Clinical characteristics and survival patterns of subsequent sarcoma, breast cancer, and melanoma after childhood cancer in the DCOG-LATER cohort
Purpose Childhood cancer survivors are at increased risk of developing subsequent malignant neoplasms (SMNs). We compared survival and clinical characteristics of survivors with SMNs (sarcoma, breast cancer, or melanoma) and a populationbased sample of similar frst malignant neoplasm (FMN) patients. Methods We assembled three case series of solid SMNs observed in a cohort of 5-year Dutch childhood cancer survivors diagnosed 1963–2001 and followed until 2014: sarcoma (n=45), female breast cancer (n=41), and melanoma (n=17). Each SMN patient was sex-, age-, and calendar year-matched to 10 FMN patients in the population-based Netherlands Cancer Registry. We compared clinical and histopathological characteristics by Fisher’s exact tests and survival by multivariable Cox regression and competing risk regression analyses. Results Among sarcoma-SMN patients, overall survival [hazard ratio (HR) 1.88, 95% confdence interval (CI) 1.23–2.87] and sarcoma-specifc mortality (HR 1.91, 95% CI 1.16–3.13) were signifcantly worse compared to sarcoma-FMN patients (foremost for soft-tissue sarcoma), with 15-year survival rates of 30.8% and 61.6%, respectively. Overall survival did not signifcantly difer for breast-SMN versus breast-FMN patients (HR 1.14, 95% CI 0.54–2.37), nor for melanoma-SMN versus melanoma-FMN patients (HR 0.71, 95% CI 0.10–5.00). No signifcant diferences in tumor characteristics were observed between breast-SMN and breast-FMN patients. Breast-SMN patients were treated more often with mastectomy without radiotherapy/chemotherapy compared to breast-FMN patients (17.1% vs. 5.6%). Conclusions Survival of sarcoma-SMN patients is worse than sarcoma-FMN patients. Although survival and tumor characteristics appear similar for breast-SMN and breast-FMN patients, treatment difers; breast-SMN patients less often receive breast-conserving therapy. Larger studies are necessary to substantiate these exploratory fndings.
|Keywords||Childhood cancer survivors · Subsequent malignant neoplasm · Survival · Epidemiology · Long-term complications|
|Persistent URL||dx.doi.org/10.1007/s10552-019-01204-z, hdl.handle.net/1765/119444|
|Journal||Cancer Causes & Control: an international journal of studies of cancer in human populations|
Teepen, J.C., Kremer, L.C.M, te Loo, M., Tissing, W.J., van der Pal, H.J, van den Heuvel-Eibrink, M.M, … Rutgers, EJT. (2019). Clinical characteristics and survival patterns of subsequent sarcoma, breast cancer, and melanoma after childhood cancer in the DCOG-LATER cohort. Cancer Causes & Control: an international journal of studies of cancer in human populations, 30(9), 909–922. doi:10.1007/s10552-019-01204-z