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.

中文翻译：

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青少年和年轻成人癌症幸存者的特定原因死亡率。

背景技术很少有研究充分地解决了青春期和年轻成人（AYA）癌症幸存者的长期生存（诊断后> 20年）。方法在这项基于美国综合卫生保健系统的基于人群的回顾性队列研究中，作者检查了2岁AYA癌症幸存者（1990年至2012年之间诊断为15-39岁的患者； N = 10574名患者（按年龄，性别和日历年）与无癌患者匹配（N = 136683），以确定死亡率是否随时间变化。使用多变量Poisson回归估计死亡率的发病率比（IRR）。多变量Cox模型用于检查AYA癌症幸存者中因特定原因死亡的预测因子。结果到2014年12月31日，在AYA癌症幸存者中观察到1352例死亡，确诊后25年的总生存率为78.5％。总体而言，与匹配的非癌症队列相比，AYA癌症幸存者的死亡风险增加了10.4倍（95％CI，死亡风险增加了9.7倍至11.2倍），并且这种风险在确诊后的20年内仍然升高（ IRR，2.9； 95％CI，2.0-4.3）。任何原因造成的绝对绝对死亡风险是每千人年12.7（95％CI，每千人年11.9-13.4）。从诊断后的15年开始，第二个与癌症相关的死亡率的发生率超过了与复发相关的死亡率，并且观察到了其他与健康相关的疾病引起的死亡的类似趋势。8年累计死亡率随时间下降（2000年之前为12.6％； 2000-2006年为10.1％； 2006年之后为7.3％； 2000年之后为7.3％； 2000-2006年为7.3％。P <.001），主要是由于与复发相关的死亡率下降。年龄，性别，种族/种族，诊断时的癌症阶段以及癌症治疗可预测特定原因的死亡率。结论当前的数据强调了对AYA癌症幸存者进行专门的长期随访护理的需要。