Abstract
BackgroundCancer-specific survival estimates rely on precise and correct data on the cause of death; however, these data can be difficult to acquire, particularly in elderly patients where comorbidity is common. Furthermore, while some deaths are directly related to cancer, others are more complex, with cancer merely contributing. Another, more precise, method is to assess the relative mortality, i.e., mortality in patients compared to the general population. The aims of this study were to describe the relative mortality in soft tissue sarcoma, and to compare the relative mortality with the cancer-specific mortality.MethodsWe included 1246 patients treated for soft tissue sarcoma and 6230 individually age- and sex-matched individuals from the general population. The relative mortality was estimated as rates, and rate ratios adjusted for comorbidity. Mortality rate ratios were computed using the Cox proportional hazard model for 0–5 years and 5–10 years, according to age, sex and level of comorbidity. The cancer-specific mortality was compared to the corresponding relative mortality.ResultsThe overall 5- and 10-year relative mortality was 32.8% and 36.0%. Patients with low-grade soft tissue sarcoma did not have increased mortality compared with the general population. Soft tissue sarcoma patients had a 4.4 times higher risk of dying within the first five years after diagnosis and a 1.6 times higher risk between five and ten years compared with the general comparison cohort. The relative mortality varied according to age, grade, stage at diagnosis, and level of comorbidity, being highest in younger patients and in patients without comorbidity. The overall 5- and 10-year cancer-specific mortality was underestimated by 1.5 and overestimated by 0.7 percentage points compared to the relative mortality, respectively. No statistical significant difference between the relative and the cancer-specific mortality was found.ConclusionThe relative mortality provides an unbiased and accurate method to differentiate between cancer-specific and non-cancer-specific deaths. However, when data on the cause of death is of a sufficient quality, there is no difference between relative mortality and disease-specific mortality based on death certificates.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2407-14-682) contains supplementary material, which is available to authorized users.
Highlights
Cancer-specific survival estimates rely on precise and correct data on the cause of death; these data can be difficult to acquire, in elderly patients where comorbidity is common
For each soft tissue sarcoma patient registered in the Aarhus Sarcoma Registry we identified 5 age- and sex-matched individuals from the general population, who were alive at the date of sarcoma diagnosis, had not previously been diagnosed with a sarcoma, and lived in the same geographical area as the soft tissue sarcoma patient
Descriptive data We identified 1246 soft tissue sarcoma patients and 6230 general comparison cohort individuals
Summary
Cancer-specific survival estimates rely on precise and correct data on the cause of death; these data can be difficult to acquire, in elderly patients where comorbidity is common. While some deaths are directly related to cancer, others are more complex, with cancer merely contributing. Using cancer-specific measures entails two potential problems; Assessing cancer-specific mortality relies on precise and correct data on the cause of death; these data can be difficult to achieve, in elderly patients where comorbidity is common. While some deaths are directly related to cancer, others are more complex, with cancer merely contributing to the death [17]. In these cases, assigning death as either cancer-specific or not can be problematic and ambiguous
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