Table 2.
Standardized mortality ratios and frequency of death among survivors of early-AYA and matched childhood cancer, overall and by diagnosis
| early-AYA | Childhood | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Cause of death | Group | Level | # deaths | # expected | Rate/1000 PY | SMR (95% CI) | # deaths | # expected | Rate/1000 PY | SMR (95% CI) | p-value |
| All causes | Among all patients | 1357 | 231·9 | 11·5 | 5·9(5·5-6·2) | 963 | 155·7 | 7·5 | 6·2(5·8-6·6) | 0·22 | |
| Primary diagnosis | Leukemia | 166 | 30·4 | 9·9 | 5·5(4·6-6·5) | 128 | 19·6 | 5·5 | 6·5(5·2·8·2) | 0·23 | |
| CNS | 170 | 21·8 | 14·1 | 7·8(6·6·9·2) | 113 | 12·2 | 9·0 | 9·3(7·6-11·3) | 01·8 | ||
| HL | 561 | 82·6 | 134 | 6·8(6·2·7·4) | 395 | 65·2 | 88 | 6·1(5·5·6·7) | 0·083 | ||
| NHL | 91 | 24·0 | 7·7 | 3·8(3·1-4·7) | 52 | 16·0 | 4·3 | 3·3(2·5-4·3) | 0·38 | ||
| Soft tissue sarcoma | 109 | 25·7 | 9·2 | 4·2(3·5-5·2) | 77 | 12·2 | 7·0 | 6·3(4·9-8·0) | 0·014 | ||
| Bone cancer | 240 | 45·8 | 10·7 | 5·2(4·6-6·0) | 195 | 29·6 | 8·6 | 6-6(5·7-7·7) | 0·027 | ||
| Nonrecurrent, Health-related cause | Among all patients | 711 | 149·0 | 6·0 | 4·8(4·4-5·1) | 506 | 74·4 | 4·0 | 6·8(6·2-7·4) | <·0001 | |
| Primary diagnosis | Leukemia | 57 | 17·8 | 3·4 | 3·2(2·5-4·2) | 41 | 8·0 | 1·8 | 5·1(3·5-7·4) | 0·056 | |
| CNS | 75 | 13·4 | 6·2 | 5·6(4·4-7·1) | 49 | 5·2 | 3·9 | 9·4(7·0-12·7) | 0·0066 | ||
| HL | 359 | 55·2 | 8·6 | 6·5(5·9-7·2) | 271 | 32·7 | 6·0 | 8·3(7·4-9·3) | 0·0026 | ||
| NHL | 66 | 14·7 | 5·6 | 4·5(3·5-5·8) | 32 | 7·0 | 2·6 | 4·6(3·2-6·5) | 0·92 | ||
| Soft tissue sarcoma | 49 | 17·6 | 4·2 | 2·8(2·1-3·7) | 37 | 5·8 | 3·4 | 6·4(4·6-9·0) | <·001 | ||
| Bone cancer | 101 | 29·2 | 4·5 | 3·5(2·8-4·2) | 75 | 15·4 | 3·3 | 4·9(3·9-6·1) | 0·029 | ||
| Subsequent malignant neoplasm | Among all patients | 323 | 41·5 | 2·7 | 7·8(7·0-8·7) | 221 | 18·6 | 1·7 | 11·9(10·4-13·6) | <·0001 | |
| Primary diagnosis | Leukemia | 20 | 4·6 | 1·2 | 4·4(2·8-6·9) | 17 | 2·0 | 0·7 | 8·8(5·3-14·5) | 0·042 | |
| CNS | 26 | 3·7 | 2·2 | 7·1(4·8-10·6) | 17 | 1·2 | 1·4 | 13·6(8·4-22·1) | 0·043 | ||
| HL | 172 | 16·1 | 4·1 | 10·7(9·2-12·4) | 120 | 8·2 | 2·7 | 14·7(12·3-17·6) | 0·0072 | ||
| NHL | 28 | 3·8 | 2·4 | 7·4(5·0-10·8) | 8 | 1·6 | 0·7 | 5·0(2·5-10·0) | 0·34 | ||
| Soft tissue sarcoma | 27 | 5·1 | 2·3 | 5·3(3·6-7·8) | 23 | 1·5 | 2·1 | 15·6(10·2-23·8) | <·001 | ||
| Bone cancer | 48 | 7·9 | 2·1 | 6·1(4·6-8·1) | 36 | 4·1 | 1·6 | 8·8(6·3-12·3) | 0·097 | ||
| Cardiac causes | Among all patients | 141 | 32·3 | 1·2 | 4·4(3·7-5·2) | 101 | 14·8 | 0·8 | 6·8(5·6-8·3) | <·001 | |
| Primary diagnosis | Leukemia | 11 | 3·9 | 0·7 | 2·9(1·6-5·2) | 2 | 1·4 | 0·1 | 1·4(0·4-5·6) | 03·6 | |
| CNS | 3 | 2·9 | 0·2 | 1·0(0·3-3·3) | 5 | 1·0 | 0·4 | 5·1(2·1-12·4) | 0·031 | ||
| HL | 95 | 11·7 | 2·3 | 8·1(6·6-9·9) | 70 | 6·7 | 1·6 | 10·4(8·2-13·2) | 0·11 | ||
| NHL | 11 | 3·3 | 0·9 | 3·3(1·8-6·0) | 7 | 1·5 | 0·6 | 4·8(2·3-10·1) | 0·44 | ||
| Soft tissue sarcoma | 3 | 3·8 | 0·3 | 0·8(0·3-2·4) | 3 | 1·1 | 0·3 | 2·6(0·8-8·2) | 0·14 | ||
