John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California.
Center for Oncology Hematology Outcomes Research and Training and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, California.
Cancer. 2018 Mar 15;124(6):1260-1268. doi: 10.1002/cncr.31170. Epub 2017 Dec 4.
The adverse impact of second primary malignancies (SPMs) on survival is substantial for adolescents and young adults (AYAs; ie, those 15-39 years old). No studies have evaluated whether the latency time between the first malignancy (the primary malignancy [PM]) and the SPM affects cancer-specific survival (CSS).
A multivariate Cox proportional hazards regression with Surveillance, Epidemiology, and End Results data for 13 regions from 1992 to 2008 was used to ascertain whether the latency time (1-5 vs ≥ 6 years) to the development of an SPM affected the CSS and overall survival with respect to either the PM or SPM for AYAs with common SPMs.
The majority of 1515 AYAs with an SPM had their PM diagnosed between the ages of 26 and 39 years (74.2%) and an SPM diagnosed within 1 to 5 years (72.9%) of the PM's diagnosis. Overall, AYAs that developed an SPM 1 to 5 years after the diagnosis (vs ≥ 6 years) had an increased risk of death from cancer (hazard ratio [HR], 2.52; 95% confidence interval [CI], 1.92-3.29) as well as any cause (HR, 2.60; 95% CI, 2.04-3.32). Specifically, for AYAs with an SPM that was leukemia or a colorectal, breast, or central nervous system malignancy, a shorter latency time (1-5 years) from their PM diagnosis was associated with an overall significantly increased risk of death (2.6-fold) from either their PM or that particular SPM. However, latency did not appear to affect the CSS with respect to either the PM or SPM for AYA patients with a lymphoma or sarcoma SPM.
Most AYAs who develop an SPM do so within 1 to 5 years of their primary cancer diagnosis, and they have an increased risk of death from cancer in comparison with AYAs with an SPM developing after longer survivorship intervals. Cancer 2018;124:1260-8. © 2017 American Cancer Society.
第二原发恶性肿瘤（SPM）对青少年和年轻成年人（15-39 岁）的生存有重大影响。目前尚无研究评估首次恶性肿瘤（原发性恶性肿瘤 [PM]）和 SPM 之间的潜伏期是否会影响癌症特异性生存（CSS）。
使用 1992 年至 2008 年 13 个地区的监测、流行病学和最终结果数据，进行多变量 Cox 比例风险回归，以确定 SPM 发展的潜伏期（1-5 年与≥6 年）是否会影响 CSS 和整体生存率，包括青少年常见 SPM 的 PM 或 SPM。
1515 名患有 SPM 的青少年中，大多数（74.2%）PM 诊断年龄在 26-39 岁之间，PM 诊断后 1-5 年内（72.9%）诊断出 SPM。总的来说，PM 诊断后 1-5 年内（vs≥6 年）发生 SPM 的青少年死于癌症的风险增加（风险比[HR]，2.52；95%置信区间[CI]，1.92-3.29）以及任何原因（HR，2.60；95%CI，2.04-3.32）。具体而言，对于 PM 为白血病或结直肠、乳腺或中枢神经系统恶性肿瘤的青少年，从 PM 诊断到 SPM 的潜伏期较短（1-5 年）与他们的 PM 或特定 SPM 导致的总死亡风险显著增加（2.6 倍）相关。然而，对于患有淋巴瘤或肉瘤 SPM 的青少年患者，潜伏期似乎并未影响 PM 或 SPM 的 CSS。
大多数发生 SPM 的青少年在 PM 诊断后 1-5 年内发生 SPM，与 SPM 发生后生存时间较长的青少年相比，他们死于癌症的风险增加。癌症 2018；124：1260-8。©2017 美国癌症协会。
