Munich Cancer Registry

Munich Cancer Registry Incidence and Mortality Selection Matrix Homepage Deutsch Survival Year of diagnosis 1988-1997 1998-16 Patients 467 1,895 Diseases 467 1,895 Cases evaluated 452 1,6 Creation date 8/22/18 Export date 8/9/18 Population 4.81 m BERLIN GERMANY BAVARIA MUNICH Munich Cancer Registry Cancer Registry Bavaria - Upper Bavaria Regional Center at Klinikum Grosshadern/IBE Marchioninistr. 15 Munich, 81377 Germany https://www.tumorregister-muenchen.de/en https://www.tumorregister-muenchen.de/en/facts/surv/sc81 E-ICD--C81-Hodgkin-lymphomasurvival.pdf

INDEX Page 2 of 12 Fig./Tbl. Index of figures and tables Page 1a Relative survival by period of diagnosis (chart) 3 1b Survival by period of diagnosis (table) 3 2a Survival by sex (chart) 4 2b Survival by sex (table) 4 2c Conditional survival by sex (chart) 5 2d Conditional survival by sex (table) 5 3a Relative survival by age category (chart) 6 3b Survival by age category (table) 6 4a Relative survival by Ann Arbor staging 1988+ (chart) 7 4b Survival by Ann Arbor staging 1988+ (table) 7 4c Relative survival by Ann Arbor staging 1998+ (chart) 8 4d Survival by Ann Arbor staging 1998+ (table) 8 5a Time to first progression (chart) 9 5b Time to first progression (table) 9 5c Observed post-progression survival (chart) 5d Observed post-progression survival (table) 5e Observed post-progression survival by period of progression (chart) 11 5f Observed post-progression survival by period of progression (table) 11

GENERAL Page 3 of 12 Period of diagnosis % Relative survival 1988-16 N=2,55 1 2 3 4 5 6 7 8 9 11 12 13 14 15 Figure 1a. Relative survival of patients with Hodgkin lymphoma by period of diagnosis. Included in the evaluation are 2,55 cases diagnosed between 1988 and 16. The survival results of the SEER program (Surveillance, Epidemiology, and End Results) of the American National Cancer Institute (NCI) are summarized as the period of diagnosis from to 14, and are represented by colored diamonds in order to facilitate comparisons between MCR and SEER. The presented survival curves are derived from clinical records with valid follow-up informations, which means that death certificate cases (DCO) cases are omitted from the analysis. With this one restriction, the MCR has provided populationbased statistics since 1998, collecting data on all cancer cases in the region of southern Bavaria. Historical data of previous time periods can be heavily selected, therefore, univariate survival comparisons of the presented time periods must be carefully considered. Nonetheless, all calculable survival curves are depicted to facilitate the comparison of long time follow-up analyses of relative survival between particular cancers. Period of diagnosis 1988-1997 1998-6 7+ n=4 n=5 n= obs. % rel. % obs. % rel. % obs. % rel. %...... 1 95.4 96. 94.6 95.1 93.4 94.2 2 92.4 93.3 93.1 94. 91.5 92.8 3 89.3.8 91.9 93.2.1 92. 4 87.1 88.9.8 92.6 87.5 89.9 5 85.4 87.7 89.9 92. 87.1. 6 83.9 86.5 88.9 91.5 86. 89.4 7 81.8 84.9 86.8 89.8 85. 88.7 8.5 83.9 86.3 89.7 81.9 85.8 9 79.7 83.5 85.2 88.9 79.5 83.5 84.1 88.3 11 77. 81.2 83.2 87.8 12 75.6.2 81.4 86.4 13 74.8 79.8.7 85.9 14 72.8 78. 79.4 85.1 15 71.7 77.2 76.9 83.3 Table 1b. Observed (obs.) and relative (rel.) survival of patients with Hodgkin lymphoma by period of diagnosis for period 1988-16 (N=2,55). Period of diagnosis 1988-1997 n=4 21.9% 1998-6 n=5 34.3% 7+ n= 43.8% SEER -14 n=25,498

GENERAL Page 4 of 12 Sex % Survival 1998-16 N=1,5 N=15 Sex Male n=928 57.8% Female n=677 42.2% Observed Expected Relative 1 2 3 4 5 6 7 8 9 11 12 13 14 15 Figure 2a. Survival of patients with Hodgkin lymphoma by sex. Included in the evaluation are 1,5 cases diagnosed between 1998 and 16. Sex Male Female n=928 n=677 obs. % rel. % obs. % rel. %.... 1 93.9 94.6 94.1 94.5 2 92.4 93.7 92. 92.8 3.8 92.7 91.1 92.3 4 89.1 91.5 89.2.8 5 88.4 91.4 88.4.3 6 87..6 87.9.2 7 85.1 89.2 86.3 88.8 8 83.7 88.2 86. 88.8 9 82.1 87. 85.3 88.3.8 86.3 84.5 88. 11.4 86.3 83.1 87. 12 77.8 84.1 82.5 86.6 13 76.6 83. 82.5 86.4 14 74.3 81.5 82.5 86.2 15 72.3 79.5 Table 2b. Observed (obs.) and relative (rel.) survival of patients with Hodgkin lymphoma by sex for period 1998-16 (N=1,5).

