Alken Scheryll, Owens Cormac, Gilham Charles, Grant Cliona, Pears Jane, Deady Sandra, O'Marcaigh Aengus, Capra Michael, O'Mahony Deirdre, Smith Owen, Walsh Paul M
St James's Hospital, Dublin, Ireland.
Children's Health Ireland, Crumlin, Dublin, Ireland.
Ir J Med Sci. 2020 Nov;189(4):1223-1236. doi: 10.1007/s11845-020-02236-0. Epub 2020 May 18.
Some studies indicate that survival of adolescents and young adults (AYA) with cancer may be inferior to that of younger children with similar cancers, possibly related (in part) to differences in access to centralized or standardized treatment.
This study aims to evaluate differences in survival for AYA patients when compared with paediatric patients treated in Ireland over a 20-year time period.
This study compares relative survival for patients diagnosed in Ireland at ages 0-15 (paediatric group) and 16-24 (AYA group) during 1994-2013, followed to the end of 2014, for cancers defined by the International Classification of Childhood Cancer (ICCC) (Third Edition) group or subgroup. Five-year relative survival estimates, and excess hazard ratios (EHR) comparing excess mortality associated with a cancer diagnosis among AYA with that in the paediatric group, are presented. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Significantly higher excess mortality was found for AYA with leukaemias, lymphomas, astrocytomas, malignant bone tumours, and Ewing and related bone sarcomas, soft tissue sarcomas and 'other/unspecified' epithelial cancers, rhabdomyosarcomas, and 'other and unspecified' carcinomas. In contrast, lower excess mortality was found in the AYA group for all cancers and intracranial/intraspinal tumours, and for gliomas other than astrocytomas or ependymomas. Comparing 1994-2003 and 2004-2013 cohorts, age-related survival differences narrowed for lymphoid leukaemias, but widened for all cancers combined and intracranial/intraspinal tumours combined. Centralization of services varied depending upon cancer subtype, with leukaemias, CNS tumours and bone sarcomas most centralized. Within these, improvements in survival for leukaemias and CNS tumours have been seen for the AYA population.
Reasons for age-related survival differences, and differences in time-trend by age group, are not clear. The significant narrowing of survival differences by age in more recent years for lymphoid leukaemias reflects a more marked recent increase in survival among AYA. More work is required to explain and improve other age-related survival differences.
一些研究表明，患有癌症的青少年及青年（AYA）的生存率可能低于患有相似癌症的年幼儿童，这可能（部分）与获得集中或标准化治疗的差异有关。
本研究旨在评估与在爱尔兰接受治疗的儿科患者相比，AYA患者在20年期间的生存差异。
本研究比较了1994年至2013年期间在爱尔兰诊断为0至15岁（儿科组）和16至24岁（AYA组）的患者的相对生存率，随访至2014年底，所患癌症由国际儿童癌症分类（ICCC）（第三版）组或亚组定义。给出了五年相对生存估计值，以及比较AYA组与儿科组中与癌症诊断相关的超额死亡率的超额风险比（EHR）。本研究未接受公共、商业或非营利部门资助机构的任何特定资助。
发现患有白血病、淋巴瘤、星形细胞瘤、恶性骨肿瘤、尤因肉瘤及相关骨肉瘤、软组织肉瘤和“其他/未明确指定”上皮癌、横纹肌肉瘤以及“其他和未明确指定”癌的AYA的超额死亡率显著更高。相比之下，AYA组中所有癌症、颅内/脊髓肿瘤以及除星形细胞瘤或室管膜瘤外的神经胶质瘤的超额死亡率较低。比较1994 - 2003年队列和2004 - 2013年队列，淋巴细胞白血病的年龄相关生存差异缩小，但所有癌症合并和颅内/脊髓肿瘤合并的差异扩大。服务集中化因癌症亚型而异，白血病、中枢神经系统肿瘤和骨肉瘤最为集中。在这些癌症中，AYA人群的白血病和中枢神经系统肿瘤的生存率有所提高。
年龄相关生存差异以及各年龄组时间趋势差异的原因尚不清楚。近年来淋巴细胞白血病年龄相关生存差异的显著缩小反映了AYA近期生存率更显著的提高。需要更多工作来解释和改善其他年龄相关生存差异。
