The effect of information on prostate cancer screening decision process: a discrete choice experiment.

BACKGROUND: Prostate cancer screening is controversial because of uncertainty about its benefits and risks. The aim of this survey was to reveal preferences of men concerning prostate cancer screening and to test the effect of an informative video on these preferences. METHODS: A stated preferences questionnaire was sent by e-mail to men aged 50-75 with no history of prostate cancer. Half of them were randomly assigned to view an informative video. A discrete choice model was established to reveal men's preferences for six prostate cancer screening characteristics: mortality by prostate cancer, number of false positive and false negative results, number of overdiagnosis, out-of-pocket costs and recommended frequency. RESULTS: A population-based sample composed by 1024 men filled in the entire questionnaire. Each attribute gave the expected sign except for overdiagnosis. The video seemed to increase the intention to abstain from prostate cancer screening. CONCLUSIONS: The participants attached greater importance to a decrease in the number of false negatives and a reduction in prostate cancer mortality than to other risks such as the number of false positives and overdiagnosis. Further research is needed to help men make an informed choice regarding screening.

Influence of social deprivation and remoteness on the likelihood of sphincter amputation for rectal cancer: a high-resolution population-based study.

BACKGROUND: Medical care in rectal cancer is subject to social inequality. According to the last French guidelines, a 1-cm distal margin below the lower pole of the rectal tumor is now considered sufficient. This extends the limits of the current sphincter preservation gold standard. Like for other innovative technics, the dissemination of such technics is often subject to social and geographical inequalities. The objective was to analyze whether sphincter preservation in rectal cancer is subject to social or geographical inequality. METHODS: The odds of sphincter preservation was modeled by logistic regression among the 1453 patients in the Calvados digestive cancer registry between 1 January 1997 and 31 December 2015 by examining some of the variables that could influence it: social inequalities and geographical remoteness, sex, age, and stage. RESULTS: A total of 69.4% of the population received sphincter preservation. Patients in the more deprived quintiles had a significantly higher probability of having sphincter amputation (odds ratio (OR) = 1.469 (1.046-2.064)). This result was no longer significant after adjustment on stage and travel time. There was a dose-effect pattern of geographical remoteness on likelihood of sphincter preservation with a progressive increase in OR between patients living the nearest and the furthest from the reference center (p-trend = 0.0178). CONCLUSION: This study shows that the probability of receiving sphincter preservation is influenced by the social environment and strongly influenced by remoteness. Although management guidelines have had a huge impact on the rates of sphincter preservation, they have not reduced the influence of the social and geographical environment on sphincter preservation.

Predictors of adherence to repeat fecal occult blood test in a population-based colorectal cancer screening program.

BACKGROUND: Socio-economic, environmental factors and general practitioner (GP) involvement may influence adherence to repeat faecal occult blood testing (FOBT) of organised colorectal cancer (CRC) screening. The aim of the study was to identify predictors of adherence to repeat testing. METHODS: The populationcomprised people eligible for the third round of a CRC screening programme in a French district (n=118,905). Multilevel logistic regression analysis was performed to identify individual and area-level characteristics associated with 'compliant participants' participating in the all three rounds vs 'occasional participants' participating in one or two rounds. RESULTS: Compared to 'occasional participants', 'compliant participants' were more likely to participate after receiving a FOBT kit from their GP (odds ratio (OR), 10.7; 95% CI, 10.01-11.5) vs FOBT received at home, and were less likely to live in socio-economically deprived areas (OR, 0.75; 0.70-0.80) and urban areas (OR, 0.94; 0.88-1.00). CONCLUSIONS: As for a screening round participation, strategies aimed at improving the participation to a screening programme should target GPs and people living in socially deprived areas.

The influence of geographical access to health care and material deprivation on colorectal cancer survival: evidence from France and England.

This article investigates the influence of distance to health care and material deprivation on cancer survival for patients diagnosed with a colorectal cancer between 1997 and 2004 in France and England. This population-based study included all cases of colorectal cancer diagnosed between 1997 and 2004 in 3 cancer registries in France and 1 cancer registry in England (N=40,613). After adjustment for material deprivation, travel times in England were no longer significantly associated with survival. In France patients living between 20 and 90min from the nearest cancer unit tended to have a poorer survival, although this was not statistically significant. In England, the better prognosis observed for remote patients can be explained by associations with material deprivation; distance to health services alone did not affect survival whilst material deprivation level had a major influence, with lower survival for patients living in deprived areas. Increases in travel times to health services in France were associated with poorer survival rates. The pattern of this influence seems to follow an inverse U distribution, i.e. maximal for average travel times.