GENERAL Page 5 of 12 Sex % Conditional relative 2 / 5 year survival 1988-16 N=2,55 Sex Male n=1,163 56.6% Female n=892 43.4% Conditional 2 year survival Conditional 5 year survival 1 2 3 4 5 6 7 8 9 Time since diagnosis (years) Figure 2c. Conditional relative 2 / 5-year survival of patients with Hodgkin lymphoma by sex. For 2,55 of 2,55 cases diagnosed between 1988 and 16 valid data could be obtained for this item. Sex Male Female Cond. surv. % Cond. surv. % n 2 yrs 5 yrs n 2 yrs 5 yrs 1,163 94.2.9 892 92.2 89.1 1 1,27 97.7 94.4 784 96.2 94. 2 936 97. 93.7 7 97.2 94.9 3 848 97.8 94. 674 98. 95.9 4 763 98.2 94.4 619 99.1 97.1 5 688 97.2 94.2 562 98.1 97.6 6 612 97.4 94.9 5 98. 95.7 7 546 97.6 94.3 465 99.5 96.8 8 486 98.1 94.5 423 99.6 97.1 9 435 98.8 93.1 376 97.7 96.7 387 97.2 91.5 348 97.2 96.5 Table 2d. Conditional relative 2 / 5-year survival of patients with Hodgkin lymphoma by sex for period 1988-16 (N=2,55). Conditional relative survival rates refer to the relative survival probability, in this case for 2 and 5 years after cancer diagnosis, compared to the age- and sex-matched population (= %) under the condition of being alive for a certain time period (x-axis in Figure 2a). The results illustrate to what extent the cancer induced mortality of particular subgroups declines in the subsequent years after detection of the malignancy. For instance, according to the presented survival statistics, patients in the subgroup sex= Male, who are alive at least 3 years after cancer diagnosis, the conditional relative 2-year survival rate is 97.8% (n=848).

GENERAL Page 6 of 12 Age category % Relative survival 1988-16 N=2,55 1 2 3 4 5 6 7 8 9 11 12 13 14 15 Figure 3a. Relative survival of patients with Hodgkin lymphoma by age category. Included in the evaluation are 2,55 cases diagnosed between 1988 and 16. Age category -29 yrs -39 yrs -49 yrs -69 yrs + yrs n=769 n=416 n=263 n=394 n=213 obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. %.......... 1 99.6 99.6 98. 98. 96.9 96.7 92.4 93.2 68.4 71.3 2 99. 99.1 96.7 96.6 95.7 95.9 89.3.7.6 66. 3 97.8 97.9 96.1 96.2 94.8 95.3 87.2 89.7 54.7 62.2 4 96.9 97. 95.8 95.9 93.8 94.4 84.4 87.7 46.2 55.3 5 96.6 96.7 95.5 95.8 92.3 93.5 83.4 87.6 42.1 53.3 6 96.2 96.3 94.8 95.1 92.3 93.3 81.2 86.5 37.4 49.9 7 95.5 95.8 94.4 94.8 91.2 92.6 76.3 82.4 32.4 45.7 8 94.8 95. 93.6 94.3 89.2 91.3 74.5 81.7 32.4 47.1 9 94.2 94.5 93.1 94. 88.5.9 72.5.4 93.9 94.2 92.6 93.8 88.5.9.4 79.5 11 93. 93.4 92.6 93.8 87.7.5 66.4 76.4 12 92.2 92.4 92.6 93.7 85.6 89.2 61.8 72.4 13 91.4 91.8 92.6 93.7 85.6 89.1 59.6.7 14.9 91.3 91.8 93.7 85.6 89. 54.5 66.3 15.4.8 91.8 93.4 79. 83.5 51.7 64.7 Table 3b. Observed (obs.) and relative (rel.) survival of patients with Hodgkin lymphoma by age category for period 1988-16 (N=2,55). Age category -29 yrs n=769 37.4% -39 yrs n=416.2% -49 yrs n=263 12.8% -69 yrs n=394 19.2% + yrs n=213.4%

