Cause-specific mortality in survivors of adolescent and young adult cancer
Menée aux Etats-Unis à partir de données portant sur 10 574 adolescents et jeunes adultes (âge : 15-39 ans) ayant survécu 2 ans ou plus à un cancer diagnostiqué entre 1990 et 2012, cette étude analyse l'évolution de la mortalité spécifique à long terme (plus de 20 ans après le diagnostic)
Background : Few studies have adequately addressed long‐term survival (>20 years from diagnosis) among survivors of adolescent and young adult (AYA) cancers.
Methods : In this retrospective, population‐based cohort study in a US integrated health care system, the authors examined cause‐specific mortality in 2‐year survivors of AYA cancers (patients aged 15‐39 years who were diagnosed between 1990 and 2012; N = 10,574) matched (by age, sex, and calendar year) to individuals without cancer (N = 136,683) to determine whether mortality rates changed over time. Incidence rate ratios (IRRs) for mortality were estimated using multivariable Poisson regression. A multivariable Cox model was used to examine predictors of cause‐specific mortality among AYA cancer survivors.
Results : Through December 31, 2014, 1352 deaths were observed among AYA cancer survivors, yielding an overall survival rate of 78.5% at 25 years after diagnosis. Overall, AYA cancer survivors were at 10.4‐fold increased risk for death (95% CI, 9.7‐fold to 11.2‐fold increased risk for death) compared with the matched noncancer cohort, and this risk remained elevated at >20 years after diagnosis (IRR, 2.9; 95% CI, 2.0‐4.3). The absolute excess risk for death from any cause was 12.7 per 1000 person‐years (95% CI, 11.9‐13.4 per 1000 person‐years). Starting at 15 years after diagnosis, the incidence of second cancer‐related mortality exceeded the rate of recurrence‐related mortality, and similar trends were observed for deaths from other health‐related conditions. The 8‐year cumulative incidence of mortality declined over time (before 2000, 12.6%; 2000‐2006, 10.1%; after 2006, 7.3%; P < .001), largely because of declines in recurrence‐related mortality. Age, sex, race/ethnicity, cancer stage at diagnosis, and cancer treatment predicted cause‐specific mortality.
Conclusions : The current data highlight the need for specialized, long‐term follow‐up care for AYA cancer survivors.
Cancer , résumé, 2019