	5	33,5	28,8	16,7	5,1	12,0	15,8
2004–2008	Number	38	150	302	275	71	836
	%	4,5	17,9	36,2	32,9	8,5
	1	78,4	61,5	46,2	27,6	40,7	43,8
	2	64,4	37,2	25,3	15,3	18,2	25,3
	3	58,8	30,8	17,4	10,0	12,7	18,9
	4	42,0	26,5	15,0	8,5	9,1	15,7
	5	33,3	24,3	13,9	8,5	7,3	14,3
2009–2013	Number	56	176	359	265	65	921
	%	6,1	19,1	38,9	28,8	7,1
	1	96,0	65,3	47,6	21,4	43,4	45,7
	2	74,9	46,2	28,8	9,4	24,4	28,7
	3	70,2	37,2	22,0	6,7	18,7	22,9
	4	70,2	33,4	17,2	4,7	18,7	19,7
	5	55,3	31,0	16,7	4,7	13,3	17,9

  

Table 9. Dynamics in the observed 5-year survival rate of tongue cancer (C01,02) patients (females) in the NWFD, taking into account the stage of the disease, NWFD RF PCR database / Табл. 9. Динамика наблюдаемой 5-летней выживаемости больных со ЗНО языка (С01, 02) (женщины) в СЗФО с учетом стадии заболевания, БД ПРР СЗФО РФ

Period		Stage					Total
		I	II	III	IV	Unk.
1999–2003	Number	19	90	76	38	34	257
	%	7,4	35,0	29,6	14,8	13,2
	1	83,8	65,2	59,2	13,2	33,3	52,8
	2	78,2	41,2	40,8	7,9	22,8	36,4
	3	67,0	34,3	38,2	5,3	19,0	31,5
	4	67,0	30,9	34,2	5,3	15,2	28,7
	5	55,9	28,6	30,3	5,3	15,2	25,9
2004–2008	Number	38	75	80	50	41	284
	%	13,4	26,4	28,2	17,6	14,4
	1	83,6	67,6	43,4	16,0	53,6	51,5
	2	69,2	51,0	28,1	12,0	35,7	37,9
	3	66,2	38,6	21,7	10,0	31,3	31,2
	4	54,2	38,6	19,1	10,0	26,8	28,4
	5	51,2	38,6	16,4	8,0	26,8	26,8
2009–2013	Number	73	134	149	75	29	460
	%	15,9	29,1	32,4	16,3	6,3
	1	88,0	71,8	53,1	26,5	51,0	59,3
	2	74,4	47,7	32,6	19,2	44,6	41,6
	3	71,1	42,1	26,8	14,6	44,6	36,7
	4	62,3	40,0	24,8	9,4	44,6	33,1
	5	62,3	37,7	19,7	7,3	44,6	30,7

 

There is, above all, the discrepancy between the distribution of patients according to the stage of the disease and the value of survival rates (especially among males).

In the first stage of the disease, the one-year survival rate of patients should be at least 90% (2% per year, considering the probabilities of dying from other causes), while our number of survivors is 30–50%. In the second stage, it should be about 80%, not 30%.

This indicates the presence of two processes. The first is the low level of diagnostics of tumours of this pathology. The second is the strongest administrative pressure with the requirement to constantly increase the proportion of patients diagnosed with stages I and II. Since in the list of analytical indicators for assessing the activities of the Russian Oncology Service there is no requirement to calculate the survival rates of patients at the population level based on the international standards, the state of treatment effectiveness is unknown (Fig. 3 and 4), even for specialists.

At the same time, it should be emphasized that the ongoing anti-cancer measures still contribute to the improvement of specialized care for tongue cancer patients. The five-year survival rate kept growing steadily among the male population from 15.8 to 17.9%, among females – from 25.9 to 30.7%. The positive effect was demonstrated mainly in patients with stages I and II. The fact that the diagnostic quality improved is also important. The proportion of patients with an unknown stage of the disease decreased among males from 14.5 to 7.1%, among females – from 13.2 to 6.3% (Tables 8, 9).

Survival of patients with cancer of the tongue in accordance with the detailed localization structure

In the state reporting, malignant neoplasms of the tongue are represented by two ICD-10 headings – C01 and С02 (Table 10).

