Poor-Prognosis Metastatic Cancers in Adolescents and Young Adults: Incidence Patterns, Trends, and Disparities
Menée à partir des données des registres américains des cancers sur la période 2000-2016, cette étude analyse les facteurs associés à l'incidence des cancers de faible pronostic de stade métastatique chez les adolescents et jeunes adultes (âge : 15-39 ans) et compare les incidences dans d'autres catégories d'âge (âges : 40-64 ans et 65-79 ans)
Background : For adolescents and young adults (AYAs, age 15–39 years old) with cancer, metastatic disease at diagnosis is the strongest predictor of mortality, but its associations with age and sociodemographic factors are largely unexplored. Methods : Using Surveillance, Epidemiology, and End Results Program data from 2000–2016, we collected incident cases of poor-prognosis metastatic cancer (5-year survival < 50%) and compared the proportion, incidence, time trends, and incidence rate ratios for race/ethnicity, sex, and socioeconomic status among AYAs, middle-aged adults (age 40–64 years) and older adults (age 65–79 years). Results : From 2000–2016, a total of 17,210 incident cases of poor-prognosis metastatic cancer were diagnosed in AYAs, 121,274 in middle-aged adults, and 364,228 in older adults. Compared with older patients, the proportion of AYAs having metastatic disease was equivalent or substantially lower in nearly every site except stomach and breast cancers, which were statistically significantly higher for AYAs compared with middle-aged and older adults (stomach: 57.3% vs 46.4% and 39.5%; breast: 6.6% versus 4.4% and 5.6%; 2-sided p < .001 for all comparisons). Incidence rates rose significantly faster among AYAs for breast, stomach and kidney cancers, and among AYAs and middle-aged adults for colorectal cancer. Markedly higher incidence rate ratios were noted for AYA racial/ethnic minorities with breast, stomach and especially kidney cancer, where only non-Hispanic Black AYAs were at considerably higher risk. For most sites, incidence rate ratios were higher among males and low socioeconomic status across age groups. Conclusions : For most cancers, AYAs are not more likely to present with metastases than middle-aged/older adults. Further investigation is warranted for the disproportionate rise in incidence of metastatic breast, stomach, and kidney cancer among AYAs and their excess burden among AYA racial/ethnic minorities. The rising incidence of colorectal cancer among AYAs and middle-aged adults remains an additional concern.
JNCI Cancer Spectrum 2021