Table 3. Risks of colorectal cancer after HL treatment; SIRs by sex, age, follow-up interval and treatment.
|
All colon sites (n=34) |
Transverse colona (n=12) |
Colon otherb (n=22) |
Rectum (n=21) |
|||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Tumour site | O | SIR | 95% CI | O | SIR | 95% CI | O | SIR | 95% CI | O | SIR | 95% CI |
|
Risk factor | ||||||||||||
| Sex | ||||||||||||
| Men | 23 | 3.3 | 2.1–5.0 | 8 | 8.5 | 3.7–16.7 | 15 | 2.4 | 1.4–4.0 | 11 | 2.9 | 1.5–5.2 |
| Women | 11 | 1.6 | 0.8–2.9 | 4 | 4.4 | 1.2–11.2 | 7 | 1.1 | 0.5–2.3 | 10 | 2.0 | 1.0–3.7 |
| Age at first HL treatment (years) | ||||||||||||
| <25 | 14 | 6.8 | 3.7–11.3 | 6 | 19.3 | 7.1–42.0 | 8 | 4.2 | 1.8–8.2 | 3 | 2.1 | 0.4–6.1 |
| 25–34 | 10 | 2.4 | 1.2–4.4 | 3 | 5.3 | 1.1–15.6 | 7 | 1.9 | 0.7–3.8 | 6 | 2.2 | 0.8–4.7 |
| 35–50 | 10 | 1.3 | 0.6–2.4 | 3 | 3.1 | 0.6–18.9 | 7 | 1.0 | 0.4–2.2 | 12 | 2.6 | 1.4–4.6 |
| Follow-up period (years) | ||||||||||||
| 5–9 | 1 | 1.0 | 0.0–5.3 | 0 | — | — | 1 | 0.9 | 0.0–5.2 | 1 | 1.4 | 0.0–7.9 |
| 10–19 | 7 | 1.7 | 0.7–3.4 | 4 | 6.7 | 1.8–17.3 | 3 | 0.8 | 0.2–2.3 | 9 | 3.2 | 1.5–6.1 |
| 20–29 | 14 | 2.8 | 1.5–4.7 | 5 | 8.1 | 2.6–18.9 | 9 | 2.1 | 0.9–3.9 | 7 | 2.2 | 0.9–4.6 |
| ⩾30 | 12 | 3.4 | 1.7–5.9 | 3 | 7.0 | 1.4–20.4 | 9 | 2.9 | 1.3–5.4 | 4 | 1.9 | 0.5–4.9 |
|
Treatment for HLc | ||||||||||||
| Treatment categoryc | ||||||||||||
| CT only | 1 | 0.6 | 0.0–3.4 | 0 | — | — | 1 | 0.7 | 0.0–3.8 | 2 | 2.0 | 0.2–7.3 |
| Supradiaphragmatic RT, no CT | 2 | 1.0 | 0.1–3.5 | 1 | 3.5 | 0.1–19.5 | 1 | 0.5 | 0.0–3.0 | 1 | 0.8 | 0.0–4.3 |
| Supradiaphragmatic RT+CT | 8 | 2.0 | 0.9–3.9 | 1 | 1.9 | 0.0–10.4 | 7 | 1.9 | 0.8–4.0 | 5 | 1.9 | 0.6–4.5 |
| Infra-±supradiaphragmatic RT, no CT | 7 | 2.2 | 0.9–4.6 | 2 | 4.9 | 0.6–17.6 | 5 | 1.8 | 0.6–4.2 | 2 | 1.0 | 0.1–3.6 |
| Infra-±supradiaphragmatic RT+CT | 16 | 5.5 | 3.1–8.9 | 8 | 19.6 | 8.5–38.6 | 8 | 3.0 | 1.3–6.0 | 11 | 5.9 | 2.9–10.5 |
| Infradiaphragmatic irradiationc | ||||||||||||
| No infradiaphragmatic RTd | 11 | 1.4 | 0.7–2.5 | 2 | 1.9 | 0.2–7.0 | 9 | 1.3 | 0.6–2.5 | 8 | 1.6 | 0.7–3.2 |
| PAO | 5 | 3.0 | 1.0–7.1 | 2 | 8.8 | 1.1–32.0 | 3 | 2.0 | 0.4–5.8 | 1 | 0.9 | 0.0–5.2 |
