在患有癌症的青少年和年轻成年人中转移性复发
Ann Brunson1, Ted Wun1, Renata Abrahão1
1Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento.
JAMA oncology
|November 26, 2025
概括
转移性复发是年轻癌症患者的一个重大问题. 这项研究发现,复发的累积发病率因癌症类型和阶段而异,复发后的生存率通常比初始诊断更差.
科学领域:
- 在瘤学瘤学.
- 癌症流行病学 癌症流行病学
- 青少年和年轻成人 (AYA) 瘤学
背景情况:
- 转移性复发仍然是癌症相关发病率和死亡率的主要原因.
- 关于青少年和年轻人 (AYA) 转移性复发后的发病率和生存率的经验数据有限.
- 传统上,癌症注册表没有捕获复发数据,因此需要专门的研究.
研究的目的:
- 估计诊断为早期癌症的AYA转移性复发的累积发病率 (CMI).
- 将经历转移性复发的AYA与最初被诊断为转移性疾病的AYA的生存结果进行比较.
- 为了确定特定的癌症类型,在AYA中转移性复发的风险更高.
主要方法:
- 使用加利福尼亚癌症登记处与全州医疗保健接触 (2006-2018年诊断) 相关的回顾性队列研究.
- 包括被诊断患有非转移性癌症的15-39岁的AYA,特别是黑色素瘤,肉瘤,乳腺,宫,结直肠,丸和甲状腺癌.
- 使用ICD代码识别的转移性复发 (诊断后≥6个月) 或癌症作为死亡原因;随访至2020年12月31日.
主要成果:
- 在48,406名AYA中,9.5%的人经历了转移性复发. 5年的CMI在肉瘤 (24.5%) 和结直肠癌 (21.8%) 中最高.
- CMI随诊断阶段的增加而增加;第三阶段癌症 (甲状腺除外) 的5年CMI>30%.
- 复发后的生存率低于最初的转移性疾病,除丸癌和甲状腺癌外. 随着时间的推移,CMI的趋势因癌症类型而异 (例如,宫癌的增加,结直肠癌的减少).
结论:
- 这项研究量化了AYA转移性复发的重大负担,突出了特定癌症类型和阶段的重大风险.
- 调查结果强调需要改善AYA的监视和幸存者护理策略.
- 这些数据为改善癌症生存率范围内的临床管理和患者结果提供了关键的见解.
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