Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Division of Pediatric Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Cancer. 2018 Jul 15;124(14):3037-3043. doi: 10.1002/cncr.31529. Epub 2018 May 9.
Many studies have examined long-term outcomes after childhood cancer, but few address outcomes for adolescent and young adult (AYA; those aged 15-39 years) cancer survivors. Conditional survival reflects changing mortality risk with time since cancer diagnosis and is a useful measure for planning long-term follow-up care.
Using the Surveillance, Epidemiology, and End Results registry 9 database, the authors identified a cohort of AYA patients diagnosed with a first malignant cancer between 1973 and 2009 and followed through 2014. They estimated 5-year relative survival at the time of diagnosis and at each additional year survived up to 25 years after diagnosis, conditional on the individual being alive at the beginning of that year.
A total of 205,954 AYA patients with cancer were identified. Thyroid cancer, melanoma, testicular cancer, breast cancer, lymphoma, leukemia, and central nervous system (CNS) tumors comprised 67% of all cancers. For all cancers combined, 5-year relative survival was 84.5% (95% confidence interval, 84.3%-84.7%) at 1 year after diagnosis and 94.0% (95% CI, 93.9%-94.2%) at 5 years. The relative survival first exceeded 95%, reflecting minimal excess mortality compared with the general population, at 7 years. Patients with thyroid cancer, testicular cancer, melanoma, and breast cancer reached a relative survival of >95% at the time of diagnosis and at 1, 3, and 18 years after diagnosis, respectively. Estimates for those with Hodgkin lymphoma and leukemia were >95% at 6 and 13 years, respectively, but declined to <95% at 20 years. AYA individuals with CNS tumors did not reach 95% by 25 years after diagnosis.
For AYA survivors of breast cancer, CNS tumors, and hematologic malignancies, long-term excess mortality should be considered when planning follow-up care. Cancer 2018;124:3037-43. © 2018 American Cancer Society.
许多研究都探讨了儿童癌症的长期预后，但很少有研究关注青少年和年轻成人（15-39 岁）癌症幸存者的结局。条件生存反映了癌症诊断后随时间推移而变化的死亡率，是规划长期随访护理的有用指标。
利用监测、流行病学和最终结果（SEER）9 数据库，作者确定了一组于 1973 年至 2009 年期间被诊断患有首例恶性肿瘤的青少年和年轻成人癌症患者，并随访至 2014 年。他们在诊断时以及在诊断后额外存活的每一年（从诊断后第 1 年开始）计算 5 年相对生存率，条件是个体在该年年初仍然存活。
共确定了 205954 例患有癌症的青少年和年轻成人患者。甲状腺癌、黑色素瘤、睾丸癌、乳腺癌、淋巴瘤、白血病和中枢神经系统（CNS）肿瘤占所有癌症的 67%。所有癌症的 5 年相对生存率在诊断后 1 年为 84.5%（95%置信区间，84.3%-84.7%），5 年时为 94.0%（95%CI，93.9%-94.2%）。首次超过 95%的相对生存率反映了与普通人群相比，死亡率的微小差异，这一转折点出现在诊断后 7 年。甲状腺癌、睾丸癌、黑色素瘤和乳腺癌患者在诊断时以及在诊断后 1、3 和 18 年的相对生存率分别超过了 95%。霍奇金淋巴瘤和白血病患者的相应生存率分别在 6 年和 13 年时超过了 95%，但在 20 年时下降到了 95%以下。CNS 肿瘤患者在诊断后 25 年内未达到 95%的生存率。
对于乳腺癌、CNS 肿瘤和血液恶性肿瘤的青少年和年轻成人幸存者，在规划随访护理时应考虑长期的超额死亡率。癌症 2018;124:3037-43。©2018 美国癌症协会。