| PAO+spleen | 5 | 2.3 | 0.8–5.4 | 4 | 14.0 | 3.8–35.8 | 1 | 0.5 | 0.0–2.9 | 3 | 2.1 | 0.4–6.1 |
| Inverted Ye±spleen | 11 | 6.0 | 3.0–10.7 | 4 | 15.9 | 4.3–40.8 | 7 | 4.2 | 1.7–8.7 | 7 | 6.3 | 2.5–13.0 |
| Infradiaphragmatic other | 2 | 5.2 | 0.6–18.9 | — | — | — | 2 | 5.7 | 0.7–20.7 | 2 | 8.1 | 1.0–29.1 |
| CT treatment according to cumulative procarbazine dosec,f | ||||||||||||
| No CT | 9 | 1.7 | 0.8–3.3 | 3 | 4.3 | 0.9–12.6 | 6 | 1.3 | 0.5–2.8 | 3 | 0.9 | 0.2–2.7 |
| Non-alkylating CT only | 2 | 1.8 | 0.2–6.4 | 0 | — | — | 2 | 2.0 | 0.2–7.1 | 1 | 1.4 | 0.0–8.0 |
| Alkylating CT, no procarbazine | 0 | — | — | 0 | — | — | 0 | — | — | 1 | 2.0 | 0.1–11.4 |
| Alkylating CT,⩽4.2 g m−2 procarbazine | 3 | 1.7 | 0.4–5.1 | 1 | 4.4 | 0.1–24.7 | 2 | 1.3 | 0.2–4.7 | 2 | 1.8 | 0.2–6.4 |
| Alkylating CT, 4.2–8.4 g m−2 procarbazine | 7 | 2.5 | 1.0–5.2 | 2 | 5.4 | 0.7–19.5 | 5 | 2.0 | 0.6–4.6 | 10 | 5.6 | 2.7–10.3 |
| Alkylating CT,>8.4 g m−2 procarbazine | 10 | 6.1 | 2.9–11.2 | 5 | 21.9 | 7.1–51.0 | 5 | 3.3 | 1.1–7.8 | 4 | 3.9 | 1.1–9.9 |
| CT, type unknown | 3 | 5.6 | 1.2–16.4 | 1 | 13.3 | 0.3–74.2 | 2 | 4.1 | 0.5–14.8 | 0 | — | — |
| Alkylating CT,>4.2 g m−2 procarbazine | 17 | 3.8 | 2.2–6.1 | 7 | 11.7 | 4.7–24.1 | 10 | 2.5 | 1.2–4.8 | 14 | 5.0 | 2.7–8.3 |
Abbreviations: 95% CI=95% confidence interval; ABVD= doxorubicin, bleomycin, vinblastine, dacarbazine AER =absolute excess risk per 10 000 person-years; Colon other=ascending colon, descending colon, colon not otherwise specified; CT=chemotherapy; EBVP=epirubicine, bleomycin, vinblastine, prednisone; MOPP=mechlorethamine, vincristine, procarbazine, prednisone; MOPP-ABV(D)= mechlorethamine, vincristine, procarbazine, prednisone—doxorubicin, bleomycin, vinblastine, dacarbazine; O=Observed number; PAO=para-aortic; RT=radiation therapy; SIR=Standardized Incidence Ratio.
Includes transverse colon and splenic flexura.
Includes ascending colon, cecum, hepatic flexura and descending colon.
Included primary and relapse therapy. RT includes all radiotherapy fields.
No RT and supradiaphragmatic RT.
Inverted Y field consists of para-aortic and iliac nodes.
Mutually exclusive categories.