Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California, Davis, School of Medicine, Sacramento.
Department of Radiation Medicine, Oregon Health and Science University, Portland.
JAMA Oncol. 2017 Nov 1;3(11):1554-1557. doi: 10.1001/jamaoncol.2017.0465.
Although the increased incidence of second primary malignant neoplasms (SPMs) is a well-known late effect after cancer, few studies have compared survival after an SPM to survival of the same cancer occurring as first primary malignant neoplasm (PM) by age.
To assess the survival impact of SPMs in adolescents and young adults (AYAs) (15-39 years) compared with that of pediatric (<15 years) and older adult (≥40 years) patients with the same SPMs.
DESIGN, SETTING, AND PARTICIPANTS: This was a population-based, retrospective cohort study of patients with cancer in 13 Surveillance, Epidemiology and End Results regions in the United States diagnosed from 1992 to 2008 and followed through 2013. Data analysis was performed between June 2016 and January 2017.
Five-year relative survival was calculated overall and for each cancer occurring as a PM or SPM by age at diagnosis. The impact of SPM status on cancer-specific death was examined using multivariable Cox proportional hazards regression.
A total of 15 954 pediatric, 125 750 AYAs, and 878 370 older adult patients diagnosed as having 14 cancers occurring as a PM or SPM were included. Overall, 5-year survival after an SPM was 33.1% lower for children, 20.2% lower for AYAs, and 8.3% lower for older adults compared with a PM at the same age. For the most common SPMs in AYAs, the absolute difference in 5-year survival was 42% lower for secondary non-Hodgkin lymphoma, 19% for secondary breast carcinoma, 15% for secondary thyroid carcinoma, and 13% for secondary soft-tissue sarcoma. Survival by SPM status was significantly worse in younger vs older patients for thyroid, Hodgkin lymphoma, non-Hodgkin lymphoma, acute myeloid leukemia, soft-tissue sarcoma, and central nervous system cancer. Adolescents and young adults with secondary Hodgkin lymphoma (hazard ratio [95% CI], 3.5 [1.7-7.1]); soft-tissue sarcoma (2.8 [2.1-3.9]); breast carcinoma (2.1 [1.8-2.4]); acute myeloid leukemia (1.9 [1.5-2.4]); and central nervous system cancer (1.8 [1.2-2.8]) experienced worse survival compared with AYAs with the same PMs.
The adverse impact of SPMs on survival is substantial for AYAs and may partially explain the relative lack of survival improvement in AYAs compared with other age groups. The impact of a particular SPM diagnosis on survival may inform age-specific prevention, screening, treatment, and survivorship recommendations.
尽管第二原发恶性肿瘤（SPM）的发病率增加是癌症的一种众所周知的晚期效应，但很少有研究比较 SPM 患者的生存情况与相同年龄的同一癌症（作为第一原发恶性肿瘤（PM））的生存情况。
通过年龄比较青少年和年轻成年人（AYA）（15-39 岁）与儿科（<15 岁）和老年（≥40 岁）患者中相同 SPM 的生存影响。
设计、设置和参与者：这是一项基于人群的回顾性队列研究，在美国 13 个监测、流行病学和最终结果区域中，对 1992 年至 2008 年诊断并随访至 2013 年的癌症患者进行研究。数据分析于 2016 年 6 月至 2017 年 1 月进行。
总体和按诊断时年龄计算的每种作为 PM 或 SPM 的癌症的 5 年相对生存率。使用多变量 Cox 比例风险回归检查 SPM 状态对癌症特异性死亡的影响。
共纳入 15954 例儿科、125750 例 AYA 和 878370 例老年患者，他们被诊断患有 14 种作为 PM 或 SPM 的癌症。总体而言，与同年龄的 PM 相比，儿童 SPM 后 5 年生存率降低 33.1%，AYA 降低 20.2%，老年患者降低 8.3%。对于 AYA 中最常见的 SPM，继发性非霍奇金淋巴瘤的 5 年生存率绝对差异降低 42%，继发性乳腺癌降低 19%，继发性甲状腺癌降低 15%，继发性软组织肉瘤降低 13%。与年龄较大的患者相比，年轻患者的 SPM 状态与甲状腺癌、霍奇金淋巴瘤、非霍奇金淋巴瘤、急性髓细胞白血病、软组织肉瘤和中枢神经系统癌症的生存情况显著更差。青少年和年轻成年人继发性霍奇金淋巴瘤（风险比[95%CI]，3.5[1.7-7.1]）；软组织肉瘤（2.8[2.1-3.9]）；乳腺癌（2.1[1.8-2.4]）；急性髓细胞白血病（1.9[1.5-2.4]）；和中枢神经系统癌症（1.8[1.2-2.8]）的生存情况比同年龄的 AYA 患者更差。
SPM 对 AYA 生存的不利影响是巨大的，这可能部分解释了与其他年龄组相比，AYA 生存改善相对较少的原因。特定 SPM 诊断对生存的影响可能为特定年龄的预防、筛查、治疗和生存建议提供信息。
