Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, Australia.
Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
J Adolesc Young Adult Oncol. 2023 Aug;12(4):537-545. doi: 10.1089/jayao.2022.0074. Epub 2022 Sep 30.
Increased risk of second primary cancers is an unwanted consequence of cancer survivorship. While the epidemiology of second cancers is well-documented for children and older people, less is known about second cancers among adolescent and young adult (AYA) cancer survivors. Unit record data were obtained from the Queensland Cancer Register. The study cohort comprised Queensland residents aged 15 to 39 years who were diagnosed with a first primary invasive cancer between 1982 and 2013. Follow-up on second cancers was available for a minimum of 5 years to the end of 2018. Standardized incidence ratios (SIRs) were used to approximate the risk of a second primary cancer relative to the general population. In total, 3086 second primary cancers were observed among 34,431 eligible AYA patients (9%), equating to an overall SIR of 1.59 (95% confidence interval [CI] 1.53-1.64). Melanoma ( = 853, 28%) and female breast cancer ( = 594, 19%) were the most common types of second primary cancer in the study cohort. Relative risk of all second primary cancers combined among AYA patients was inversely associated with age and was highest within the period immediately after first diagnosis irrespective of age group; for example, patients aged 15-24 at first diagnosis recorded more than four times as many second primary cancers than expected within 2 years of their first cancer (SIR = 4.40, 95% CI 2.83-6.82). Detailed data on second primary cancers among AYA cancer survivors are important in promoting increased awareness and to inform the development of targeted prevention and surveillance strategies.
第二原发癌的风险增加是癌症生存者的一个意外后果。虽然儿童和老年人的第二癌症的流行病学已有充分记录，但青少年和年轻成人（AYA）癌症生存者的第二癌症知之甚少。单位记录数据是从昆士兰州癌症登记处获得的。研究队列包括 1982 年至 2013 年间在昆士兰州被诊断出患有第一原发性浸润性癌症的 15 至 39 岁的居民。第二原发癌的随访时间至少为 5 年，截至 2018 年底。标准化发病比（SIR）用于近似相对于一般人群的第二原发癌的风险。在 34431 名符合条件的 AYA 患者中，共观察到 3086 例第二原发癌（9%），总体 SIR 为 1.59（95%置信区间[CI]1.53-1.64）。黑色素瘤（=853，28%）和女性乳腺癌（=594，19%）是研究队列中最常见的第二原发癌类型。AYA 患者中所有第二原发癌的相对风险与年龄呈反比，并且无论年龄组如何，在首次诊断后立即的时期内风险最高；例如，首次诊断时年龄为 15-24 岁的患者在其首次癌症后 2 年内记录的第二原发癌数超过预期的四倍（SIR=4.40，95%CI2.83-6.82）。AYA 癌症生存者的第二原发癌详细数据对于提高认识和制定有针对性的预防和监测策略非常重要。
