Second Primary Malignant Neoplasms and Survival in Adolescent and Young Adult Cancer Survivors

Second Primary Malignant Neoplasms and Survival in Adolescent and Young Adult Cancer Survivors
It is well known that second primary malignant neoplasms (SPMs) are often associated with prior cancer treatment. Adolescent and young adult (AYA) survivors are considered to have the highest absolute excess risk of SPMs among all age group. However, no study has assessed the survival impact of different SPMs in AYAs compared with pediatric and older patients until now.
Using data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program, the authors have compared survival of patients with SPMs with their corresponding first primary cancer types.
The secondary outcome was to assess if there were age-specific differences in survival after SPMs. From 13 SEER registries, all patients diagnosed with a primary malignant neoplasm (PM) or SPM during 1992 to 2008 were included. Only 14 common AYA cancers were considered for this study.
A total of 15,954 pediatric, 125,750 AYA and 878,370 older adult patients with a diagnosis of 14 cancers occurring as a PM or SPM were included in the analysis. As expected, the 5 year relative survival for all selected cancers were lower for those with SPMs than those with a PM. Focusing on AYA, with the exception of melanoma and testicular cancer who had a relative high survival for both PM and SPMs, the 5 year relative survival for all other SPMs was lower when compared to the corresponding PMs in AYAs.
In multivariable-adjusted models, secondary Hodgkin lymphoma and thyroid cancer had a more than a 3-fold increased risk of death .
There are the classical limitations of a study using the SEER registry: risk of unrecorded variables, variations in data coding and reporting, migration of patients in and out of SEER registry areas, lack of detailed treatment information.
Keeping in mind the inherent limitations, this study on a significant number of patients (1,020,074) outlines how SPMs seem to have an inferior relative survival and higher risk of cancer death for AYA and pediatric patients compared with the older population with cancer.
This underlines once more the importance of treatment protocols aiming at reduction of treatment toxicity in our pediatric and AYA patients with cancer, whenever this is appropriate and good surveillance protocols for early recognition of SMNs.