Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Leeds Institute of Medical Research at St James's, School of Medicine, St James's University Hospital, Leeds, UK.
Lancet Oncol. 2019 Apr;20(4):531-545. doi: 10.1016/S1470-2045(18)30903-3. Epub 2019 Feb 21.
Few studies have investigated the risks of subsequent primary neoplasms after adolescent and young adult (AYA) cancer. We investigated the risks of specific subsequent primary neoplasms after each of 16 types of AYA cancer.
The Teenage and Young Adult Cancer Survivor Study is a population-based cohort of 200 945 survivors of cancer diagnosed when aged 15-39 years in England and Wales from Jan 1, 1971, to Dec 31, 2006. The cohort was established using cancer registrations from the Office for National Statistics and the Welsh Cancer registry. Follow-up was from 5-year survival until the first occurrence of death, emigration, or study end date (Dec 31, 2012). In this analysis, we focus on the risk of specific subsequent primary neoplasms after 16 types of AYA cancer: breast; cervical; testicular; Hodgkin lymphoma (female); Hodgkin lymphoma (male); melanoma; CNS (intracranial); colorectal; non-Hodgkin lymphoma; thyroid; soft-tissue sarcoma; ovarian; bladder; other female genital; leukaemia; and head and neck cancer. We report absolute excess risks (AERs; per 10 000 person-years) and cumulative incidence of specific types of subsequent primary neoplasm after each type of AYA cancer.
During the 2 631 326 person-years of follow-up (median follow-up 16·8 years, IQR 10·5-25·2), 12 321 subsequent primary neoplasms were diagnosed in 11 565 survivors, most frequently among survivors of breast cancer, cervical cancer, testicular cancer, and Hodgkin lymphoma. AERs of any subsequent primary neoplasms were 19·5 per 10 000 person-years (95% CI 17·4-21·5) in survivors of breast cancer, 10·2 (8·0-12·4) in survivors of cervical cancer, 18·9 (16·6-21·1) in survivors of testicular cancer, 55·7 (50·4-61·1) in female survivors of Hodgkin lymphoma, and 29·9 (26·3-33·6) in male survivors of Hodgkin lymphoma. The cumulative incidence of all subsequent primary neoplasms 35 years after diagnosis was 11·9% (95% CI 11·3-12·6) in survivors of breast cancer, 15·8% (14·8-16·7) in survivors of cervical cancer, 20·2% (18·9-21·5) in survivors of testicular cancer, 26·6% (24·7-28·6) in female survivors of Hodgkin lymphoma, and 16·5% (15·2-18·0) in male survivors of Hodgkin lymphoma. In patients who had survived at least 30 years from diagnosis of cervical cancer, testicular cancer, Hodgkin lymphoma in women, breast cancer, and Hodgkin lymphoma in men, we identified a small number of specific subsequent primary neoplasms that account for 82%, 61%, 58%, 45%, and 41% of the total excess number of neoplasms, respectively. Lung cancer accounted for a notable proportion of the excess number of neoplasms across all AYA groups investigated.
Our finding that a small number of specific subsequent primary neoplasms account for a large percentage of the total excess number of neoplasms in long-term survivors of cervical, breast, and testicular cancer, and Hodgkin lymphoma provides an evidence base to inform priorities for clinical long-term follow-up. The prominence of lung cancer after each of these AYA cancers indicates the need for further work aimed at preventing and reducing the burden of this cancer in future survivors of AYA cancer.
Cancer Research UK, National Institute for Health Research, Academy of Medical Sciences, and Children with Cancer UK.
鲜有研究调查青少年和年轻成人（AYA）癌症后发生继发原发性肿瘤的风险。我们研究了 16 种 AYA 癌症中每一种癌症后发生特定继发原发性肿瘤的风险。
青少年和年轻成人癌症幸存者研究是一项基于人群的队列研究，纳入了 200945 名年龄在 15-39 岁的英格兰和威尔士癌症幸存者，这些患者于 1971 年 1 月 1 日至 2006 年 12 月 31 日确诊。该队列是通过国家统计局和威尔士癌症登记处的癌症登记建立的。随访时间为 5 年生存率至首次死亡、移民或研究结束日期（2012 年 12 月 31 日）。在本分析中，我们关注 16 种 AYA 癌症后特定继发原发性肿瘤的风险：乳腺癌；宫颈癌；睾丸癌；女性霍奇金淋巴瘤；男性霍奇金淋巴瘤；黑色素瘤；中枢神经系统（颅内）；结直肠癌；非霍奇金淋巴瘤；甲状腺癌；软组织肉瘤；卵巢癌；膀胱癌；其他女性生殖器官癌；白血病；头颈部癌。我们报告了每种 AYA 癌症后特定类型继发原发性肿瘤的绝对超额风险（AER；每 10000 人年）和累积发病率。
在 2631326 人年的随访期间（中位随访时间 16.8 年，IQR 10.5-25.2），在 11565 名幸存者中诊断出 12321 例继发原发性肿瘤，最常见于乳腺癌、宫颈癌、睾丸癌和霍奇金淋巴瘤幸存者。乳腺癌幸存者的任何继发原发性肿瘤 AER 为 19.5/10000 人年（95%CI 17.4-21.5），宫颈癌幸存者为 10.2/10000 人年（8.0-12.4），睾丸癌幸存者为 18.9/10000 人年（16.6-21.1），女性霍奇金淋巴瘤幸存者为 55.7/10000 人年（50.4-61.1），男性霍奇金淋巴瘤幸存者为 29.9/10000 人年（26.3-33.6）。诊断后 35 年所有继发原发性肿瘤的累积发病率为乳腺癌幸存者 11.9%（95%CI 11.3-12.6），宫颈癌幸存者 15.8%（14.8-16.7），睾丸癌幸存者 20.2%（18.9-21.5），女性霍奇金淋巴瘤幸存者 26.6%（24.7-28.6），男性霍奇金淋巴瘤幸存者 16.5%（15.2-18.0）。在至少 30 年生存的宫颈癌、睾丸癌、女性霍奇金淋巴瘤、乳腺癌和男性霍奇金淋巴瘤幸存者中，我们发现少数特定的继发原发性肿瘤占总超额肿瘤数的 82%、61%、58%、45%和 41%。在所有研究的 AYA 组中，肺癌在超额肿瘤数中占了很大比例。
我们发现，少数特定的继发原发性肿瘤在宫颈癌、乳腺癌和睾丸癌以及霍奇金淋巴瘤的长期幸存者中占总超额肿瘤数的很大比例，这为临床长期随访提供了优先考虑的依据。在这些 AYA 癌症后，肺癌的突出存在表明需要进一步努力预防和减少未来 AYA 癌症幸存者的这种癌症的负担。
英国癌症研究中心、英国国家卫生研究院、英国皇家学会和英国儿童癌症协会。
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