Management of colorectal cancer explains differences in 1-year relative survival between France and England for patients diagnosed 1997-2004.

BACKGROUND: Few international population-based studies have provided information on potential determinants of international disparities in cancer survival. This population-based study was undertaken to identify the principal differences in disease characteristics and management that accounted for previously observed poorer survival in English compared with French patients with colorectal cancer. METHODS: The study population comprised all cases of colorectal cancer diagnosed between 1997 and 2004 in the areas covered by three population-based cancer registries in France and one in England (N=40 613). To investigate the influence of clinical and treatment variables on survival, we applied multivariable excess hazard modelling based on generalised linear models with Poisson error. RESULTS: Poorer survival for English patients was primarily due to a larger proportion dying within the first year after diagnosis. After controlling for inter-country differences in the use of chemotherapy and surgical resection with curative intent, country of residence was no-longer associated with 1-year survival for advanced colon cancer patients (excess hazard ratio (EHR)=0.99 (0.92-1.01), P=0.095)). Longer term (2-5 years) excess hazards of death for colon and rectal cancer patients did not differ between France and England. CONCLUSION: This study suggests that difference in management close to diagnosis of colon and rectum cancer is related to differences in survival observed between France and England. All efforts (collection and standardisation of additional variables such as co-morbidity) to investigate the reasons for these disparities in management between these two countries, and more generally across Europe, should be encouraged.

European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition--Faecal occult blood testing.

Multidisciplinary, evidence-based guidelines for quality assurance in colorectal cancer screening and diagnosis have been developed by experts in a project coordinated by the International Agency for Research on Cancer. The full guideline document covers the entire process of population-based screening. It consists of 10 chapters and over 250 recommendations, graded according to the strength of the recommendation and the supporting evidence. The 450-page guidelines and the extensive evidence base have been published by the European Commission. The chapter on faecal occult blood testing includes 21 graded recommendations. The content of the chapter is presented here to promote international discussion and collaboration by making the principles and standards recommended in the new EU Guidelines known to a wider professional and scientific community. Following these recommendations has the potential to enhance the control of colorectal cancer through improvement in the quality and effectiveness of screening programmes and services.

[Elements of completeness and results of the first year of registration of the "Registre général des cancers de Lille et de sa région"]. / Éléments d'exhaustivité et résultats pour la première année d'enregistrement du Registre général des cancers de Lille et de sa région.

BACKGROUND: In 2005, following the first cancer plan of the national health authorities, a general cancer registry was established in northern France, in a territory designated as a "zone in proximity to the city of Lille" (ZPL). The aim of the present work was to evaluate the completeness of the registry's first year of incident cancer registration (2005) and to compare the observed cancer incidence in the "ZPL" with the estimated incidence in France. METHODS: Completeness was assessed using the average number of sources per case, the percentage of histological verification and a method of independent case ascertainment (mortality/incidence ratio). A direct standardization on the world population was used to calculate the ZPL/France ratios of standardized incidence rates. Analyses were conducted for 21 cancer sites. RESULTS: In 2005, 3635 cases of invasive cancer were recorded by the registry. The average number of sources per case was 2.7 and histological proof was available for 91.4% of cases. Mortality/incidence ratios showed satisfactory completeness of the data for men for most cancer sites. For women however, for cancer sites for which the number of cases was low, data will have to be confirmed during the subsequent years of observation. A lack of completeness was found for cutaneous melanoma. In men, an overincidence was identified for cancers of lip-mouth-pharynx, larynx, esophagus, lung, liver, bladder, kidney and colon-rectum. In women, an overincidence has been identified for cancers of lip-mouth-pharynx, liver, bladder, colon-rectum, corpus uteri and ovaries. CONCLUSION: The first year of incidence validated at the "Registre général des cancers de Lille et de sa région" shows a completeness of records with regards to studied criteria. The comparison with national data shows an overincidence of cancers related to tobacco and alcohol consumption in the geographical area covered by the registry. The incidence of lip-mouth-pharynx cancer in men is the highest of all French registries.

Influence of socioeconomic environment on survival in patients diagnosed with esophageal cancer: a population-based study.