| Bone cancer | 18 | 6·4 | 0·8 | 2·8(1·8-4·4) | 13 | 3·0 | 0·6 | 4·3(2·5-7·4) | 0·24 | ||
| Pulmonary causes | Among all patients | 58 | 7·9 | 0·5 | 7·4(5·7-9·5) | 42 | 4·1 | 0·3 | 10·3(7·6-14·0) | 0·095 | |
| Primary diagnosis | Leukemia | 7 | 0·9 | 0·4 | 8·1(3·8-17·0) | 2 | 0·5 | 0·1 | 4·2(1·0-16·7) | 0·41 | |
| CNS | 11 | 0·7 | 0·9 | 15·4(8·5-28·0) | 4 | 0·3 | 0·3 | 13·4(5·0-35·8) | 0·81 | ||
| HL | 26 | 3·0 | 0·6 | 8·6(5·9-12·7) | 23 | 1·7 | 0·5 | 13·4(8·9-20·1) | 0·13 | ||
| NHL | 6 | 0·8 | 0·5 | 8·0(3·6-17·7) | 5 | 0·4 | 0·4 | 13·5(5·6-32·3) | 0·39 | ||
| Soft tissue sarcoma | 2 | 1·0 | 0·2 | 2·1(0·5-8·4) | 3 | 0·3 | 0·3 | 9·2(3·0-28·8) | 0·11 | ||
| Bone cancer | 6 | 1·5 | 0·3 | 3·9(1·8-8·8) | 5 | 0·8 | 0·2 | 5·9(2·5-14·2) | 0·50 | ||
| Other medical causes$ | Among all patients | 188 | 67·2 | 1·6 | 2·8(2·4-3·2) | 141 | 36·9 | 1·1 | 3·8(3·2-4·6) | 0·0073 | |
| Primary diagnosis | Leukemia | 18 | 8·4 | 1·1 | 2·2(1·4-3·5) | 19 | 4·1 | 0·8 | 4·7(2·5-8·8) | 0·060 | |
| CNS | 35 | 6·2 | 2·9 | 5·7(4·1-7·9) | 23 | 2·7 | 1·8 | 8·6(5·7-13·1) | 0·12 | ||
| HL | 66 | 24·3 | 1·6 | 2·7(2·1-3·5) | 58 | 16·1 | 1·3 | 3·6(2·8-4·7) | 0·11 | ||
| NHL | 21 | 6·8 | 1·8 | 3·1(2·0-4·7) | 12 | 3·5 | 1·0 | 3·4(1·9-6·0) | 0·79 | ||
| Soft tissue sarcoma | 17 | 7·7 | 1·4 | 2·2(1·4-3·6) | 8 | 2·9 | 0·7 | 2·8(1·4-5·6) | 0·58 | ||
| Bone cancer | 29 | 13·4 | 1·3 | 2·2(1·5-3·1) | 21 | 7·5 | 0·9 | 2·8(1·8-4·3) | 0·37 | ||
| External causes | Among all patients | 91 | 82·9 | 0·8 | 1·1(0·9-1·3) | 95 | 81·3 | 0·7 | 1·2(0·9-1·5) | 0·65 | |
| Primary diagnosis | Leukemia | 10 | 12·6 | 0·6 | 0·8(0·4-1·5) | 17 | 11·6 | 0·7 | 1·5(0·8-3·0) | 0·17 | |
| CNS | 14 | 8·4 | 1·2 | 1·7(1·0-2·8) | 9 | 7·0 | 0·7 | 1·3(0·7-2·5) | 0·54 | ||
| HL | 27 | 27·4 | 0·6 | 1·0(0·7-1·4) | 37 | 32·6 | 0·8 | 1·1(0·8-1·6) | 0·57 | ||
| NHL | 10 | 9·3 | 0·8 | 1·1(0·6-2·0) | 12 | 9·0 | 1·0 | 1·3(0·8-2·3) | 0·62 | ||
| Soft tissue sarcoma | 8 | 8·1 | 0·7 | 1·0(0·5-2·0) | 3 | 6·4 | 0·3 | 0·5(0·1-1·4) | 0·27 | ||
| Bone cancer | 22 | 16·6 | 1·0 | 1·3(0·9-2·0) | 16 | 14·1 | 0·7 | 1·1(0·7-1·9) | 0·63 | ||
| Recurrence/progression of primary cancer | Among all patients | 492 | NA | NA | NA | 325 | NA | NA | NA | NA | |
| Primary diagnosis | Bone cancer | 109 | NA | NA | NA | 100 | NA | NA | NA | NA | |
| CNS | 72 | NA | NA | NA | 51 | NA | NA | NA | NA | ||
| HL | 152 | NA | NA | NA | 67 | NA | NA | NA | NA | ||
| Leukemia | 86 | NA | NA | NA | 64 | NA | NA | NA | NA | ||
| NHL | 11 | NA | NA | NA | 7 | NA | NA | NA | NA | ||
| Soft tissue sarcoma | 46 | NA | NA | NA | 35 | NA | NA | NA | NA | ||
Abbreviations: y, year; PY, person-year; SMR, standardized mortality ratio; CI, confidence interval; CNS, central nervous system; HL, Hodgkin lymphoma; NHL, non-Hodgkin lymphoma; NA, not applicable.
*
Kidney and Neuroblastoma not included due to low # of early-AYA survivors with these diagnoses.
#
and % include weighting, e.g. 1357 deaths after weighting.
$
Other medical causes: Nonrecurrent, health-related causes of death other than subsequent malignant neoplasms, cardiac causes, or pulmonary causes.