Hughes Taylor, Diaz Ruth L, McKillop Sarah, Nathan Paul C, Fidler-Benaoudia Miranda M
Department of Oncology, University of Calgary, Calgary, AB, Canada.
Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Arthur Child Comprehensive Cancer Centre, Calgary, AB, Canada.
Lancet Public Health. 2025 Jan;10(1):e36-e46. doi: 10.1016/S2468-2667(24)00268-8.
Adolescent and young adult (AYA) cancer survivors are at an increased risk of premature mortality due to their cancer and its treatment. Herein, we aimed to quantify the excess risks of mortality among AYA cancer survivors and identify target populations for intervention.
The Alberta AYA Cancer Survivor Study is a retrospective, population-based cohort of individuals diagnosed with a first primary neoplasm at age 15-39 years in Alberta, Canada, between 1983 and 2017. We assessed cancer survivors (ie, all individuals included in the cohort) overall and for 2-year and 5-year survivorship subpopulations. We calculated standardised mortality ratios and absolute excess risks (AERs; per 10 000 person-years) compared with the general population, and cumulative mortality probability. Causes of death were categorised as deaths due to recurrence or progression (of the first primary neoplasm), deaths due to a subsequent primary neoplasm (SPN), and deaths due to non-neoplastic causes.
Among the 24 459 individuals included in the cohort, 5916 deaths were observed, which was 11·4 times (95% CI 11·1-11·7) that expected for the general population, equating to 191·6 (186·2-196·9) excess deaths; correspondingly, 5-year survivors had 4·2 times (4·0-4·4) more deaths than expected, equating to 74·3 (69·8-78·8) excess deaths. Increased age at diagnosis, poorer neighbourhood income quintile at diagnosis, first primary neoplasm type, and initial treatment plan were identified as important risk factors for mortality. While recurrence or progression was the main cause of excess mortality (AER 172·2 [167·4-177·1]), the majority of deaths beyond 10 years from diagnosis were due to SPNs and non-neoplastic causes among survivors of endometrial cancer, testicular cancer, and Hodgkin lymphoma. The cumulative mortality probability significantly decreased among more recently diagnosed survivors for all-cause mortality (p<0·0001) as well as recurrence or progression deaths (p<0·0001) and SPN deaths (p=0·0070), suggesting that long-term survival is improving.
AYA cancer survivors have substantial excess mortality. Given the high burden of late SPN and non-neoplastic deaths, survivors of endometrial cancer, testicular cancer, and Hodgkin lymphoma are notable populations that might benefit from primary, secondary, and tertiary prevention strategies.
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青少年及年轻成人（AYA）癌症幸存者因其所患癌症及其治疗而面临过早死亡风险增加的情况。在此，我们旨在量化AYA癌症幸存者的额外死亡风险，并确定可进行干预的目标人群。
艾伯塔省AYA癌症幸存者研究是一项基于人群的回顾性队列研究，研究对象为1983年至2017年期间在加拿大艾伯塔省15至39岁被诊断为原发性肿瘤的个体。我们评估了癌症幸存者（即队列中的所有个体）总体以及2年和5年生存亚组的情况。我们计算了标准化死亡比和绝对超额风险（AERs；每10000人年），并与一般人群进行比较，以及累积死亡概率。死亡原因分为因首次原发性肿瘤复发或进展导致的死亡、因后续原发性肿瘤（SPN）导致的死亡以及因非肿瘤原因导致的死亡。
在队列纳入的24459名个体中，观察到5916例死亡，这是一般人群预期死亡数的11.4倍（95%CI 11.1 - 11.7），相当于有191.6例（186.2 - 196.9）额外死亡；相应地，5年幸存者的死亡数比预期多4.2倍（4.0 - 4.4），相当于有74.3例（69.8 - 78.8）额外死亡。诊断时年龄增加、诊断时邻里收入五分位数较低、首次原发性肿瘤类型以及初始治疗方案被确定为死亡的重要风险因素。虽然复发或进展是额外死亡的主要原因（AER 172.2 [167.4 - 177.1]），但在诊断后10年以上，子宫内膜癌、睾丸癌和霍奇金淋巴瘤幸存者中的大多数死亡是由于SPN和非肿瘤原因。所有原因导致的死亡（p<0.0001）以及复发或进展导致的死亡（p<0.0001）和SPN导致的死亡（p = 0.0070）的累积死亡概率在最近诊断的幸存者中显著降低，这表明长期生存率正在提高。
AYA癌症幸存者有大量额外死亡情况。鉴于晚期SPN和非肿瘤死亡负担较高，子宫内膜癌幸存者、睾丸癌幸存者和霍奇金淋巴瘤幸存者是可能从一级、二级和三级预防策略中受益的显著人群。
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