The influence of social environment on survival in patients with cancer has been demonstrated in many studies, subjects living in the most deprived areas having a poorer prognosis. Geographic remoteness and limited access to specialized care centers are often associated with socioeconomic deprivation. The aim was to assess the influence of social environment and geographic remoteness on the relative survival of patients diagnosed with esophageal cancer between 1997 and 2004 in the department of Calvados in France. The study population, which was provided by the Calvados digestive cancer registry, included 629 patients. Relative survival was used to estimate the influence of social environment and geographic remoteness on patient survival. Five-year survival rates were 14.1%, 15.1%, 11.8%, 8.8%, and 11.4%, respectively, for patients living in the least to the most deprived areas (P= 0.39). The influence of social environment was significant after adjustment for clinical variables, patients living in the most deprived areas having the worst survival. These discrepancies cannot totally be explained by differences in access to care, cancer extension, or morphology at diagnosis. No association was observed between distance to the nearest cancer center and survival. Social environment appears to induce disparities among patients diagnosed with esophageal cancer, with a worse prognosis for patients living in the most deprived areas.

Pulmonary nodules detected by thoracic computed tomography scan after exposure to asbestos: diagnostic significance.

OBJECTIVE: To analyse the relationship between pulmonary nodules detected by radiologists using computed tomography and cumulative exposure to asbestos or asbestos-related pleuro-pulmonary diseases in 5662 asbestos-exposed subjects, and the relationship between pulmonary nodules and thoracic cancer, to determine whether a specific surveillance strategy based on cumulative asbestos exposure should be adopted. DESIGN: Standardised incidence and mortality ratios (SIR) for lung cancer and pleural mesothelioma were calculated in patients with and without mention of pulmonary nodules and compared using comparative morbidity figures. RESULTS: A significant excess incidence of primary lung cancer and pleural mesothelioma was observed among subjects presenting with pulmonary nodule(s) (SIR respectively 1.95, 95%CI 1.22-2.95, and 11.88, 95%CI 3.20-30.41). However, there was no significant relationship between pulmonary nodules mentioned by radiologists and cumulative asbestos exposure or between pulmonary nodules and the presence of asbestos-related benign diseases. CONCLUSIONS: This study confirms the expected excess prevalence of lung cancer in subjects presenting with pulmonary nodules according to the radiologist's report, and shows the absence of relationship between the presence of nodules and level of cumulative asbestos exposure. Our study therefore offers no argument in favour of specific surveillance modalities based on estimated cumulative asbestos exposure.

Indirect comparison of two quantitative immunochemical faecal occult blood tests in a population with average colorectal cancer risk.

Magstream and OC Sensor quantitative immunochemical faecal occult blood tests (IFOBT) have shown better performances than guaiac (G) tests in colorectal cancer screening, however Magstream and OC Sensor have never been compared. We hypothesized that similar performances could be observed with Magstream and OC Sensors, provided a similar cut-off (expressed in concentration of haemoglobin in the stools) is used. We performed a literature-based indirect comparison between these tests, taking into account the cut-off, the number of samples, and the way they were combined (I(2+): at least one positive sample of 2; I(2++): both positive samples; I(1): only one sample). Six studies conducted in general average-risk populations were included in this review. For each [test]*[cut-off], positivity rate (PR) decreased and predictive positive value (PPV) increased from I(2+) to I(1) and I(2++.) For similar PR, PPV with OC Sensor was greater than with Magstream. This could be due to factors other than the test, because PPVs associated with GFOBT in studies evaluating OC Sensor were greater than PPVs associated with GFOBT in the study evaluating Magstream. Direct comparison between Magstream and OC Sensor is needed to confirm the suspected superiority of OC Sensor.

[Epidemiology of oral cavity cancers in France]. / Épidémiologie des cancers de la cavité buccale en France.

INTRODUCTION: We had for objective to describe the updated epidemiology of oral cancers in France. MATERIAL AND METHODS: Estimates made from data collected from various French cancer institutions. The distribution by topography, histology, regions, mean age, and specific incidence rates were calculated from the collected data. The survival data was taken from the Francim network studies. RESULTS: Approximately 7000 oral cavity cancers were diagnosed in France in 2005. In 2007, 1746 people died of that cancer. Standardized (world population) incidence rates are respectively, in men and women, 12.3 and 3.0 cases per 100,000 person-years. These cancers have significantly decreased in men: the standardized incidence rate decreased by 43.2% between 1980 and 2005. Among women, the trend is reversed with an increased incidence of 51.7% over the same period. CONCLUSION: In France, the incidence of oral cavity cancers has been strongly decreasing in men and strongly increasing in women. This trend should be compared to the frequency of the main risk factors: alcohol and tobacco.

