青少年和年轻成年癌症幸存者中 HPV 相关后续恶性肿瘤的风险因素和趋势。
Risk Factors and Trends for HPV-Associated Subsequent Malignant Neoplasms among Adolescent and Young Adult Cancer Survivors.
机构信息
Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah.
Cancer Biostatistics Shared Resource, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah.
出版信息
Cancer Epidemiol Biomarkers Prev. 2023 May 1;32(5):625-633. doi: 10.1158/1055-9965.EPI-22-0826.
BACKGROUND
Subsequent malignant neoplasms (SMN; new cancers that arise after an original diagnosis) contribute to premature mortality among adolescent and young adult (AYA) cancer survivors. Because of the high population prevalence of human papillomavirus (HPV) infection, we identify demographic and clinical risk factors for HPV-associated SMNs (HPV-SMN) among AYA cancer survivors in the SEER-9 registries diagnosed from 1976 to 2015.
METHODS
Outcomes included any HPV-SMN, oropharyngeal-SMN, and cervical-SMN. Follow-up started 2 months after their original diagnosis. Standardized incidence ratios (SIR) compared risk between AYA survivors and general population. Age-period-cohort (APC) models examined trends over time. Fine and Gray's models identified therapy effects controlling for cancer and demographic confounders.
RESULTS
Of 374,408 survivors, 1,369 had an HPV-SMN, occurring on average 5 years after first cancer. Compared with the general population, AYA survivors had 70% increased risk for any HPV-SMN [95% confidence interval (CI), 1.61-1.79] and 117% for oropharyngeal-SMN (95% CI, 2.00-2.35); cervical-SMN risk was generally lower in survivors (SIR, 0.85; 95% CI, 0.76-0.95), but Hispanic AYA survivors had a 8.4 significant increase in cervical-SMN (SIR, 1.46; 95% CI, 1.01-2.06). AYAs first diagnosed with Kaposi sarcoma, leukemia, Hodgkin, and non-Hodgkin lymphoma had increased HPV-SMN risks compared with the general population. Oropharyngeal-SMN incidence declined over time in APC models. Chemotherapy and radiation were associated with any HPV-SMN among survivors with first HPV-related cancers, but not associated among survivors whose first cancers were not HPV-related.
CONCLUSIONS
HPV-SMN in AYA survivors are driven by oropharyngeal cancers despite temporal declines in oropharyngeal-SMN. Hispanic survivors are at risk for cervical-SMN relative to the general population.
IMPACT
Encouraging HPV vaccination and cervical and oral cancer screenings may reduce HPV-SMN burden among AYA survivors.
背景
继发恶性肿瘤（SMN；在原发诊断后出现的新癌症）导致青少年和年轻成人（AYA）癌症幸存者过早死亡。由于人乳头瘤病毒（HPV）感染的高人群流行率，我们在 1976 年至 2015 年期间从 SEER-9 登记处诊断出的 AYA 癌症幸存者中确定了与 HPV 相关的 SMN（HPV-SMN）的人口统计学和临床危险因素。
方法
结果包括任何 HPV-SMN、口咽-SMN 和宫颈-SMN。随访从最初诊断后 2 个月开始。标准化发病比（SIR）比较了 AYA 幸存者与一般人群之间的风险。年龄-时期-队列（APC）模型检查了随时间的趋势。精细和灰色模型确定了控制癌症和人口统计学混杂因素的治疗效果。
结果
在 374408 名幸存者中，有 1369 人患有 HPV-SMN，平均在首次癌症后 5 年发生。与一般人群相比，AYA 幸存者患任何 HPV-SMN 的风险增加 70%[95%置信区间（CI），1.61-1.79]，患口咽-SMN 的风险增加 117%（95%CI，2.00-2.35）；幸存者的宫颈-SMN 风险普遍较低（SIR，0.85；95%CI，0.76-0.95），但西班牙裔 AYA 幸存者的宫颈-SMN 风险显著增加 8.4（SIR，1.46；95%CI，1.01-2.06）。首次诊断为卡波西肉瘤、白血病、霍奇金病和非霍奇金淋巴瘤的 AYA 患者与一般人群相比，HPV-SMN 风险增加。在 APC 模型中，口咽-SMN 的发病率随时间下降。在患有首次 HPV 相关癌症的幸存者中，化疗和放疗与任何 HPV-SMN 相关，但在首次癌症与 HPV 无关的幸存者中，两者没有相关性。
结论
尽管口咽-SMN 的发病率随时间下降，但 AYA 幸存者中的 HPV-SMN 由口咽癌驱动。与一般人群相比，西班牙裔幸存者患宫颈-SMN 的风险增加。
影响
鼓励 HPV 疫苗接种和宫颈及口腔癌筛查可能会降低 AYA 幸存者的 HPV-SMN 负担。
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