GENERAL Page 7 of 12 Ann Arbor staging % Relative survival 1988-16 N=1,621 Ann Arbor staging I II III n=213 13.1% n=8 51.8% n=332.5% IV n=236 14.6% NA n=434 26.8% 1 2 3 4 5 6 7 8 9 11 12 13 14 15 Figure 4a. Relative survival of patients with Hodgkin lymphoma by Ann Arbor staging. For 1,621 of 2,55 cases diagnosed between 1988 and 16 valid data could be obtained for this item. The grey line represents the subgroup of 434 patients with missing values regarding Ann Arbor staging (21.1 % of 2,55 patients, the percent values of all other categories are related to n=1,621). Ann Arbor staging I II III IV NA n=213 n=8 n=332 n=236 n=434 obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. %.......... 1 96.5 97.3 98.9 99.2 94.8 95.5 88.8 89.5 86.5 87.4 2 95.5 97. 97.2 97.9 92.2 93.2 85.5 86.3 84.4 85.8 3 92.6 95. 96. 97. 88.8.5 83.5 84.8 83.9 85.7 4.2 93.8 94.7 96. 87.6 89.8 79.8 81.5 81.4 83.8 5 88.9 93.3 93.7 95.4 86.1 88.6 79.3 81.4.7 83.6 6 86.1 91. 93.5 95.4 84.4 87.5 77.2.1 79.3 82.8 7 83.9 89.8 91.7 93.8 81.1 84.6 76.5 79.4 78.1 82. 8 83.9..6 93.1.1 84. 73.9 77.1 77.2 81.9 9 81.1 88.6.4 93.1 77.5 81.7 72. 75.7 77.2 81.9 81.1 88.4 89.6 92.7 76.3.9 72. 75.7 76.2 81.6 11 76.8 84.7 89.3 92.5 75.6.4 72. 75.7 72.3 78.1 12 74.3 83. 88. 91.6 74.1 79.1 72. 75.7 69.8 75.8 13 71.7.7 87.6 91.5 74.1 78.9.6 74.7 69.1 75.1 14.2 79.8 86.6.9 73.1 78.2 67.2 71.2 65.9 72.6 15.2 79.2 86.1.8 72. 77.6 61.7 66.2 63.3.3 Table 4b. Observed (obs.) and relative (rel.) survival of patients with Hodgkin lymphoma by Ann Arbor staging for period 1988-16 (N=1,621).

GENERAL Page 8 of 12 Ann Arbor staging % Relative survival 1998-16 N=1,254 Ann Arbor staging I II III n=155 12.4% n=653 52.1% n=2 19.9% IV n=196 15.6% NA n=351 28.% 1 2 3 4 5 6 7 8 9 Figure 4c. Relative survival of patients with Hodgkin lymphoma by Ann Arbor staging. For 1,254 of 1,5 cases diagnosed between 1998 and 16 valid data could be obtained for this item. The grey line represents the subgroup of 351 patients with missing values regarding Ann Arbor staging (21.9 % of 1,5 patients, the percent values of all other categories are related to n=1,254). Ann Arbor staging I II III IV NA n=155 n=653 n=2 n=196 n=351 obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. %.......... 1 96.6 97.5 99.2 99.5 93. 93.8.2.4 85.3 86.3 2 96.6 98. 98.2 98.8.5 91.7 86.8 87.5 83. 84.3 3 95. 97.3 97.7 98.6 87.6 89.5 84.3 85.5 82.3 83.9 4 92.5 96.5 96.5 97.8 86.1 88.3 81.1 82.6.2 82.6 5 91.5 96. 96.1 97.7 84.4 87.1.3 82.3 79.8 82.4 6 88.4 93.2 96.1 97.9 82.5 86. 78.6 81.2 78.8 82. 7 86.1 92.1 94.3 96.5 79.7 83.5 78.6 81. 77.1 81. 8 86.1 92. 93.7 96.2 78.9 83. 74.7 77.8 76.4 81. 9 83..6 93.3 96.1 75.4 79.9 73.3 76.8 76.4.8 83..1 92.1 95.2 74.4 79.4 73.3 76.6 74.8.3 Table 4d. Observed (obs.) and relative (rel.) survival of patients with Hodgkin lymphoma by Ann Arbor staging for period 1998-16 (N=1,254).

