Adolescents and young adults with cancer and the risk of subsequent primary neoplasms: not just big children
Menée au Royaume-Uni à partir de données portant sur 200 945 patients ayant survécu à un cancer diagnostiqué entre l'âge de 15 et 39 ans sur la période 1971-2006 (16 types de cancers), cette étude de cohorte analyse le risque de second cancer primitif (période de suivi : 2 631 326 personnes-années ; durée médiane de suivi : 16,8 ans ; 12 321 cas de second cancer)
Improved outcomes in childhood cancer have led to an increased focus on the cost of long-term survival: long-term physical, psychological, and financial morbidities that arise as a consequence of cancer therapy or the cancer itself. Several landmark childhood cancer survivor cohorts have informed our ability to describe, predict, and minimise these late effects. About 80% of adolescents and young adults (AYAs) with cancer will also achieve long-term cure. Consequently, late effects are also highly relevant to this population, but very few AYA-specific data exist, forcing clinicians to extrapolate from the literature on childhood cancer survivors. Subsequent primary neoplasms (also known as second malignant neoplasms) are one of the most feared late effects, and are associated with substantial morbidity and mortality. Previous work has shown that survivors of AYA cancer have a higher absolute risk of subsequent primary neoplasms than do younger or older populations, which in turn has a substantial impact on overall survival.In The Lancet Oncology, Chloe Bright and colleagues describe the risk of subsequent primary neoplasms in a population-based cohort of more than 200 000 survivors of AYA cancer. The large sample size and more than 2·6 million person-years of follow-up allow the investigators to describe, comprehensively for the first time and in great detail, the risk of specific subsequent primary neoplasms after specific primary cancers. The cumulative incidence of any subsequent primary neoplasm at 35 years from diagnosis ranged from 11·9% in survivors of breast cancer to 26·6% in female survivors of Hodgkin lymphoma. The level of granularity provided in the risk estimates (eg, by primary cancer, type of subsequent primary neoplasm, and years from diagnosis) should assist clinicians and policy makers in determining what type of interventions would be of greatest benefit for specific populations of AYA cancer survivors. (....)
The Lancet Oncology , commentaire en libre accès, 2018