[Diversity of incidence trend patterns: implications for carcinogenesis?]. / Diversité des modèles d'évolution des incidences: implication en cancérogenèse?

OBJECTIVE: Cancers of the ENT, oesophagus and lungs are caused mainly by alcohol and/or tobacco consumption but have potentially heterogeneous latencies and dose-incidence relationships. The incidence of cancers having the same risk factors may vary in a similar way over time and space. The aim of the study was to identify groups of cancers with similar spatio-temporal incidence trends. METHODS: Fifty thousand nine hundred and eighty cases of ten cancer types were collected between 1982 and 2002 in six French departments. The incidence levels and trends were assessed using an age-cohort random-effect model that took into account heterogeneity of incidence levels and trends between departments. RESULTS: Three groups of cancer sites/types with similar spatio-temporal incidence trends were identified: (1) oral cavity, oropharynx, hypopharynx, larynx, oesophagus, and lung squamous cell carcinomas in which the incidence decreased similarly in time and space; (2) other types of lung cancer and lung adenocarcinomas whose incidence increased similarly; and (3) lung large- and small-cell carcinomas whose incidence trends were heterogeneous. CONCLUSION: Using the tools of descriptive epidemiology different cancer groups with different temporal and spatial incidence trends were identified. This diversity suggests different latencies and different sensitivities of those groups to the main risk factors, alcohol and tobacco.

[Social inequalities in health from observational studies to intervention: can the patient navigator reduce social inequalities in cancer patients?]. / Inégalités sociales, de santé du constat à l'action - Intérêt de la mise en place d'un accompagnement personnalisé pour la réduction des inégalités sociales en cancérologie.

The impact of social factors on healthcare inequality is well-recognized in many industrialized countries and involves a wide range of pathological conditions (cardiovascular disease, cancer, etc.). In general, the poorest indicators of health are observed in socially disadvantaged populations. Beyond this observation is the question of actions taken to prevent the formation of social inequality in healthcare. The purpose of this work was to evaluate the potential contribution of an intervention tool called the "patient navigator", used in English-speaking countries and to determine its feasibility in France.

[Social and geographical determinants of cancer care management in France - colorectal cancer incidence in Calvados from 1997 to 2004]. / Déterminants socio-géographiques de la prise en charge des cancers en France - Exemple des cancers colorectaux incidents entre 1997 et 2004 dans le département du Calvados.

BACKGROUND: Numerous studies have underlined an important deprivation gap in survival in all industrialized countries, prognosis being constantly poorer for the most deprived patients. Beside clinical factors, the explanation of this gap in survival could be partly explained by the influence of socio-geographical environment on cancer care management. The aim of this retrospective population-based study was to investigate the influence of socio-geographical determinants on access to a reference care centre. METHODS: The study population included all colorectal cancer patients with surgical treatment diagnosed between 1/01/1997 and 31/12/2004 in Calvados (n=2318). Individual clinical data were supplied by the Calvados registry of the gastrointestinal tumors. Beside geographical variables (distance to nearest cancer center), aggregate socioeconomic data were derived from the last exhaustive census organized by the national statistics institute (INSEE) in 1999. The Townsend deprivation index was used for this study. Due to the hierarchical structure of such variables, a multilevel logistic model was used (Level 1: Patients; Level 2: IRIS2000). RESULTS: After adjustment on the individual variables, most remote patients were less frequently treated in a reference care center than those who were living near a reference care center (Odds Ratio adjust=0.20 [0.15-0.28], p-trend<0.001). Patients living in an IRIS2000 with high medical density were more likely to receive surgical treatment in a reference care centre (p-trend=0.05). Townsend Deprivation index was not associated with access to reference care center. CONCLUSION: Access to a reference care center was strongly determined by the distance to nearest care center. Dissemination of clinical guidelines and improvement in treatment in non-reference care centers are crucial in ensuring equality in health care.

Survival improvement in Child-Pugh C cirrhotic patients with hepatocellular carcinoma diagnosed during 1990-2002.

