Decreasing mortality and changes in treatment patterns in patients with acromegaly from a nationwide study

in European Journal of Endocrinology
Correspondence should be addressed to D S Olsson; Email: daniel.olsson@gu.se

The authors apologise for errors that have appeared in the article by Espito et al. published in the May 2018 issue of the European Journal of Endocrinology (vol 178, iss 5, pages 459–469).

They state that after publishing the paper, the collaboration between the research parties was continued to further understand the excess mortality that was found among patients with acromegaly in Sweden between 1987 and 2013. During this process, the authors discovered that all standardized mortality ratios (SMRs) in the article were systematically overestimated. The correct SMRs are summarised in Table 6 below.

Table 6

Standardized mortality ratio in patients with acromegaly in Sweden between 1987 and 2013.

MortalityNo. observedNo. expectedSMR (95% CI)P Value
Overall mortality
 Acromegalic patients (n = 1089)232174.11.33 (1.17–1.52)<0.0001
  Men (n = 509)10780.71.33 (1.09–1.60)0.0058
  Women (n = 580)12593.51.34 (1.11–1.59)0.0021
Cause-specific mortality (ICD chapters)
 ICD-10 chapter 9, circulatory disease9369.31.34 (1.08–1.64)0.0077
 ICD-10 chapter 10, respiratory disease1410.71.31 (0.71–2.19)0.39
Cause-specific mortality (specific causes)
 Ischemic heart disease3633.21.08 (0.76–1.50)0.68
 Cerebrovascular disease2515.31.63 (1.06–2.41)0.028
 Malignant neoplasms4950.60.97 (0.72–1.28)0.90

CI, confidence interval; SMR, standardized mortality ratio.

The authors have suggested the following changes to the various sections in their article.

Changes to the Abstract

Results: Overall SMR was 1.33 (95% CI: 1.17–1.52) with 232 observed and 174 expected deaths. Mortality was mainly related to circulatory diseases (SMR: 1.34 (95% CI: 1.08–1.64)), including cerebrovascular disease (1.63, 1.06–2.41). Mortality was only increased during the first time period, suggesting a reduction in mortality over time.

Conclusions: Excess mortality was found in this nationwide cohort of patients with acromegaly, mainly related to circulatory diseases.

Changes to the Results section

The corrected Fig. 1, Tables 3 and 5 are printed in full below. Supplementary Table 3 (see section on supplementary data given at the end of this article) has also been revised and is available with the online version of this Erratum article.

Figure 1
Figure 1

Mortality in patients with acromegaly in Sweden followed between 1987 and 2013. Overall mortality in the entire cohort of patients (A), men (B) and women (C) with acromegaly. ***P < 0.001.

Citation: European Journal of Endocrinology 180, 2; 10.1530/EJE-18-0015e

Table 3

Standardized mortality ratio in patients with acromegaly in Sweden between 1987 and 2013.

