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Resume Introduction L’incidence, la mortalite, la survie et la prevalence sont des indicateurs epidemiologiques fondamentaux pour evaluer les politiques de sante publique et estimer les besoins en prise en charge de la population. L’objectif de cet article est de presenter les dernieres actualisations de ces indicateurs et s’inscrit dans l’objectif 15 du Plan Cancer 2014–2019 « Appuyer les politiques publiques sur des donnees robustes et partagees ». Methodes Les donnees d’incidence observee et de survie etaient issues des registres de cancers. Les donnees de mortalite provenaient du Centre d’epidemiologie sur les causes medicales de deces. La prevalence etait calculee a partir des estimations nationales d’incidence observee et de survie. Resultats En 2017, le nombre de nouveaux cas de cancers en France metropolitaine etait estime a 399 500 et le nombre de deces a 150 000. Les cancers les plus frequents (sein, prostate) avaient des survies nettes elevees : respectivement 78 % et 84 % a 10 ans. Plusieurs cancers (dont les cancers pulmonaires, hepatiques, pancreatiques) avaient un mauvais pronostic (survie ≤ 33 % a 5 ans). En 2017, 1 396 000 hommes et 1 359 000 femmes avaient eu un cancer dans les 15 annees precedentes, soit respectivement 5,4 % et 4,8 % de la population âgee de 15 ans et plus. Discussion Bien que la mortalite par cancer baisse, le pronostic reste mauvais pour certains cancers et la prevalence est elevee. Ceci souligne la necessite d’intensifier les efforts deja deployes en matiere de prevention, de diagnostic et de traitement du cancer et de s’interesser a l’apres-cancer.

Actually, pancreatic cancer is a major challenge in digestive oncology. Its prognosis remains very poor with a five-year net survival less than 10%. Although if pancreatic cancer incidence was low, data from French digestive cancer registries show a dramatic increase in recent years, more marked in women (annual variation of +3.6% between 1982 and 2012) than in men (+2.3%). The currently recognized risk factors like tobacco or obesity cannot explain this evolving epidemiology. Moreover, progress in understanding pancreatic carcinogenesis is still insufficient. Except for familial aggregation, systematic screening couldn't be proposed.

The incidence of colorectal cancer increased in France until the 2000s' then decreased. Time trends in incidence for this cancer varied according to its sublocation along the gut. Incidence increased for right and left colon cancers, whereas it remained stable for sigmoid cancers in males and decreased in females. Incidence decreased over time for rectal cancers. The proportion of colorectal cancer in the overall French cancer prevalence is 12%. In 2008, 121,000 patients had a colorectal cancer diagnosed in the 5 previous years. The cumulative risk of colorectal cancer increased from 3.9% for males born around 1900 to 4.9% for those born around 1930 and then slightly decreased, being 4.5% among those born around 1950. It remained at the same level for females and was 2.9% for those born around 1950. The prognosis of colorectal cancer improved over time. Net 5-year survival increased in males from 53% for cancers diagnosed between 1989 and 1991 to 58% for those diagnosed between 2001 and 2004. The highest improvement of 10 year survival rates concerned left colon and rectosigmoid junction (+19% in a decade). The progressive set up of national colorectal screening since the early 2000's and the introduction of recent immunological tests in 2015 should decrease the mortality for this cancer and, at term, should decrease its incidence too.

Hepatic metastases from colorectal cancer represent a serious complication, often at the origin of death. Very few studies allow to know their epidemiological characteristics. From available data the proportion of colorectal cancer with synchronous liver metastases is 15% and the 5 year cumulative risk of metachronous metastases is 16%. According to Côte-d'Or data, it was 4.6% for TNM stage 1 cancer, 14.1% for stage 2 and 32.0% for stage 3. Taking into account incidence and prevalence of colorectal cancer it can be estimated that the number of synchronous hepatic metastases is 5,400 per year and the number of metachronous hepatic metastases 9,000 per year. In the Côte-d'Or area 6.5% of synchronous hepatic metastases, were resected for cure and 21% of metachronous hepatic metastases. The survival rates for synchronous hepatic metastases were 31% at 1 year and 2% at 5 year. The corresponding rates for metachronous metastases were 31% and 4%. After surgery for cure the 5 year survival rate was 11% for synchronous metastases and 16% for metachronous metastases. Population based data indicates that liver metastases from colorectal cancer represent a frequent problem and are more frequent that suggested by hospital-based data.

