Artikel
Late excess mortality in survivors of childhood and adolescent cancer: Results from the PanCareSurFup Study
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Autoren
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Irene Schmidtmann
- Universitätsmedizin der Johannes Gutenberg-Universität, Institut für Medizinische Biometrie, Epidemiologie und Informatik, Mainz, Germany
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Julianne Byrne
- Boyne Research Institute, Drogheda, Ireland
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Humayra Rashid
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Institut für Medizinische Biometrie, Epidemiologie und Informatik, Mainz, Germany
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Desiree Grabow
- IMBEI, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Deutsches Kinderkrebsregister, Mainz, Germany
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Oskar Hagberg
- Regional Cancer Centre South, Lund, Sweden
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Edit Bardi
- Semmelweis University, 2nd Department of Pediatrics, Budapest, Hungary; Kepler Universitätsklinikum, Linz, Austria
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Florent De Vathaire
- Cancer and Radiation Unit 1018 INSERM, University Paris-Saclay, Paris, France
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Jeanette Falck Winther
- Danish Cancer Society Research Center, Childhood Cancer Research Group, Kopenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
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Thorgerdur Gudmundsdottir
- Children’s Hospital, Landspitali University Hospital, Reykjavik, Iceland
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Riccardo Haupt
- Epidemiology and Biostatistics Unit, Italian Off-Therapy Registry (OTR), Instituto Giannina Gaslini, Genua, Italy
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Michael M. Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
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Momcilo Jankovic
- Pediatric Clinic, University of Milano-Bicocca, Foundation MBBM, Mailand, Italy; Italian Off-Therapy Register (OTR), Monza, Italy
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Peter Kaatsch
- IMBEI, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Deutsches Kinderkrebsregister, Mainz, Germany
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Leontien C.M. Kremer
- Department of Pediatric Oncology, Emma Children’s Hospital/Academic Medical Center Amsterdam, Amsterdam, Netherlands; Princess Maxima Centre for Paediatric Oncology, Utrecht, Netherlands
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Claudia E. Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Department of Paediatrics, University Children’s Hospital of Bern, University of Bern, Bern, Switzerland
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Päivi Maria Lähteenmäki
- Department of Pediatric and Adolescent Medicine, Turku University and Turku University Hospital, Turku, Finland
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Cécile M. Ronckers
- Department of Pediatric Oncology, Emma Children’s Hospital/Academic Medical Center Amsterdam, Amsterdam, Netherlands; Princess Maxima Centre for Paediatric Oncology, Utrecht, Netherlands
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Carlotta Sacerdote
- Childhood Cancer Registry of Piedmont, Cancer Epidemiology Unit, Città della Salute e Della Scienza Hospital-University of Turin and Center for Cancer Prevention (CPO), Turin, Italy
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Roderick Skinner
- Northern Institute of Cancer Research, Newcastle University, Newcastle, United Kingdom; Department of Paediatric and Adolescent Haematology and Oncology, Children’s BMT Unit, Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle, United Kingdom
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Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Mailand, Italy
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Lorna Zadravec Zaletel
- Division of Radiotherapy, Institute of Oncology, Ljubljana, Slovenia
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Lars Hjorth
- Department of Clinical Sciences, Skåne University Hospital, Lund Hospital, Pediatrics, Lund, Sweden
| Veröffentlicht: | 6. September 2019 |
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Gliederung
Text
Background: Overall, mortality beyond five years after diagnosis of childhood or adolescent cancer has dropped sharply over the last 60 years. Yet mortality in long-term survivors continues to be substantially higher than in the general population. So far, little is known about the mortality risk beyond 35 years after diagnosis.
Methods: The PanCareSurFup consortium pooled data from 12 cancer registries and clinics in 11 European countries. We followed 77,423 five-year survivors of cancer diagnosed before age 20 from 1940 to 2008 to determine their risk of death, especially into their middle and older years. Median time from diagnosis was 19.0 years. This is the largest cohort of survivors with the longest follow-up available for research to date.
Results: At the end of follow-up, 9,166 patients (11.8%) had died compared to 927 expected, an SMR (standardised mortality ratio) of 9.89 (95% confidence interval (CI) 9.69 to 10.09), and AER (absolute excess risk) of 6.47 per 1000 person years (PY) (95% CI 6.32- 6.62 per PY).
The primary malignancy was the major cause of death, with cumulative mortality function for death due to primary malignancy amounting to 8.7% at 40 years after diagnosis. This compares to 4.3% due to secondary tumors, 1.8% due to cardiovascular causes, 0.8% due to infections, 1.3% due to external causes, 2.6% due to other known causes and 1.6% due to unknown causes (all at 40 years after diagnosis).
For each era of treatment, the cumulative mortality function at any time after diagnosis was lower than in every previous era of treatment. However, this is largely attributable to reduced mortality from the primary malignancy while the cumulative mortality functions from other causes of death were relatively unchanged.
We observed that mortality rates overall and for most survivors of first neoplasms (FN) followed a U-shaped curve, reaching a minimum between 20 and 30 years from diagnosis and increased from there. At 50-54 years from diagnosis the SMR overall was 3.75 (95% CI 2.85-4.83), and the AER was 20.47 per 1000 PY (CI 13.81 – 28.58 per 1000 PY). At the end of follow-up, i.e. between 45 and 60 years from diagnosis, the mortality rate exceeded that at entry (5 years after diagnosis) for survivors of most types of first malignancy.
Discussion: The PanCareSurFup Late Mortality study observed persistent excess mortality among older survivors of childhood and adolescent cancer. However, this varied by FN. These findings highlight the need for more intense surveillance of survivors and the need to raise awareness of the persistently higher health risks of childhood cancers survivors of some first neoplasms. Strategies may need to modified according to the type of FN.
The authors declare that they have no competing interests.
The authors declare that an ethics committee vote is not required.
Der Beitrag wurde bereits publiziert: Byrne, J., Schmidtmann, I., Rashid, H. , Grabow, D., Hagberg, O. , Haupt, R. et al. Variation in very late excess mortality with type of first malignancy: PanCareSurFup study of 77,423 5-year survivors of childhood and adolescent cancer. 23rd PanCare Meeting in Opatija, Croatia https://www.pancare.eu/en/meetings/opatija-2019/
References
- 1.
- University of California Berkeley (USA), Max Planck Institute for Demographic Research (Germany). Human Mortality Database. 2019 [Accessed 12 March 2018]. Available at: http://www.mortality.org
- 2.
- Grabow D, Kaiser M, Hjorth L, Byrne J, Alessi D, Allodji RS, Bagnasco F, Bárdi E, Bautz A, Bright CJ, de Vathaire F. The PanCareSurFup cohort of 83,333 five-year survivors of childhood cancer: a cohort from 12 European countries. European journal of epidemiology. 2018 Mar 1;33(3):335-49.