 

Table 10. Distribution of headings of the tongue cancer (С01, 02) according to the fourth character of ICD-10 / Табл. 10. Распределение рубрик ЗНО языка (С01, 02) по четвертому знаку МКБ-10

С01 – Malignant neoplasm of base of tongue
С02 – Malignant neoplasm of other and unspecified parts of tongue
С02.0 – dorsal surface of tongue:
С02.1	border of tongue
С02.2	ventral surface of tongue
С02.3	anterior two-thirds of tongue, part unspecified
С02.4	lingual tonsil
С02.8	overlapping sites of tongue
С02.9	tongue, unspecified

 

PCR database provides an opportunity to study the structure and survival of patients for separate ICD headings and for the detailed characteristics of the C.02 heading (with the fourth character) as well.

Table 11 shows the detailed structure of the primary tongue cancer cases recorded in the Northwestern Federal District, along with the observed one-year and five-year survival rates of patients.

 

Table 11. The structure and survival rate of tongue cancer (C01,02) patients in the NWFD. NWFD RF PCR database (both sexes) / Табл. 11. Структура и выживаемость больных со ЗНО языка (С01, 02) в СЗФО. БД ПРР СЗФО РФ (оба пола)

Nosology		1999–2003					2004-–2008				2009–2013				2014–2017
		Abs. No	%	Survival			Abs. No	%	Survival		Abs. No	%	Survival		Abs. No	%	Survival
				1-year	5-year	10-year			1-year	5-year			1-year	5-year			1-year
С01		544		41,2	15,7	10,8	527		42,5	12,8	462		46,5	19,2	392		54,2
С02		603		45,5	20,1	17,1	593		48,5	21,3	919		52,0	23,6	1148		57,3
	.0	15	2,5	40,0	6,7	0,0	27	4,6	48,0	14,4	68	7,4	47,2	13,1	51	4,4	64,0
	.1	291	48,2	54,6	26,8	23,1	293	49,4	55,2	26,2	485	52,8	59,5	27,4	658	57,3	61,0
	.2	20	3,3	55,0	15,0	15,0	18	3,0	50,0	16,7	38	4,1	55,6	30,0	94	8,2	71,4
	.3	12	2,0	58,3	16,7	16,7	10	1,7	50,0	20,0	14	1,5	73,9	24,6	11	1,0	88,9
	.4	13	2,2	38,5	15,4	15,4	6	1,0	50,0	16,7	6	0,7	60,0	30,0	6	0,5	100,0
	.8	36	6,0	29,6	7,9	7,9	49	8,3	40,8	10,2	73	7,9	34,7	8,2	110	9,6	36,4
	.9	216	35,8	35,1	15,0	12,1	190	32,0	40,0	18,2	235	25,6	41,2	22,3	218	19,0	46,3

 

Of the two headings (5188 observations), the share of the C01 heading (malignant neoplasm of the base of the language) accounted for 1925 registered cases (37.1%), and the heading C02 (malignant neoplasm of other and unspecified parts of the language) – 3262 cases (62.9%).

It should be noted that during the first observation period (1999–2003), the C.02.9 heading (Malignant neoplasm of tongue, unspecified) accounted for 35.8% of all cases from the C02 heading, in 2014–2017 – 19.0%. The main part of the C02 heading is the C02.1 subheading – malignant neoplasm of border of tongue (from 48.2% to 57.3%). The one-year survival rate by the fourth observation period (2014–2017) for the C01 heading was 54.2%, for the C02 heading – 57.3%.

The survival rate of tongue cancer patients during the first year of follow-up increased to 100% for heading C02.4 (lingual tonsil) and up to 88.9% for heading C02.3 (anterior two-thirds of tongue, part unspecified) (Table 10).

The five-year survival rate of patients with cancer of the tongue for the three observation periods increased for the C01 column from 15.7% to 19.2%; for the heading С02 – from 20.1% to 23.6%.

Table 11 contains the rest of the data.

Survival of tongue cancer patients by histological types of tumors

To study the characteristics of the histological structure and survival of tongue cancer patients, 5188 patients were selected over the entire observation period. In 4671 (90.0%) patients, the diagnosis was histologically confirmed. The share of morphologically confirmed diagnoses was 43.7% by 2014–2017.

Over the four observation periods, the histological structure of the tongue cancer has not shown any significant changes. The most common was squamous cancer (M-8070/3, M-8071/3, M-8072-3). Adenocarcinoma NOS represent a small part. The share of the M-8000/3 rubric – Neoplasm, malignant has slightly decreased, which is, in fact, without a specific tumor histotype. The one-year survival rate of patients exceeded 50% for almost all the presented histotypes, (Table 12).

