Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam.
Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam.
ESMO Open. 2024 Jan;9(1):102203. doi: 10.1016/j.esmoop.2023.102203. Epub 2024 Jan 2.
Few studies have comprehensively investigated the long-term second cancer risk among adolescent and young adult (AYA, aged 15-39 years) cancer survivors. This study investigated the long-term second cancer risk by including the full range of first and second cancer combinations with at least 10 observations in the Netherlands between 1989 and 2018.
First and second primary cancer data of all 6-month AYA cancer survivors were obtained from the nationwide population-based Netherlands Cancer Registry. Excess cancer risk compared to the general population was assessed with standardized incidence ratio (SIR) and absolute excess risk (AER) statistics up to 25 years after diagnosis. Cumulative incidences were estimated, using death as a competing risk factor. Analyses were carried out with and without applying multiple cancer rules.
The cohort included 99 502 AYA cancer survivors. Male survivors had a 2-fold higher risk of developing any cancer compared to the general population, whereas this was around 1.3-fold in females. AERs were 17.5 and 10.1 per 10 000 person-years for males and females. The long-term excess risk of cancer was significantly higher for most first and second primary cancer combinations, but comparable and lower risk estimates were also observed. Application of the multiple cancer rules resulted in a noticeable risk underestimation in melanoma, testicular, and breast cancer survivors. Risk outcomes remained similar in most cases otherwise. The cumulative incidence of second cancer overall increased over time up to 8.9% in males and 10.3% in females at 25 years' follow-up. Highest long-term cumulative incidences were observed among lymphoma survivors (13.3% males and 18.9% females).
AYA cancer survivors have a higher cancer risk compared to the general population for most cancers up to 25 years after their initial cancer diagnosis. Additional studies that investigate risk factors for the specific cancer type combinations are needed to develop personalized follow-up strategies.
鲜有研究全面调查青少年和年轻成人（AYA，年龄 15-39 岁）癌症幸存者的长期第二癌症风险。本研究通过纳入荷兰在 1989 年至 2018 年间至少有 10 例观察的所有第一和第二癌症组合的全范围，调查了长期第二癌症风险。
所有 6 个月 AYA 癌症幸存者的第一和第二原发性癌症数据均从全国性基于人群的荷兰癌症登记处获得。使用标准化发病比（SIR）和绝对超额风险（AER）统计学评估与普通人群相比的超额癌症风险，直至诊断后 25 年。使用死亡作为竞争风险因素估计累积发生率。在不应用多个癌症规则和应用多个癌症规则的情况下进行分析。
该队列包括 99502 名 AYA 癌症幸存者。与普通人群相比，男性幸存者患任何癌症的风险增加了两倍，而女性则增加了约 1.3 倍。男性和女性的 AER 分别为每 10000 人年 17.5 和 10.1。大多数第一和第二原发性癌症组合的长期癌症超额风险明显更高，但也观察到可比和较低的风险估计。应用多个癌症规则会导致黑色素瘤、睾丸和乳腺癌幸存者的风险低估明显。否则，大多数情况下风险结果仍然相似。总体而言，第二癌症的累积发生率随时间增加，男性 25 年随访时达到 8.9%，女性达到 10.3%。淋巴瘤幸存者的长期累积发生率最高（男性为 13.3%，女性为 18.9%）。
与普通人群相比，AYA 癌症幸存者在最初癌症诊断后 25 年内大多数癌症的癌症风险更高。需要进一步研究特定癌症类型组合的风险因素，以制定个性化的随访策略。
