Background

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.

Methods

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.

Findings

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.

Interpretation

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.

Funding

None.

中文翻译：

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加拿大阿尔伯塔省 24 459 名青少年和年轻成人癌症幸存者的总体死亡率和晚期死亡率：一项基于人群的队列研究

 背景

青少年和年轻成人 （AYA） 癌症幸存者因癌症及其治疗而过早死亡的风险增加。在此，我们旨在量化 AYA 癌症幸存者的超额死亡风险并确定干预的目标人群。

 方法

艾伯塔省 AYA 癌症幸存者研究是一项回顾性、基于人群的队列，研究对象是 1983 年至 2017 年间在加拿大艾伯塔省 15-39 岁时被诊断出患有第一原发性肿瘤的个体。我们评估了癌症幸存者 （即队列中包含的所有个体） 总体以及 2 年和 5 年生存亚群。我们计算了与一般人群相比的标准化死亡率和绝对超额风险 （AERs;每 10 000 人年）以及累积死亡率概率。死亡原因分为（第一个原发性肿瘤）复发或进展导致的死亡、随后的原发性肿瘤 （SPN） 导致的死亡以及非肿瘤原因导致的死亡。

 发现

在纳入队列的 24 459 人中，观察到 5916 例死亡，是普通人群预期死亡的 11·4 倍（95% CI 11·1-11·7），相当于 191·6 （186·2–196·9） 超额死亡;相应地，5 年幸存者的死亡人数比预期多 4·2 倍 （4·0–4·4），相当于 74·3 （69·8–78·8） 的超额死亡人数。诊断时年龄增加、诊断时社区收入较差的五分位数、首次原发性肿瘤类型和初始治疗计划被确定为死亡的重要危险因素。虽然复发或进展是超额死亡率的主要原因 （AER 172·2 [167·4–177·1]），但在子宫内膜癌、睾丸癌和霍奇金淋巴瘤的幸存者中，诊断后 10 年以上的大多数死亡是由于 SPN 和非肿瘤原因。在最近诊断的幸存者中，全因死亡率 （p<0·0001） 以及复发或进展性死亡 （p<0·0001） 和 SPN 死亡 （p=0·0070） 的累积死亡率显著降低，表明长期生存率正在提高。

 解释

AYA 癌症幸存者的死亡率很高。鉴于晚期 SPN 和非肿瘤性死亡的高负担，子宫内膜癌、睾丸癌和霍奇金淋巴瘤的幸存者是可能受益于一级、二级和三级预防策略的重要人群。

 资金

 没有。