Clinical characteristics and survival patterns of subsequent sarcoma, breast cancer, and melanoma after childhood cancer in the DCOG-LATER cohort
DCOG-LATER Study Group
(2019) Cancer Causes and Control, volume 30, issue 9, pp. 909 - 922
(Article)
Abstract
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 population-based sample of similar first malignant neoplasm (FMN) patients. Methods: We assembled three case series of solid SMNs observed
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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% confidence interval (CI) 1.23–2.87] and sarcoma-specific mortality (HR 1.91, 95% CI 1.16–3.13) were significantly 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 significantly differ 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 significant differences 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 differs; breast-SMN patients less often receive breast-conserving therapy. Larger studies are necessary to substantiate these exploratory findings.
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Keywords: Childhood cancer survivors, Epidemiology, Long-term complications, Subsequent malignant neoplasm, Survival, Cancer Survivors, Humans, Male, Melanoma/epidemiology, Breast Neoplasms/epidemiology, Skin Neoplasms/epidemiology, Netherlands, Survival Analysis, Adult, Female, Neoplasms, Second Primary/epidemiology, Child, Cohort Studies, Sarcoma/epidemiology, Oncology, Cancer Research, Journal Article
ISSN: 0957-5243
Publisher: Springer Netherlands
Note: Funding Information: This study was funded by the Dutch Cancer Society (Grant Numbers DCOG2011-5027 and UVA2012-5517) and the European Union’s Seventh Framework Programme for research, technological development, and demonstration under Grant Agreement No. 257505 (PanCareSurFup). Funding Information: We thank all data managers in the seven participating centers and Aslihan Mantici for obtaining the data for this study. Furthermore, we thank the following other members of the DCOG-LATER group for their contributions: Dorine Bresters, Lilian Batenburg, Margreet Veening, Gea Huizinga, Lideke van der Steeg, Monique Jaspers, and Andrica de Vries. We thank the staff of the Netherlands Cancer Registry and Statistics Netherlands for providing data for this study. The DCOG -LATER Study Group includes the listed authors and the following collaborators BMP Aleman (The Netherlands Cancer Institute, Amsterdam). HN Caron (Emma Children?s Hospital/Academic Medical Center, Amsterdam). MA Grootenhuis (Emma Children?s Hospital/Academic Medical Center, Amsterdam, and Princess M?xima Center for Pediatric Oncology, Utrecht). JG den Hartogh (Dutch Childhood Cancer Parent Organisation (VOKK), Nieuwegein). N Hollema (Dutch Childhood Oncology Group, Utrecht). SJCMM Neggers (Erasmus Medical Center, Rotterdam). A Postma (Dutch Childhood Oncology Group, The Hague). JG de Ridder-Sluiter (Princess M?xima Center for Pediatric Oncology, Utrecht). EJT Rutgers (The Netherlands Cancer Institute, Amsterdam). Publisher Copyright: © 2019, The Author(s).
(Peer reviewed)