OBJECTIVES: The aim of this study was to describe the evolution of diagnostic modalities, treatment and survival in cases of hepatocellular carcinoma (HCC) between 1990 and 2002 in Calvados. METHODS: All cases registered as HCC in the Calvados Tumour Registry from 1990 to 2002 were retrospectively reviewed. Incidence rates were standardized in comparison to the world reference population. The Kaplan-Meier method was used for survival analysis, and the log-rank test and Cox's model were used to compare patient survival according to demographic and tumour characteristics, as well as diagnosis period. Multivariate analysis were performed to determine independent prognostic factors and to assess the impact of the diagnosis period on survival. RESULTS: From 1990 to 2002, 729 cases registered as HCC were retrospectively validated. Standard incidence rates were 11.1/100,000 in men and 1.9/100,000 in women. Mean age was 66.6+/-11.8 years. Cirrhosis was present in 90.4% of cases. The cause of cirrhosis was alcohol in 66.8% of cases, HCV in 12.5%, HBV in 2.9%, haemochromatosis in 3.5%, and "other" in 13.1%. Curative treatment was possible in 14.7% of cases. Median survival was 7.15 months. On multivariate analysis, male gender, age greater than 70 years, Child-Pugh C (advanced-stage) cirrhosis, portal or suprahepatic venous thrombosis, alpha-fetoprotein (AFP) level greater than 200 ng/mL and non-curative treatment were poor prognostic factors. However, the diagnosis period was a good prognostic factor, associated with survival improvement over time in Child-Pugh C patients independent of tumour size, but not in Child-Pugh A and B. CONCLUSION: From 1990 to 2002, improvement in the survival of Child-Pugh C cirrhosis patients with HCC was observed that was apparently essentially attributable to better management of cirrhosis, and an improved balance between treatment and the degree of portal hypertension and hepatocellular insufficiency.

A population-based study of adjuvant chemotherapy for stage-II and -III colon cancers.

BACKGROUND: Although clinical trials have demonstrated that adjuvant chemotherapy improves survival for stage-III colon cancer, the benefits remain controversial for stage-II lesions. The objective of the present study was to determine the extent to which adjuvant chemotherapy is used for patients with stage-II and -III colon cancers. METHODS: The study population comprised 1074 patients with stage-II and -III colon cancers diagnosed in 2000 in 12 French administrative districts and recorded in population-based cancer registries. Data were collected using a standardized procedure. RESULTS: Overall, 20.4% of patients with stage II and 61.9% with stage III received adjuvant chemotherapy. Age at diagnosis was the strongest determinant of chemotherapy. Among stage-II patients, those receiving chemotherapy decreased from 57.6% in patients aged or=85. The corresponding percentages with stage III were 93.6% and 1.4%. In multivariate analyses, other factors found to be independently and significantly associated with administration of adjuvant chemotherapy for stage II were extension of the cancer (stage IIA vs. stage IIB), clinical presentation (obstruction or perforation vs. uncomplicated cancer) and discussion of the case at a multidisciplinary case-review meeting. For stage III, apart from age, discussion of the case at a multidisciplinary meeting was the only factor independently associated with administration of chemotherapy. CONCLUSION: Adjuvant chemotherapy for stage-III colon cancer is used extensively for patients under 75 years of age. However, many elderly patients do not receive such treatment. On the other hand, a substantial percentage of stage-II colon cancer patients receive adjuvant chemotherapy despite its uncertain benefits.

Socioeconomic determinants for compliance to colorectal cancer screening. A multilevel analysis.

BACKGROUND: Compliance in cancer screening among socially disadvantaged persons is known to be lower than among more socially advantaged persons. However, most of the studies regarding compliance proceed via a questionnaire and are thus limited by self-reported measures of participation and by participation bias. This study aimed at investigating the influence of socioeconomic characteristics on compliance to an organised colorectal cancer screening programme on an unbiased sample based on data from the entire target population within a French geographical department, Calvados (n=180 045). METHODS: Individual data of participation and aggregate socioeconomic data, from the structure responsible for organising screening and the French census, respectively, were analysed simultaneously by a multilevel model. RESULTS: Uptake was significantly higher in women than in men (OR=1.33; 95% CI 1.21 to 1.45), and significantly lower in the youngest (50-59 years) and in the oldest (70-74 years) persons, compared with intermediate ages (60-69 years), with OR=0.70 (95% CI 0.63 to 0.77) and OR=0.82 (95% CI 0.72 to 0.93), respectively. Uptake fell with increasing level of deprivation. There was a significant difference of uptake probability between the least deprived and the most deprived areas (OR=0.68; 95% CI 0.59 to 0.79). No significant influence of the general practitioners density was found. CONCLUSION: Multilevel analysis allowed to detect areas of weak uptake linked to areas of strong deprivation. These results suggest that targeting populations with a risk of low compliance, as identified both socially and geographically in our study, could be adopted to minimise inequalities in screening.

