Bleyer Archie, Tai Eric, Siegel Stuart, Roth Michael, DeAngelo Daniel J, Stock Wendy
Radiation Medicine and Knight Cancer Institute, Oregon Health & Science University, Portland Oregon, USA.
Department of Pediatrics, University of Texas McGovern Medical School, Houston Texas, USA.
J Adolesc Young Adult Oncol. 2025 Feb;14(1):33-42. doi: 10.1089/jayao.2024.0095. Epub 2024 Sep 25.
In 2018, a "survival cliff" in the United States was identified among older adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL). This study reassessed the cliff and associated putative causes. Survival data were obtained using the U.S. Surveillance Research Program, National Cancer Institute (NCI) SEER 22 Registries. Accrual data on cancer treatment trials conducted by the NCI cooperative groups and NCI-designated cancer centers were obtained from the NCI Cancer Therapy Evaluation Program. Trend and average percent changes and statistical significances were identified with the NCI Joinpoint Regression Program. A previous cliff-like decrement in the survival of 17- to 20-year-olds is no longer apparent, overall and in all racial and ethnic groups. The "survival cliff" age range was coincident with a clinical trial accrual cliff, and both diminished when more clinical trials were available to, and participated in by, young adult patients. Older AYA patients of ages 30-39 had minimal improvement in clinical trial accrual and least survival gain among the AYA age group. The survival cliff has abated, resulting in thousands of fewer premature deaths and tens of thousands of years of life saved-a remarkable achievement. The survival improvement may be attributed to improved clinical trial availability for and recruitment and participation of AYAs on treatment trials, application of pediatric-inspired ALL treatment regimens to AYAs, expanded national health insurance for -18 to 25 year olds, improved AYA cancer services, and a national focus on AYA oncology.
2018年，美国在患有急性淋巴细胞白血病（ALL）和淋巴细胞淋巴瘤（LBL）的青少年及青年成人（AYA）患者中发现了一个“生存悬崖”。本研究重新评估了这一悬崖及相关的假定原因。生存数据通过美国国立癌症研究所（NCI）监测研究计划的SEER 22登记处获得。国立癌症研究所合作组和NCI指定癌症中心开展的癌症治疗试验的入组数据来自国立癌症研究所癌症治疗评估计划。趋势、平均百分比变化及统计学显著性通过NCI Joinpoint回归程序确定。17至20岁人群先前类似悬崖状的生存率下降在总体以及所有种族和族裔群体中已不再明显。“生存悬崖”的年龄范围与临床试验入组悬崖相吻合，当有更多临床试验可供青年成人患者使用并参与时，两者均有所减少。30至39岁的年长AYA患者在临床试验入组方面改善甚微，在AYA年龄组中生存获益最少。生存悬崖已经缓解，导致过早死亡减少数千例，挽救了数万年的生命——这是一项了不起的成就。生存改善可能归因于可供AYA患者使用并招募其参与治疗试验的临床试验增加、将受儿科启发的ALL治疗方案应用于AYA患者、为18至25岁人群扩大国家医疗保险、改善AYA癌症服务以及全国对AYA肿瘤学的关注。
