Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
J Natl Cancer Inst. 2023 Apr 11;115(4):447-455. doi: 10.1093/jnci/djac206.
Advancements in treatment and supportive care have led to improved survival for adolescents and young adults (AYAs) with cancer; however, a subset of those diagnosed remain at risk for early death (within 2 months of diagnosis). Factors that place AYAs at increased risk of early death have not been well studied.
The Surveillance, Epidemiology, and End Results registry was used to assess risk of early death in AYAs with hematologic malignancies, central nervous system tumors, and solid tumors. Associations between age at diagnosis, sex, race, ethnicity, socioeconomic status, insurance status, rurality, and early death were assessed.
A total of 268 501 AYAs diagnosed between 2000 and 2016 were included. Early death percentage was highest in patients diagnosed with hematologic malignancies (3.1%, 95% confidence interval [CI] = 2.9% to 3.2%), followed by central nervous system tumors (2.5%, 95% CI = 2.3% to 2.8%), and solid tumors (1.0%, 95% CI = 0.9% to 1.0%). Age at diagnosis, race, ethnicity, lower socioeconomic status, and insurance status were associated with increased risk of early death in each of the cancer types. For AYAs with hematologic malignancies and solid tumors, risk of early death decreased statistically significantly over time.
A subset of AYAs with cancer remains at risk for early death. In addition to cancer type, sociodemographic factors also affect risk of early death. A better understanding of the interplay of factors related to cancer type, treatment, and health systems that place certain AYA subsets at higher risk for early death is needed to address these disparities and improve outcomes.
治疗和支持性护理的进步提高了青少年和年轻成人（AYA）癌症患者的生存率；然而，仍有一部分患者有早期死亡的风险（在诊断后 2 个月内）。导致 AYA 早期死亡风险增加的因素尚未得到很好的研究。
利用监测、流行病学和最终结果（SEER）登记处评估了患有血液系统恶性肿瘤、中枢神经系统肿瘤和实体瘤的 AYA 早期死亡风险。评估了诊断时年龄、性别、种族、民族、社会经济地位、保险状况、农村或城市居住环境与早期死亡之间的关系。
共纳入了 2000 年至 2016 年间诊断的 268501 例 AYA。血液系统恶性肿瘤患者的早期死亡率最高（3.1%，95%置信区间[CI]为 2.9%至 3.2%），其次是中枢神经系统肿瘤（2.5%，95%CI 为 2.3%至 2.8%）和实体瘤（1.0%，95%CI 为 0.9%至 1.0%）。在每种癌症类型中，诊断时的年龄、种族、民族、较低的社会经济地位和保险状况均与早期死亡风险增加相关。对于患有血液系统恶性肿瘤和实体瘤的 AYA，早期死亡风险随时间呈统计学显著下降。
一部分癌症 AYA 仍有早期死亡的风险。除了癌症类型外，社会人口因素也会影响早期死亡风险。需要更好地了解与癌症类型、治疗和卫生系统相关的因素之间的相互作用，这些因素会使某些 AYA 亚组面临更高的早期死亡风险，以解决这些差异并改善预后。
