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Long‐term cause‐specific mortality in survivors of adolescent and young adult bone and soft tissue sarcoma: A population‐based study of 28,844 patients
Author(s) -
Youn Paul,
Milano Michael T.,
Constine Louis S.,
Travis Lois B.
Publication year - 2014
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.28733
Subject(s) - medicine , sarcoma , soft tissue sarcoma , rhabdomyosarcoma , population , epidemiology , standardized mortality ratio , confidence interval , bone sarcoma , excess mortality , pediatrics , surgery , mortality rate , pathology , environmental health
BACKGROUND Despite improved cure rates for bone and soft tissue sarcomas, to the authors' knowledge, no large population‐based study to date has evaluated long‐term cause‐specific mortality in patients diagnosed in the adolescent and young adult (AYA) age range (15 years‐39 years). METHODS A total of 28,844 survivors of AYA bone and soft tissue sarcoma, who accrued 113,206 person‐years of follow‐up, were identified in the population‐based Surveillance, Epidemiology, and End Results program. Standardized mortality ratios (SMR) and absolute excess risks (AER) (per 10,000 person‐years) were calculated to evaluate associations with histology (chemotherapy‐sensitive subtypes: Ewing sarcoma, osteosarcoma, and rhabdomyosarcoma vs all other subtypes), age, and initial therapy. RESULTS All‐cause mortality in survivors of AYA sarcoma was found to be significantly increased compared with that of the general population (SMR, 1.76; 95% confidence interval [95% CI], 1.60‐1.92 [AER of 19]), and persisted for > 20 years (SMR, 1.39; 95% CI, 1.04‐1.82 [AER of 20]). Significant excess mortality was observed for both second malignant neoplasms (SMR, 2.05; 95% CI, 1.71‐2.43 [AER of 7]) and noncancer causes (SMR, 1.66; 95% CI, 1.49‐1.85 [AER of 19]). Significant excess deaths occurred among patients with chemotherapy‐sensitive (SMR, 2.76; 95% CI, 2.20‐3.41 [AER of 32]) and nonchemosensitive (SMR, 1.63; 95% CI, 1.47‐1.80 [AER of 17]) subtypes. Significantly elevated noncancer mortality in the former group included cardiovascular disease (SMR, 2.33) and infections (SMR, 15.6), whereas significant excess deaths in the latter group included diabetes (SMR, 2.40) and infections (SMR, 2.77). CONCLUSIONS Survivors of AYA bone and soft tissue sarcoma experience significant long‐term mortality due to second malignant neoplasms and noncancer causes. Further research is needed to develop preventive and surveillance guidelines in this understudied population to prevent and reduce long‐term excess mortality. Cancer 2014;120:2334–2342. © 2014 American Cancer Society .