Sarcoma Survivors Have Increased Mortality Risk

Survivors of adolescent and young adult bone and soft-tissue sarcoma have significant long-term mortality from both second cancers and noncancer-specific causes when compared with the general population, a large study showed.

In addition, the analysis of more than 25,000 patients also indicated that those survivors of chemotherapy-sensitive sarcoma subtypes experienced a significantly increased mortality risk.

“The results of the current study further emphasize the importance of vigilant screening for second malignant neoplasms and other late effects in this young population, as well as the future conduct of analytic studies to further understand underlying mechanisms to develop preventive and interventional strategies,” wrote researchers led by Paul Youn, MD, of the James P. Wilmot Cancer Center, University of Rochester Medical Center.

Data for the study were taken from the population-based Surveillance, Epidemiology, and End Results (SEER) program database, which included 28,844 survivors of adolescent and young adult bone and soft-tissue sarcoma. Together, these patients had accrued 113,206 person-years of follow-up.

Youn and colleagues investigated long-term cause-specific mortality among these patients and compared it with that of the general population. The results were published in Cancer.

Compared with the general population survivors had significantly increased mortality from causes other than the original diagnosis, equating to a standardized mortality ratio of 1.76 (95% CI, 1.60-1.92). This difference in mortality risk was observed to exist as far out as 20 years.

“However, it is important to note that 88% of all deaths were due to the original sarcoma diagnosis, which remained the predominant cause of death until ≥ 20 years of follow-up,” the researchers wrote.

Survivors were found to have twice the risk for death from a second malignant neoplasm (SMR = 2.05; 95% CI, 1.71-2.43). Second malignancy deaths were most frequently caused by respiratory and hematopoietic cancers. However, survivors were also found to have a significantly increased mortality related to noncancer causes as well (SMR = 1.66; 95% CI, 1.49-1.85). Cardiovascular disease was the most common noncancer cause of death.

Death from causes not related to their original diagnosis were the most common among survivors with chemotherapy-sensitive subtypes of sarcoma-Ewing sarcoma, osteosarcoma, and rhabdomyosarcoma-compared with non-chemotherapy–sensitive subtypes (SMR 2.76 vs 1.63).

“In recent years, treatment approaches for Ewing sarcoma, osteosarcoma, and rhabdomyosarcoma have included surgery and/or radiotherapy to achieve local control and systemic chemotherapy to prevent disease recurrence,” the researchers wrote. “Excess second malignant neoplasms among cancer survivors have been associated with antecedent exposure to anthracyclines, alkylating agents and radiotherapy.”

The researchers wrote that to their knowledge, this study was the first showing increased mortality risk among adolescent and young adult survivors of sarcoma and its associations with their original treatments.