Trama Annalisa, Vener Claudia, Lasalvia Paolo, Bernasconi Alice
Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Oncology and Haemato-Oncology Department, University of Milan, Milan, Italy.
Front Oncol. 2022 Feb 25;12:823115. doi: 10.3389/fonc.2022.823115. eCollection 2022.
Increased success in the treatment of hematological cancers contributed to the increase of 5-year survival for most adolescent and young adults (AYAs) with these tumours. However, as 5-year survival increased, it became clear that AYA long-term survivors were at increased risk for severe late effects. Moreover, limited information on long-term cancer impact is available for AYAs, since most studies focused on children and adolescents. We aimed to assess various long-term outcomes on AYA survivors of hematological cancers.
We selected patients diagnosed with a first primary hematological cancer between 1997 and 2006, in the Italian nationwide population-based cohort of AYA cancer survivors (i.e. alive at least 5 years after cancer diagnosis). Long-term outcomes of interest were: second malignant neoplasms (SMNs), hospitalizations and overall mortality. We calculated standardized incidence ratios (SIRs), standardized hospitalization rate ratios (SHRs) and standardized mortality rate ratios (SMRs). To study morbidity patterns over time, we modeled observed incidence rates by fitting flexible parametric models for nonlinear patterns and we used linear regression for linear patterns.
The study cohort included 5,042 AYA hematological cancer survivors of which 1,237 and 3,805 had a leukaemia and lymphoma diagnosis, respectively. AYA survivors were at substantially increased risk for SMN (SIR=2.1; 95%CI=1.7; 2.6), hospitalisation (SHR=1.5; 95%CI=1.5; 1.6), and mortality (SMR=1.4; 95%CI=1.2; 1.6) with differences between leukaemia and lymphoma survivors. The highest excess risks of hospitalisations were for infectious diseases, respiratory diseases, and diseases of blood and blood-forming organs. The morbidity pattern differs over time by morbidity type.
Our results support the need for strict follow-up plans for survivors, and call for further study to better personalised follow-up plans for AYA cancer survivors.
血液系统癌症治疗成功率的提高促使大多数患有这些肿瘤的青少年及年轻成人（AYA）的5年生存率有所上升。然而，随着5年生存率的提高，很明显AYA长期幸存者出现严重晚期效应的风险增加。此外，由于大多数研究聚焦于儿童和青少年，关于AYA癌症长期影响的信息有限。我们旨在评估血液系统癌症AYA幸存者的各种长期结局。
我们在意大利全国基于人群的AYA癌症幸存者队列中，选取了1997年至2006年间首次诊断为原发性血液系统癌症的患者（即癌症诊断后至少存活5年）。感兴趣的长期结局包括：第二原发性恶性肿瘤（SMN）、住院情况和总体死亡率。我们计算了标准化发病比（SIR）、标准化住院率比（SHR）和标准化死亡率比（SMR）。为了研究发病率随时间的变化模式，我们通过拟合非线性模式的灵活参数模型对观察到的发病率进行建模，并对线性模式使用线性回归。
研究队列包括5042名AYA血液系统癌症幸存者，其中分别有1237名和3805名被诊断为白血病和淋巴瘤。AYA幸存者患SMN（SIR = 2.1；95%CI = 1.7；2.6）、住院（SHR = 1.5；95%CI = 1.5；1.6）和死亡（SMR = 1.4；95%CI = 1.2；1.6）的风险大幅增加，白血病和淋巴瘤幸存者之间存在差异。住院风险最高的是传染病、呼吸系统疾病以及血液和造血器官疾病。发病率模式随时间因发病类型而异。
我们的结果支持对幸存者制定严格随访计划的必要性，并呼吁进一步研究以更好地为AYA癌症幸存者制定个性化随访计划。
