gms | German Medical Science

Objectives: Primary bone cancer is a relatively rare disease, but one which results in significant morbidity and mortality. While several studies have analyzed the epidemiology of bone cancer throughout the world, detailed estimates of incidence, mortality, survival and prevalence for the adult German population are not currently available.

Methods: We analyzed population-based data on primary bone cancer from the German Centre for Cancer Registry Data (ZfKD) from 1970 to 2013. Using population data from the Federal Statistical Office of Germany, we calculated the incidence rate and mortality rate of patients older than 15 years. We also estimated the survival rates at one year and at five years after a diagnosis of bone cancer. Using incidence and survival estimates, we calculated the 5-year prevalence of bone cancer in Germany. In addition, we assessed the quality of the bone cancer data, by calculating the mortality:incidence (M:I) ratio, the proportion of death certificate-only (DCO) cases and the rate of cases coded with an unspecified ICD-O-3 code.

Results and conclusion: A total of 10,721 cases of bone cancer in adults were identified, with female patients comprising 46% of all cases. Chondrosarcoma was the most commonly reported major bone tumor type (28%), followed by osteosarcoma (23%), Ewing sarcoma (10%) and chordoma (7%). About 9% of cases were other specified tumors and 23% were coded as "unspecified". In 2013, the age-standardized incidence rate per 100,000 was 0.82 and the mortality rate per 100,000 was 0.42. The relative survival of patients with any type of bone cancer for the period 1970 to 2013 was 84% at one year and 64% at five years. The 5-year prevalence of bone cancer in Germany in 2013 was 3.2 per 100,000. Residents in the Old German Federal States had higher survival rates than those residing in the New German Federal States. The M:I ratio in 2013 was 0.52. The proportion of DCO cases in the whole cohort was very high (16%) and a large proportion of tumor staging data was missing (69-75%). The rate of DCO cases increased with age, with 79% of all DCO cases occurring in patients aged 60 years or older, and it was higher in women (18%) than men (14%). One fifth of all tumors were reported as "unspecified."

The calculated estimates could serve as reference to track nationwide outcomes of bone cancer in Germany over time. They are also an objective measure to assess the current and future needs within the German health care system for this group of patients. The increased rates of incidence and mortality are likely due to improved reporting of cases after passage of the Federal Cancer Registry Act and the requirement for compulsory registration in each German state. Further improvement of the data collected is recommended, so that more detailed prognostic estimates according to tumor staging and therapeutic options can be calculated.