Evolution of pleural cancers and malignant pleural mesothelioma incidence in France between 1980 and 2005.

The evolution of pleural cancers and malignant pleural mesothelioma incidence in France between 1980 and 2005 was analysed using data derived from the French network of cancer registries (FRANCIM) and the French National Mesothelioma Surveillance Program (PNSM). Mesothelioma proportions in pleural cancers were calculated by diagnosis year in the 1980-2000 period. Our results suggest that the incidences of pleural cancer and mesothelioma levelled off in French men since 2000 and continued to increase in French women. A decrease of the annual pleural cancer incidence average in men was noticed (-3.4% of annual rate of change) between 2000 and 2005. The proportion of pleural cancers that were mesothelioma was unchanged between 1980 and 2003 with an average of 86%. The age standardised incidence rate of pleural mesothelioma remained relatively stable between 1998 and 2005 with a slight falling trend. For women, the age standardised incidence rate of pleural cancers and mesothelioma increased during the period 1998-2005. Additionally, the proportion of pleural cancers that were mesothelioma increased during the same period of time. Finally, the increased trend observed in the incidence of pleural mesothelioma and cancers in women is credibly due to their under diagnosis in the 1980-1997 period. The comparison between the French incidence and the American and British ones shows that the decreasing trend in incidence of mesothelioma and pleural cancers in French men since 2000 is potentially associated with a lower amphibole consumption and by the implementation of safety regulations at work from 1977.

Pancreatic cancer: incidence, treatment and survival trends--1175 cases in Calvados (France) from 1978 to 2002.

AIM: To assess the trends in incidence, therapeutic modalities and survival of pancreatic cancer between 1978 and 2002 in a well-defined population, as recorded in the Calvados digestive cancer registry database. PATIENTS AND METHODS: All patients living in Calvados with a diagnosis of pancreatic cancer were registered. Clinical data and treatment modalities were prospectively recorded. This 25-year database was divided into five 5-year periods. Data were compared using log-rank tests and the Cox model. RESULTS: A total of 1175 cases of pancreatic cancer (617 men, 558 women) were registered. Its incidence increased with an average annual coefficient of +2.8% in men and +5.1% in women. Therapeutic modalities changed over the five time periods: surgical resection increased from 6.8 to 13.4% (median survival 15 months) while radiation therapy and/or chemotherapy also increased from 5.5 to 13.2%. Palliative surgery decreased from 54.6 to 32.0% and favored interventional endoscopic techniques. Postoperative mortality decreased significantly. Survival increased significantly over the five time periods, although the median survival time remained stable (4 months). CONCLUSION: From 1978 to 2002, pancreatic cancer incidence increased in Calvados (France). Therapeutic modalities changed, with endoscopic treatments preferred over palliative surgery. The improvement in survival could be explained by the decrease in postoperative mortality.

[Current management and prognosis of intrahepatic cholangiocarcinoma in France]. / Prise en charge et pronostic du cholangiocarcinome intrahépatique en France.

INTRODUCTION: Intrahepatic cholangiocarcinoma (ICC) is a rare tumor with a poor prognosis. The aim of this study was to evaluate current management and prognosis of ICC in nine French administrative areas, which are covered by population-based cancer registries. METHODS: Between 1997 and 1998, 1100 cases of primary liver cancer were observed in nine French departments: 68 were ICC. Clinicopathological characteristics and applied treatments were recorded and a comparative analysis and a 5-year survival study were performed. RESULTS: In most cases (85%), the presence of symptoms was the principal mode of discovery. Histological confirmation revealed ICC in two thirds of cases. The remaining liver was normal in 72% of cases (patients with cirrhosis: 12%). The mean size of tumours was 6 cm. Metastases were present in one out of four cases. Surgical management, chemotherapy and radiotherapy were performed in 40%, 20% and 11.5% of patients, respectively. Hepatic surgical resection was correlated with age and bilirubin level. One third of the patients were treated for symptoms. Five-year survival rate was 7.4% and median survival was 7 months. Patients with hepatic surgical resection had 5-year survival rate of 24.5%. CONCLUSION: At present, complete resection is the only therapy offering possible long-term survival in this entity. New adjuvant chemotherapy after surgery must be offered to these patients.