 

Table 12. Dynamics in the histological structure and survival rate of tongue cancer patients in the NWFD. NWFD RF PCR database (both sexes)) / Табл. 12. Динамика гистологической структуры и выживаемости больных со ЗНО языка в СЗФО. БД ПРР СЗФО РФ (оба пола)

…	1999–2003					2004-–2008				2009–2013				2014–2017
	Abs. No	%	Survival			Abs. No	%	Survival		Abs. No	%	Survival		Abs. No	%	Survival
			1-year	5-year	10-year			1-year	5-year			1-year	5-year			1-year
8070/3	365	31,8	53,9	23,6	19,9	416	37,1	46,6	14,9	585	42,4	52,2	22,0	718	46,6	55,4
8071/3	362	31,6	44,4	15,3	11,6	335	29,9	50,2	22,2	417	30,2	49,0	23,1	413	26,8	56,3
8072/3	128	11,2	49,0	25,3	18,0	117	10,4	58,6	21,0	122	8,8	55,0	25,6	97	6,3	58,6
8140/3	13	1,1	61,5	38,5	30,8	23	2,1	33,3	13,2	19	1,4	54,3	40,7	10	0,6	57,9
8000/3	27	2,4	25,9	11,1	11,1	17	1,5	35,3	5,9	9	0,7	44,4	33,3	26	1,7	47,8
8020/3	13	1,1	53,8	15,4	15,4	9	0,8	44,4	22,2	3	0,2	66,7	0,0	1	0,1	0,0
Group total	908	79,2				917	81,9			1155	83,6			1265	82,1
Total	1147		43,4	18,0	14,1	1120		45,7	17,4	1381		50,2	22,2	1540		56,5

Note:

M-8070/3 – Squamous cell carcinoma, NOS

M-8071/3 – Squamous cell carcinoma, keratinizing, NOS

M-8072/3 – Squamous cell carcinoma, large cell, nonkeratinizing

М-8140/3 – Adenocarcinoma, NOS

M8000/3 – Neoplasm, malignant

M-8020/3 – Carcinoma, undifferentiated, NOS

Примечания:

М-8070/3 – плоскоклеточный рак БДУ

М-8071/3 – плоскоклеточный рак ороговевающий БДУ

М-8072/3 – плоскоклеточный рак крупноклеточный неороговевающий

М-8140/3 – аденокарцинома БДУ

М8000/3 – новообразования злокачественные

М-8020/3 – недифференцированный рак БДУ

 

SUMMARY

The research has considered the characteristics of the detailed localization distribution and histological structure of the tongue cancer at the federal district level for the first time in Russia.

State of Cancer Care at the level of the federal district and a large city has been described. The effectiveness of the Russian Oncology Service has been compared to the average European survival rates of patients. The year-by-year lethality of tongue cancer patients has been considered.

The results indicate that there is a positive dynamics in the calculated rates: the median survival, year-by-year lethality, one- and five-year survival of patients. However, Russia is significantly behind the European average.

 

The Authors declare that they have no conflicts of interest.

About the authors

Vakhtang M. Merabishvili

N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation

Email: MVM@niioncologii.ru
ORCID iD: 0000-0002-1521-455X

Doctor of Medicine (MD), Professor, Chief of the Oncological Statistics Scientific Laboratory “N.N. Petrov National Medical Research Center of Oncology”, Chairman of the Scientific-Methodological Council on Development of Information Systems of Cancer Control of the Northwestern Federal District, Head of the Population-based Cancer Registry of the Northwestern Federal District of the Russian Federation

Russian Federation, Saint Petersburg

Elvira N. Merabishvili

North-Western State Medical University named after I.I. Mechnikov of the Healthcare Ministry of the Russian Federation

Email: MVM@niioncologii.ru

Ph.D. in Medicine, Senior Lecturer, Department of Human Morphology

Russian Federation, Saint Petersburg

Alexander M. Scherbakov

N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation

Email: oncl@rion.spb.ru

Doctor of Medicine (MD), Professor, Deputy Director

Russian Federation, Saint Petersburg

Alexander B. Vasilyev

Saint Petersburg Regional Charitable Foundation “Cancer Prevention”

Email: 5849898@bk.ru

Chief Medical Officer

Russian Federation, Saint Petersburg

Nikolay F. Krotov

N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation

Email: MVM@niioncologii.ru

Doctor of Medicine (MD), Professor, Leading Researcher, Head of the Scientific Department of Surgical Oncology

Russian Federation, Saint Petersburg

Alexey F. Barsukov

North-Western State Medical University named after I.I. Mechnikov of the Healthcare Ministry of the Russian Federation

Author for correspondence.
Email: MVM@niioncologii.ru

Ph.D. in Medicine, Doctor of the highest qualification category, Department of Otorhinolaryngology (ENT), Clinic named after Peter the Great

Russian Federation, Saint Petersburg

References

Supplementary files