Almost 10% of adolescents and young adults (AYAs) diagnosed with earlier-stage cancer develop metastatic disease, and survival outcomes were found to be worse for patients who developed metastatic recurrence compared with those who had metastatic disease at initial diagnosis for almost all analyzed cancer types, according to research findings published in JAMA Oncology.
“These findings highlight the significant burden of metastatic recurrence among [AYAs] and the need for tailored survivorship care,” said senior study author Theresa Keegan, PhD, MS, Professor of Medicine, UC Davis Health Medical Center. “Understanding these patterns helps us identify inequities and evaluate how well our efforts are working to prevent, detect, and treat both early and metastatic disease.”
Study Methods
Researchers conducted a retrospective cohort study of adolescents and young adults between the ages of 15 and 39 years who were diagnosed with nonmetastatic cancer between 2006 and 2018. A total of 48,406 adolescents and young adults with melanoma, sarcoma, breast, cervical, colorectal, testicular, and thyroid cancers were identified from the California Cancer Registry.
Key Findings
Among all identified patients, 9.2% had metastatic disease at diagnosis and 9.5% had metastatic recurrence. Colorectal cancer and sarcoma were associated with the highest rates of metastatic disease.
The 5-year cumulative incidence of metastatic recurrence among patients with initial nonmetastatic disease was highest for patients with sarcoma (24.5%; 95% confidence interval [CI] = 22.6%–26.6%) and colorectal cancer (21.8%; 95% CI = 20.3%–23.4%).
Cases of metastatic recurrence were more frequent with increasing stage at diagnosis; all stage III cancers, except for those with thyroid cancer, had 5-year cumulative incidence rates of over 30%. Patients with stage III cervical cancer had a cumulative incidence of metastatic recurrence of 41.7%.
The 5-year cumulative incidence for metastatic recurrence of cervical cancer increased over time, with rates of 12.7% from 2006 to 2009 rising to 20.4% for 2015 to 2018; meanwhile, rates for metastatic recurrence of colorectal cancer decreased over time, with rates of 24.4% for 2006 to 2009 and 19.2% for 2015 to 2018.
Survival in adolescent and young adult patients with metastatic recurrence was worse than survival for those with metastatic disease at diagnosis for all cancer types except testicular and thyroid cancers. The hazard ratio for overall survival for patients with breast cancer who had metastatic recurrence was 2.87, 2.10 for patients with cervical cancer, 1.61 for patients with melanoma, 1.57 for patients with sarcoma, and 1.53 for patients with colorectal cancer.
“As treatments improve survival, young patients with cancer face unique challenges,” said lead study author Ann Brunson, MS, Research Analyst at UC Davis Comprehensive Cancer Center. “Our research deepens understanding of survivorship and the impact of metastatic recurrence, using statewide data to reveal trends and guide future studies.”
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