MortalityNo. observedNo. expectedSMR (95% CI)P Value
Overall mortality
 Acromegalic patients (n = 1089)232174.11.33 (1.17–1.52)<0.0001
  Men (n = 509)10780.71.33 (1.09–1.60)0.006
  Women (n = 580)12593.51.34 (1.11–1.59)0.002
Cause-specific mortality (ICD chapters)
 ICD-10 chapter 1, infectious disease62.72.20 (0.81–4.79)0.12
  Men (n = 509)21.2NCNC
  Women (n = 580)41.52.60 (0.71–6.66)0.14
 ICD-10 chapter 9, circulatory disease9369.31.34 (1.08–1.64)0.008
  Men (n = 509)3832.21.18 (0.84–1.62)0.35
  Women (n = 580)5537.11.48 (1.12–1.93)0.007
 ICD-10 chapter 10, respiratory disease1410.71.31 (0.71–2.19)0.39
  Men (n = 509)54.71.06 (0.35–2.48)0.99
  Women (n = 580)96.01.49 (0.68–2.83)0.31
Cause-specific mortality (specific causes)
 Ischemic heart disease3633.21.08 (0.76–1.50)0.68
  Men (n = 509)1517.80.85 (0.47–1.40)0.61
  Women (n = 580)2115.51.36 (0.84–2.07)0.21
 Cerebrovascular disease*2515.31.63 (1.06–2.41)0.028
  Men (n = 509)95.81.54 (0.71–2.93)0.27
  Women (n = 580)169.51.69 (0.96–2.74)0.066
 Malignant neoplasms4950.60.97 (0.72–1.28)0.90
  Men (n = 509)2724.11.12 (0.74–1.63)0.61
  Women (n = 580)2226.50.83 (0.52–1.26)0.44
 Malignant neoplasm of brain31.42.16 (0.45–6.32)0.33
Overall mortality in subgroups
 All patients treated with surgery (n = 700)10085.51.17 (0.95–1.42)0.13
  Men (n = 340)4642.01.10 (0.80–1.46)0.58
  Women (n = 360)5443.51.24 (0.93–1.62)0.14
 Patients treated with surgery alone (n = 584)9175.61.20 (0.97–1.48)0.093
  Men (n = 290)4137.01.11 (0.80–1.50)0.55
  Women (n = 294)5038.61.30 (0.96–1.71)0.089
 All patients treated with radiotherapy (n = 144)188.92.02 (1.20–3.20)0.009
  Men (n = 67)104.82.07 (0.99–3.80)0.053
  Women (n = 77)84.11.97 (0.85–3.88)0.11
 Patients treated with radiotherapy alone (n = 28)93.22.82 (1.29–5.34)0.011
  Men (n = 17)52.22.25 (0.73–5.26)0.15
  Women (n = 11)41.04.09 (1.12–10.5)0.035
 Patients treated with both surgery and radiotherapy (n = 116)95.71.59 (0.73–3.01)0.24
  Men (n = 50)52.61.93 (0.63–4.50)0.24
  Women (n = 66)43.11.30 (0.35–3.32)0.74
 Patients treated without both surgery and radiotherapy (n = 361)12380.11.54 (1.28–1.83)<0.0001
  Men (n = 152)5634.21.64 (1.24–2.12)0.0008
  Women (n = 209)6745.91.46 (1.13–1.86)0.004

*No deaths caused by cerebrovascular disease were observed in patients treated with radiotherapy.

CI, confidence interval; NC, not calculated; SMR, standardized mortality ratio.

Table 5

Time trends in mortality in patients with acromegaly in Sweden followed between 1987 and 2013.

MortalityNo. observedNo. expectedSMR (95% CI)P Value
Overall mortality
 1987–199513999.61.40 (1.17–1.65)0.0002
 1996–20047360.11.21 (0.95–1.53)0.12
 2005–20132014.41.40 (0.85–2.15)0.18
Men
 1987–19955946.21.28 (0.97–1.65)0.078
 1996–20043728.01.32 (0.93–1.83)0.12
 2005–2013116.51.69 (0.84–3.02)0.13
Women
 1987–19958053.41.50 (1.19–1.86)0.0008
 1996–20043632.21.12 (0.78–1.55)0.55
 2005–201397.81.15 (0.53–2.18)0.77
Patients treated with surgery alone
 1987–19956344.51.42 (1.09–1.81)0.010
 1996–20042625.11.03 (0.68–1.52)0.92
 2005–201325.9NCNC
Patients treated with radiotherapy alone
 1987–199541.52.60 (0.71–6.65)0.14
 1996–200440.94.30 (1.17–11.02)0.030
 2005–201310.7NCNC
Patients treated with both surgery and radiotherapy
 1987–199541.33.07 (0.84–7.87)0.086
 1996–200433.70.80 (0.17–2.35)0.97
 2005–201320.6NCNC
Patients treated without both surgery and radiotherapy
 1987–19956846.91.45 (1.13–1.84)0.0044
 1996–20044027.31.46 (1.05–1.99)0.027
 2005–2013155.92.53 (1.41–4.16)0.003

CI, confidence interval; NC, not calculated (for groups with less than three deaths); SMR, standardized mortality ratio.

A summary of the correct SMRs is presented in Table 6.

Changes to the Discussion section

Page 464: Mortality due to ischemic heart disease and malignancy was not increased.

Page 465: We did not observe an excess mortality from malignancies, which is in line with a Finnish study including 333 patients followed for 20 years.

Page 465: The mortality was only increased during the first time period (1987–1995) suggesting decreasing mortality over time.

Page 467: In conclusion, excess mortality was found in this nationwide cohort of unselected patients with acromegaly, mainly related to circulatory diseases.

The authors once again apologise for these errors.

Supplementary data

This is linked to the online version of this erratum at https://doi.org/10.1530/EJE-18-0015e.

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    Mortality in patients with acromegaly in Sweden followed between 1987 and 2013. Overall mortality in the entire cohort of patients (A), men (B) and women (C) with acromegaly. ***P < 0.001.

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