Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina.
Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
Cancer. 2019 Jun 15;125(12):2107-2114. doi: 10.1002/cncr.32063. Epub 2019 Mar 20.
Relative to the general population, cancer patients and survivors may have an elevated risk of mortality from noncancer causes, such as cardiovascular disease and infections, but few studies have examined rates of noncancer mortality among patients diagnosed as adolescents and young adults (AYAs) (ages 15-39 years).
The Surveillance, Epidemiology, and End Results database was used to identify AYA patients who were diagnosed with a first malignant cancer between 1973 and 2015. Rates of mortality from noncancer causes among AYAs with cancer were compared with those in the general US population using standardized mortality ratios (SMRs), adjusted for age, sex, race, and calendar year.
Among 235,541 AYAs with cancer, a total of 12,948 deaths from noncancer causes occurred over 3.1 million total person-years of follow-up. Overall, noncancer mortality was significantly increased among AYAs with cancer relative to the general population (SMR, 1.84; 95% CI, 1.80-1.87). SMRs were particularly elevated for infectious diseases (SMR, 5.13; 95% CI, 4.95-5.32), cardiovascular disease (SMR, 1.55; 95% CI, 1.50-1.60), and renal diseases (SMR, 2.40; 95% CI, 2.12-2.71). These associations persisted for more than 20 years after cancer diagnosis. Cancer types associated with the highest SMRs for all noncancer mortality included leukemias (SMR, 5.26), Hodgkin lymphoma (SMR, 3.12), non-Hodgkin lymphoma (SMR, 6.33), central nervous system tumors (SMR, 3.38), head and neck cancers (SMR, 2.09), and cervical/uterine cancers (SMR, 2.03).
AYAs with cancer have an elevated burden of mortality from noncancer causes that persists many years after cancer diagnosis, highlighting the importance of comprehensive, long-term follow-up care for noncancer conditions throughout survivorship.
与一般人群相比，癌症患者和幸存者可能因非癌症原因（如心血管疾病和感染）而导致死亡率升高，但很少有研究调查青少年和年轻成人（AYA）（15-39 岁）患者的非癌症死亡率。
利用监测、流行病学和最终结果数据库，确定了 1973 年至 2015 年间诊断出患有首例恶性肿瘤的 AYA 患者。通过标准化死亡率比（SMR）比较癌症 AYA 患者的非癌症原因死亡率与普通美国人群的死亡率，SMR 调整了年龄、性别、种族和日历年份。
在 235541 名患有癌症的 AYA 中，在 310 万总随访人年中，共有 12948 例非癌症原因死亡。总体而言，与普通人群相比，癌症 AYA 的非癌症死亡率显著升高（SMR，1.84；95%CI，1.80-1.87）。传染病（SMR，5.13；95%CI，4.95-5.32）、心血管疾病（SMR，1.55；95%CI，1.50-1.60）和肾脏疾病（SMR，2.40；95%CI，2.12-2.71）的 SMR 特别高。这些关联在癌症诊断后持续了 20 多年。所有非癌症死亡的 SMR 最高的癌症类型包括白血病（SMR，5.26）、霍奇金淋巴瘤（SMR，3.12）、非霍奇金淋巴瘤（SMR，6.33）、中枢神经系统肿瘤（SMR，3.38）、头颈部癌症（SMR，2.09）和宫颈/子宫癌（SMR，2.03）。
癌症 AYA 有非癌症原因导致的死亡率升高，在癌症诊断后多年仍持续存在，这强调了在整个生存期间对非癌症疾病进行全面、长期随访护理的重要性。
