Risk of subsequent primary neoplasms in survivors of adolescent and young adult cancer (Teenage and Young Adult Cancer Survivor Study): a population-based, cohort study
Risk of subsequent primary neoplasms in survivors of adolescent and young adult cancer (Teenage and Young Adult Cancer Survivor Study): a population-based, cohort study
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DOI：
10.1016/s1470-2045(18)30903-3
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发表时间：
2019-04-01
期刊：
影响因子：
51.1
通讯作者：
Hawkins, Michael M.
中科院分区：
文献类型：
--
作者：
Bright, Chloej;Reulen, Raoul C.;Hawkins, Michael M.
很少有研究调查青少年和年轻成人（AYA）癌症后继发原发性肿瘤的风险。我们调查了特定的后续原发性肿瘤的风险后，每16种类型的AYA cancer.Methods的青少年和年轻的成年人癌症幸存者研究是一个以人群为基础的队列200 945名幸存者的癌症诊断时，年龄在15-39岁，在英格兰和威尔士从1971年1月1日至2006年12月31日。该队列是使用国家统计局和威尔士癌症登记处的癌症登记建立的。随访时间为5年生存期至首次发生死亡、移民或研究结束日期（2012年12月31日）。在这项分析中，我们重点关注16种AYA癌症后发生特定原发性肿瘤的风险：乳腺癌、宫颈癌、睾丸癌、霍奇金淋巴瘤（女性）、霍奇金淋巴瘤（男性）、黑色素瘤、CNS（颅内）、结直肠癌、非霍奇金淋巴瘤、甲状腺癌、软组织肉瘤、卵巢癌、膀胱癌、其他女性生殖器癌、白血病和头颈部癌。我们报告绝对超额风险（不良反应率，每10000人年）和累积发病率的特定类型的后续原发性肿瘤后，每种类型的AYA cancer.Findings在2631326人年的后续（中位数随访16.8年，IQR 10.5-25。2），在11 565名幸存者中诊断出12 321例后续原发性肿瘤，最常见于乳腺癌，宫颈癌，睾丸癌和霍奇金淋巴瘤的幸存者中。在乳腺癌幸存者中，任何后续原发性肿瘤的AER为19.5/10 000人-年（95% CI 17.4-21.5），10。2（8.0-12.4）宫颈癌幸存者，18.9（16.6-21.1）睾丸癌幸存者，55.7（50.4-61.1）霍奇金淋巴瘤女性幸存者，29.9（26.3-33.6）霍奇金淋巴瘤男性幸存者。诊断后35年所有后续原发性肿瘤的累积发生率在乳腺癌幸存者中为11.9%（95%CI 11.3-12.6），在宫颈癌幸存者中为15.8%（14.8-16.7），在乳腺癌幸存者中为20. 2%（18.9-21.5）的睾丸癌幸存者，26.6%（24.7-28.6）的霍奇金淋巴瘤的女性幸存者，16.5%（15。2-18.0）在霍奇金淋巴瘤的男性幸存者。在诊断为宫颈癌、睾丸癌、女性霍奇金淋巴瘤、乳腺癌和男性霍奇金淋巴瘤后存活至少30年的患者中，我们发现了少数特定的继发原发性肿瘤，分别占肿瘤总数的82%、61%、58%、45%和41%。肺癌占所有AYA groupsinvestigated. Interpretation肿瘤的过剩数量的显着比例，我们的发现，一个特定的后续原发性肿瘤占一个很大的比例，在宫颈癌，乳腺癌，睾丸癌和霍奇金淋巴瘤的长期幸存者肿瘤的总过剩数量提供了一个证据基础，告知临床长期随访的优先事项。在每种AYA癌症之后，肺癌的突出表明需要进一步开展工作，旨在预防和减轻未来AYA癌症幸存者的这种癌症负担。版权所有（C）2019作者。爱思唯尔有限公司出版
Background Few studies have investigated the risks of subsequent primary neoplasms after adolescent and young adult (AYA) cancer. We investigated the risks of specific subsequent primary neoplasms after each of 16 types of AYA cancer.Methods The Teenage and Young Adult Cancer Survivor Study is a population-based cohort of 200 945 survivors of cancer diagnosed when aged 15-39 years in England and Wales from Jan 1, 1971, to Dec 31, 2006. The cohort was established using cancer registrations from the Office for National Statistics and the Welsh Cancer registry. Follow-up was from 5-year survival until the first occurrence of death, emigration, or study end date (Dec 31, 2012). In this analysis, we focus on the risk of specific subsequent primary neoplasms after 16 types of AYA cancer: breast; cervical; testicular; Hodgkin lymphoma (female); Hodgkin lymphoma (male); melanoma; CNS (intracranial); colorectal; non-Hodgkin lymphoma; thyroid; soft-tissue sarcoma; ovarian; bladder; other female genital; leukaemia; and head and neck cancer. We report absolute excess risks (AERs; per 10000 person-years) and cumulative incidence of specific types of subsequent primary neoplasm after each type of AYA cancer.Findings During the 2631326 person-years of follow-up (median follow-up 16.8 years, IQR 10.5-25. 2), 12 321 subsequent primary neoplasms were diagnosed in 11 565 survivors, most frequently among survivors of breast cancer, cervical cancer, testicular cancer, and Hodgkin lymphoma. AERs of any subsequent primary neoplasms were 19.5 per 10 000 person-years (95% CI 17.4-21.5) in survivors of breast cancer, 10. 2 (8.0-12.4) in survivors of cervical cancer, 18.9 (16.6-21.1) in survivors of testicular cancer, 55.7 (50.4-61.1) in female survivors of Hodgkin lymphoma, and 29.9 (26.3-33.6) in male survivors of Hodgkin lymphoma. The cumulative incidence of all subsequent primary neoplasms 35 years after diagnosis was 11.9% (95% CI 11.3-12.6) in survivors of breast cancer, 15.8% (14.8-16.7) in survivors of cervical cancer, 20. 2% (18.9-21.5) in survivors of testicular cancer, 26.6% (24.7-28.6) in female survivors of Hodgkin lymphoma, and 16.5% (15. 2-18.0) in male survivors of Hodgkin lymphoma. In patients who had survived at least 30 years from diagnosis of cervical cancer, testicular cancer, Hodgkin lymphoma in women, breast cancer, and Hodgkin lymphoma in men, we identified a small number of specific subsequent primary neoplasms that account for 82%, 61%, 58%, 45%, and 41% of the total excess number of neoplasms, respectively. Lung cancer accounted for a notable proportion of the excess number of neoplasms across all AYA groups investigated.Interpretation Our finding that a small number of specific subsequent primary neoplasms account for a large percentage of the total excess number of neoplasms in long-term survivors of cervical, breast, and testicular cancer, and Hodgkin lymphoma provides an evidence base to inform priorities for clinical long-term follow-up. The prominence of lung cancer after each of these AYA cancers indicates the need for further work aimed at preventing and reducing the burden of this cancer in future survivors of AYA cancer. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.