Survivors of adolescent and young adult (AYA) cancer (ie, those aged 15 to 39 years at diagnosis) are a large and growing population. There are more than 2 million survivors of AYA cancer in the USA alone,¹ and efforts targeted at reducing late morbidity and mortality are urgently needed. In The Lancet Public Health, Taylor Hughes and colleagues² evaluate the risk of mortality after a diagnosis of cancer as an AYA over a median of 9 years from diagnosis. Including 24 459 individuals with primary AYA cancer in the Alberta AYA Cancer Survivor Study, they found that all-cause cumulative morality was 35·6% (95% CI 34·6–36·7) at 30 years from diagnosis. This translated to an 11-fold increased risk of mortality in the overall cohort and a 4-fold increased risk of mortality among those who reached 5 years of survival compared with expected mortality in the general population. Cancer recurrence or progression was the main driver of excess mortality, whereas beyond 10-years from diagnosis, subsequent primary neoplasms (SPN) and non-cancer causes of death became more prevalent. Encouragingly, the authors found reductions in mortality for AYAs diagnosed with cancer in more recent decades, largely the result of decreased deaths due to cancer recurrence or progression. These results are similar to those of previous population-based survival analyses using data from the Surveillance, Epidemiology, and End Results database and California Cancer Registry, which found improvements in primary cancer mortality over time, as well as persistently elevated long-term risks of non-cancer and SPN mortality among survivors of AYA cancer.3, 4, 5

中文翻译：

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青少年和年轻成人癌症幸存者的死亡率：进展和机遇


青少年和年轻成人 （AYA） 癌症的幸存者（即诊断时年龄在 15 至 39 岁之间的人）是一个庞大且不断增长的人群。仅在美国就有超过 200 万 AYA 癌症幸存者，¹ 迫切需要努力降低晚期发病率和死亡率。在《柳叶刀公共卫生》中，Taylor Hughes 及其同事² 评估了诊断后 AYA 在诊断后中位 9 年的死亡风险。在艾伯塔省 AYA 癌症幸存者研究中包括 24 459 名原发性 AYA 癌症患者，他们发现诊断后 30 年全因累积道德为 35·6%（95% CI 34·6-36·7）。这意味着与普通人群的预期死亡率相比，整个队列的死亡风险增加了 11 倍，生存率达到 4 年的人群的死亡风险增加了 5 倍。癌症复发或进展是超额死亡率的主要驱动因素，而诊断后 10 年后，随后的原发性肿瘤 （SPN） 和非癌症死亡原因变得更加普遍。令人鼓舞的是，作者发现近几十年来被诊断患有癌症的 AYA 的死亡率降低，这主要是由于癌症复发或进展导致的死亡人数减少。这些结果与之前使用来自监测、流行病学和最终结果数据库和加州癌症登记处的数据进行的基于人群的生存分析相似，该分析发现原发性癌症死亡率随着时间的推移而改善，以及 AYA 癌症幸存者非癌症和 SPN 死亡的长期风险持续升高。3、4、5