Background A comprehensive examination of the incidence and mortality of subsequent primary cancers (SPCs) among adolescent and young adult (AYA) cancer survivors in the US is lacking. Methods Cancer incidence and mortality among 170,404 ≥ 5-year cancer survivors aged 15–39 years at first primary cancer diagnosis during 1975–2013 in 9 Surveillance, Epidemiology, and End Results registries were compared to those in the general population using standardized incidence ratio (SIR), absolute excess incidence (AEI), standardized mortality ratio (SMR), and absolute excess mortality (AEM). Results During a mean follow-up of 14.6 years, 13,420 SPC cases and 5,008 SPC deaths occurred among survivors (excluding the same-site as index cancer), corresponding to 25% higher incidence (95%CI = 1.23–1.27; AEI = 10.8 per 10,000) and 84% higher mortality (95%CI = 1.79–1.89; AEM = 9.2 per 10,000) than that in the general population. Overall SPC risk was statistically significantly higher for 20 of 29 index cancers for incidence and 26 for mortality, with the highest SIR among female Hodgkin lymphoma survivors (SIR = 3.05, 95%CI = 2.88–3.24; AEI = 73.0 per 10,000) and the highest SMR among small intestine cancer survivors (SMR = 6.97, 95%CI = 4.80–9.79; AEM = 64.1 per 10,000). Type-specific SPC risks varied substantially by index cancers; however, SPCs of the female breast, lung, and colorectum combined constituted 36% of all SPC cases and 39% of all SPC deaths, with lung cancer alone representing 11% and 24% of all cases and deaths, respectively. Conclusion AYA cancer survivors are almost twice as likely to die from a new primary cancer as the general population, highlighting the need for primary care clinicians to prioritize cancer prevention and targeted surveillance strategies in these individuals.

中文翻译：

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青少年和青年癌症五年幸存者的后续原发性癌症风险

背景 缺乏对美国青少年和年轻成人 (AYA) 癌症幸存者后续原发性癌症 (SPC) 的发病率和死亡率的全面检查。方法 将 1975-2013 年间 9 个监测、流行病学和最终结果登记处的 170,404 名年龄在 15-39 岁且年龄在 15-39 岁的 ≥ 5 岁癌症幸存者的癌症发病率和死亡率与使用标准化发病率的一般人群进行了比较（ SIR）、绝对超额发病率（AEI）、标准化死亡率（SMR）和绝对超额死亡率（AEM）。结果 在平均 14.6 年的随访期间，幸存者中发生了 13,420 例 SPC 病例和 5,008 例 SPC 死亡（不包括与指数癌症相同的部位），对应的发病率高出 25%（95%CI = 1.23–1.27；AEI = 10.8每 10,000 人）和 84% 的高死亡率（95%CI = 1. 79–1.89；AEM = 9.2 / 10,000) 高于一般人群。29 种指数癌症中有 20 种的发病率指数癌症和 26 种指数癌症的总体 SPC 风险在统计学上显着升高，女性霍奇金淋巴瘤幸存者的 SIR 最高（SIR = 3.05，95%CI = 2.88-3.24；AEI = 73.0 / 10,000）和小肠癌幸存者中 SMR 最高（SMR = 6.97，95%CI = 4.80–9.79；AEM = 64.1 / 10,000）。特定类型的 SPC 风险因指数癌症而有很大差异；然而，女性乳腺癌、肺癌和结直肠癌合并占所有 SPC 病例的 36% 和所有 SPC 死亡病例的 39%，仅肺癌就分别占所有病例和死亡病例的 11% 和 24%。结论 AYA 癌症幸存者死于新原发性癌症的可能性几乎是普通人群的两倍，