Metastatic Recurrence Among Adolescents and Young Adults With Cancer

Area of Science:

• Oncology
• Cancer Epidemiology
• Adolescent and Young Adult (AYA) Oncology

Background:

• Metastatic recurrence remains a primary cause of cancer-related morbidity and mortality.
• Limited empirical data exists on the incidence and survival rates following metastatic recurrence in adolescents and young adults (AYAs).
• Cancer registries traditionally do not capture recurrence data, necessitating dedicated studies.

Purpose of the Study:

• To estimate the cumulative incidence (CMI) of metastatic recurrence in AYAs diagnosed with earlier-stage cancers.
• To compare survival outcomes for AYAs experiencing metastatic recurrence versus those diagnosed with metastatic disease initially.
• To identify specific cancer types with higher risks of metastatic recurrence in AYAs.

Main Methods:

• Retrospective cohort study utilizing the California Cancer Registry linked with statewide healthcare encounters (2006-2018 diagnoses).
• Included AYAs aged 15-39 years diagnosed with nonmetastatic cancers, specifically melanoma, sarcoma, breast, cervical, colorectal, testicular, and thyroid cancers.
• Metastatic recurrence identified using ICD codes (≥6 months post-diagnosis) or cancer as cause of death; follow-up through December 31, 2020.

Main Results:

• Of 48,406 AYAs, 9.5% experienced metastatic recurrence. The 5-year CMI was highest for sarcoma (24.5%) and colorectal cancer (21.8%).
• CMI increased with stage at diagnosis; Stage III cancers (except thyroid) had >30% 5-year CMI.
• Survival post-recurrence was poorer than initial metastatic disease, except for testicular and thyroid cancers. Trends in CMI over time varied by cancer type (e.g., increasing for cervical, decreasing for colorectal).

Conclusions:

• This study quantifies the substantial burden of metastatic recurrence in AYAs, highlighting significant risks for specific cancer types and stages.
• Findings underscore the need for improved surveillance and survivorship care strategies for AYAs.
• The data provides crucial insights for enhancing clinical management and patient outcomes across the cancer survivorship spectrum.