BACKGROUND Over the past several decades, treatment of cancer in adolescents and young adults (AYAs) has evolved substantially, leading to steady improvements in estimated five-year survival at diagnosis. However, the impact on late mortality in this population is largely unexamined. We investigated temporal trends in mortality among five-year AYA cancer survivors. METHODS The Surveillance, Epidemiology, and End Results database was used to identify AYAs (age 15-39) diagnosed with cancer during 1975-2011 who survived ≥5 years beyond diagnosis. Survival months were accrued from five years post-diagnosis until death or end of 2016. Cumulative mortality from all causes, the primary cancer, other cancers, and noncancer/nonexternal causes (i.e. excluding accidents, suicide, homicide) were estimated according to diagnosis era. RESULTS Among 282,969 five-year AYA cancer survivors, five-year mortality (i.e. from 5 through 10 years post-diagnosis) from all causes decreased from 8.3% (95% CI: 8.0%-8.6%) among those diagnosed in 1975-1984 to 5.4% (95% CI: 5.3%-5.6%) among those diagnosed in 2005-2011. This was largely explained by decreases in mortality from the primary cancer (6.8% to 4.2%) between these periods. However, for specific cancer types, including colorectal, bone, sarcomas, cervical/uterine, and bladder, cumulative mortality curves demonstrated little improvement in primary cancer-mortality over time. Some reduction in late mortality from noncancer/nonexternal causes was apparent for Hodgkin lymphoma, leukemia, kidney cancer, head and neck cancers, and trachea, lung, and bronchus cancers. CONCLUSION Over the past four decades, all-cause and cancer-specific mortality have decreased among five-year AYA cancer survivors overall, but several cancer types have not shared in these improvements.

中文翻译：

---

青少年和年轻成人（AYA）癌症幸存者的晚期死亡率趋势。

背景技术在过去的几十年中，青少年和年轻人（AYA）的癌症治疗已经有了实质性的发展，从而导致诊断时估计的五年生存率不断提高。但是，对这一人群晚期死亡率的影响在很大程度上尚未得到证实。我们调查了五年期AYA癌症幸存者死亡率的时间趋势。方法使用监测，流行病学和最终结果数据库来确定1975-2011年诊断出患有癌症的AYA（年龄在15-39岁之间），他们在诊断后存活了≥5年。从诊断后五年到死亡或2016年底为止的生存期为几个月。根据诊断时代估算了所有原因，原发癌，其他癌症以及非癌症/非外部原因（即不包括事故，自杀，杀人）的累计死亡率。 。结果282，969名5年AYA癌症幸存者的所有原因导致的5年死亡率（即从诊断后5年到10年）从1975-1984年诊断的比例中的8.3％（95％CI：8.0％-8.6％）降低到5.4在2005-2011年诊断出的那些患者中占％（95％CI：5.3％-5.6％）。这主要是由于在这两个时期之间原发性癌症的死亡率降低（6.8％至4.2％）。但是，对于特定的癌症类型，包括结直肠癌，骨癌，肉瘤，宫颈癌/子宫癌和膀胱癌，累积死亡率曲线显示随着时间的推移，原发癌死亡率几乎没有改善。对于非霍奇金淋巴瘤，白血病，肾癌，头颈癌，气管癌，肺癌和支气管癌，非癌症/非外部原因的晚期死亡率明显降低。结论在过去的40年中，