Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, North Holland, The Netherlands.
Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, North Holland, The Netherlands.
Oncologist. 2024 Apr 4;29(4):e526-e534. doi: 10.1093/oncolo/oyad307.
Adolescent and young adult cancer survivors (AYAs, aged 18-39 years at first diagnosis) have a higher second cancer risk. Accelerated aging is hypothesized as underlying mechanism and has been described clinically by 6 indicators; fatigue, low quality of sleep, low mood, lack of motivation, subjective memory complaints, and poor exercise tolerance. Using patient-reported outcomes, we aimed to identify clusters of accelerated aging among AYA cancer survivors and to investigate their association with second cancer development.
Patient, tumor, and treatment data were obtained from the Netherlands Cancer Registry. Patient-reported clinical indicators and second cancer data were obtained from the SURVivors (5-20 years) of cancer in AYAs (SURVAYA) questionnaire study between 1999 and 2015. Latent class and multivariable logistic regression analyses were performed.
In total, n = 3734 AYA survivors with known second cancer status (n = 278 [7.4%] second cancers) were included. Four latent clusters were identified and named based on their clinical indicator features; (1) high accelerated aging (31.3%), (2) intermediate accelerated aging without poor exercise tolerance (15.1%), (3) intermediate accelerated aging without lack of motivation (27.4%), and (4) low accelerated aging (26.2%). AYAs in the high accelerated aging cluster were more likely to have second cancer (odds ratio: 1.6; 95% CI, 1.1-2.3) compared to the low accelerated aging cluster.
AYAs with a higher burden of accelerated aging were more likely to develop a second cancer. Validation of the clinical indicators and how to best capture them is needed to improve (early) detection of AYAs at high risk of developing second cancer.
青少年和年轻成人癌症幸存者（AYAs，初诊时年龄为 18-39 岁）具有更高的二次癌症风险。加速衰老被认为是潜在的机制，并通过 6 个指标在临床上描述；疲劳、睡眠质量差、情绪低落、缺乏动力、主观记忆抱怨和运动耐量差。使用患者报告的结果，我们旨在确定 AYA 癌症幸存者中加速衰老的聚类，并研究它们与二次癌症发展的关系。
患者、肿瘤和治疗数据从荷兰癌症登记处获得。患者报告的临床指标和二次癌症数据从 1999 年至 2015 年期间的青少年癌症幸存者（AYAs）的生存者（5-20 年）（SURVAYA）问卷调查研究中获得。进行了潜在类别和多变量逻辑回归分析。
共有 3734 名已知二次癌症状态的 AYA 幸存者（n=278[7.4%]例二次癌症）被纳入研究。根据其临床指标特征确定并命名了四个潜在聚类；（1）高加速老化（31.3%）、（2）缺乏运动耐量的中等加速老化（15.1%）、（3）缺乏动力的中等加速老化（27.4%）和（4）低加速老化（26.2%）。与低加速老化组相比，高加速老化组的 AYA 更有可能发生二次癌症（优势比：1.6；95%置信区间，1.1-2.3）。
加速衰老负担较高的 AYA 更有可能发展为第二癌症。需要验证临床指标以及如何最好地捕捉它们，以提高（早期）检测有发展第二癌症高风险的 AYA 的能力。