The aim of a registry is to obtain information from all new cases in a well defined geographic area. They represent a source of data of great scientific quality. They have the double interest of describing and monitoring the cancer risk and to conduct research from collected data or punctual investigations. In the field of descriptive epidemiology, they allow to estimate national incidence, to predict times trends in incidence, to estimate the prevalence or to analyse the geographic distribution of cancers. It is important to dispose of representative health care practices information, really in use, those of specialised centres series being affected by selection bias. Population-based survival, as computed by cancer registries is an indicator of the effectiveness of health systems in cancer control. In the field of analytic epidemiology, information is measured at an individual level in the aim of identifying risk factors. For such studies a cancer registry is not indispensable but the constituted net correspondent make them easier in a rapid identification of new cases and in avoiding many bias. Population-based registries are also an essential tool for the evaluation of organized mass-screening programmes.

Colorectal cancer is one of the most common malignancies in France and predominantly affects older patients. Few studies evaluating baseline quality of life of those patients, its short term evolution and its prognosis value on patients' survival have been performed in the context of a population-based study. This work is based on a prospective longitudinal cohort study performed by the Burgundy Digestive Cancer Registry. All patients aged 65 and over, diagnosed with a new colorectal cancer and registered by the Registry between 2003 and 2005 were eligible. Among the 401 eligible patients, 246 fulfilled at least one questionnaire. Non-respondents were older and diagnosed with a more advanced cancer stage.Patients' quality of life improved with time. Quality of life was affected neither by the presence of adjuvant treatment, nor by the palliative or curative intent of cares. Quality of life was an independent prognosis factor of survival, only when assessed by patients themselves. The agreement between the levels of quality of life declared by patients and the level of quality of life estimated by patients' general practitioner was low. In conclusion, this study shows that quality of life is of major importance when evaluating elderly colorectal cancer patients' care. For those patients, adjuvant treatment did not seem to impact quality of life or its evolution with time, suggesting that chronological age should not determine candidacy for treatments. Lastly, it underlines the value of elderly patients' rating of their quality of life in the context of a population based study, even if getting this assessment is challenging.; Par sa fréquence et sa gravité, le cancer colorectal pose un problème majeur de santé publique en France et touche majoritairement les sujets âgés. Peu d’études évaluant la qualité de vie au diagnostic de ces patients et son impact sur leur survie ont été menées en population générale. Ce travail s'appuie sur une étude de population réalisée par le Registre Bourguignon des cancers digestifs portant sur les patients âgés de 65 ans ou plus et diagnostiqués entre 2003 et 2005 en Saône et Loire. Parmi les 401 patients éligibles, 246 ont renvoyé un questionnaire à au moins un des temps d'étude. Les non-répondeurs étaient plus âgés et diagnostiqués avec un stade tumoral plus avancé. La qualité de vie des patients s'améliorait avec le temps. Elle n'était pas modifiée par la présence de traitements adjuvants. La qualité de vie au diagnostic était un facteur pronostique indépendant de la survie des patients quand elle était évaluée par les patients eux-mêmes. La concordance entre le niveau de qualité de vie déclaré par les patients et l'appréciation de leur qualité de vie par le médecin traitant était moyenne à faible En conclusion, cette étude montre que chez les patients âgés, l'administration d'un traitement adjuvant n’entraîne pas d'altération de la qualité de vie à court et moyen terme, confirmant la nécessité de ne pas prendre uniquement en compte l'âge chronologique lors de la décision thérapeutique. Enfin, elle souligne l'importance de l'évaluation de la qualité de vie par le patient lui-même, y compris dans un contexte d'étude épidémiologique en population réalisée auprès de patients âgés dont il est parfois difficile d'obtenir la participation à une étude.