PROGRESSION Page 9 of 12 35 % Time to first progression (TTP) 1998-16 N=1,591 Type of progression Any type (CI) Events=522 Any type (1-KM) Events=522 25 15 5 1 2 3 4 5 6 7 8 9 Figure 5a. Time to first progression of 1,591 patients with Hodgkin lymphoma diagnosed between 1998 and 16 (in solid cancers M only) estimated by cumulative incidence function (CI, solid line) accounting for death as competing risk and by inverse Kaplan-Meier estimate (1-KM, dashed line). The frequency of events may be underestimated due to underreporting. Type of progression Any type (CI) Any type (1-KM) n=1,591 n=1,591 % %.. 1 24.3 24.6 2 29.6 29.9 3 31.3 31.7 4 32.3 32.8 5 33.1 33.7 6 33.8 34.3 7 34.4 35. 8 34.8 35.4 9 35.4 36. 35.4 36. Table 5b. Time to first progression of patients with Hodgkin lymphoma for period 1998-16 (N=1,591).

PROGRESSION Page of 12 Progression type % Observed post-progression survival 1998-16 N=458 1 2 3 4 5 6 7 8 9 Figure 5c. Observed post-progression survival of 458 patients with Hodgkin lymphoma diagnosed between 1998 and 16. These 458 patients with documented progression events during their course of disease represent 28.8 % of the totally 1,591 evaluated cases. Patients with cancer relapse documented via death certificates only were excluded (n=64, 4. %). Medical record documentation often lacks the linguistic severity to distinguish between local relapse, regional lymph node metastasis and distant spread in solid cancers. Frequently, the statement not specified is the only information in registries regarding relapse of the disease. The category Any type denotes all cases who suffered from at least one relapse during the course of disease (incl. primary M1-status). Although, the real number of relapsed patients is likely to be much higher. The accumulated percentage of patients with local relapse or distant metastasis exceeds the % value because patients are potientially considered in more than one subgroup. Type of progression Any type n=458 %. 1 93. 2 89.1 3 85.3 4 82.9 5 81. 6.6 7 79.7 8 76.9 9 75.1 74.4 Table 5d. Observed post-progression survival of patients with Hodgkin lymphoma for period 1998-16 (N=458). Type of progression Any type n=458.%

PROGRESSION Page 11 of 12 Type of Progression: Any type % Observed post-progression survival by period of progression date 1988-16 N=4 1 2 3 4 5 6 7 8 9 Figure 5e. Observed post-progression (any type) survival of 4 patients with Hodgkin lymphoma diagnosed between 1988 and 16 by period of progression. Period of progression 1988-1997 1998-6 7+ n=8 n=3 n=293 % % %... 1 87.6 92.5 94. 2 78.9 88.4 89.5 3 75.9 85.7 85.5 4 69. 83.1 82.8 5 68..3.2 6 65. 79.8.2 7 65. 78.7 78.7 8 61.9 76.9 9.9 75.8 59.8 74.6 Table 5f. Observed post-progression (any type) survival of patients with Hodgkin lymphoma for period 1988-16 by period of progression (N=4). Period of progression 1988-1997 n=8 17.9% 1998-6 n=3 33.6% 7+ n=293 48.5%

USAGE Page 12 of 12 Shortcuts MCR Munich Cancer Registry, Germany NCI National Cancer Institute, USA SEER Surveillance, Epidemiology, and End Results, USA UICC Union for International Cancer Control, Geneva DCO Death certificate only NA Not available NOS Not otherwise specified Death certificate provides the only notification to the registry. OS Overall/Observed survival Overall/Observed survival (Kaplan-Meier estimate) Date of entry: diagnosis Event: death from any cause RS Relative survival Survival compared to general population, ratio of observed to expected survival (Ederer II method), reflecting cancer specific survival AS Assembled survival Assembled chart of observed, expected, relative survival CS Conditional survival Survival probability under the condition of surviving a given period of time TTP Time to progression Time to first progression / relapse Date of entry: diagnosis Event: (progression/ relapse): first local-, lymph node recurrence, distant metastasis or unspecified progression 1-KM CI 1 minus Kaplan-Meier estimator ( inverse Kaplan-Meier estimator) Cumulative incidence Death as competing risk (according to Kalbfleisch und Prentice) PPS Post-progression survival Survival since first progression / relapse (Kaplan-Meier estimate) Date of entry (progression / relapse): first local-, lymph node recurrence, distant metastasis or unspecified progression Event: death from any cause Recommended Citation Munich Cancer Registry. Survival [Internet]. 18 [updated 18 Aug 22; cited 18 Oct 1]. Available from: https://www.tumorregister-muenchen.de/en/facts/surv/sc81 E-ICD-- C81-Hodgkin-lymphoma-survival.pdf Copyright The content of the public web site provided by the Munich Cancer Registry is available worldwide and free of charge. All documents are free to download, utilize, copy, print-out and distribute, providing that the MCR is referenced. Disclaimer The Munich Cancer Registry reserves the right to not be responsible for the topicality, correctness, completeness or quality of the information provided. Liability claims regarding damage caused by the use of any information provided, including any kind of information which is incomplete or incorrect, will therefore be rejected.