TOPLINE:

In a population-based cohort of 15- to 39-year-olds diagnosed with cancer, the risk for metastatic recurrence varied widely by cancer type and stage, and survival after recurrence was worse than after de novo metastatic disease for most cancers.

METHODOLOGY:

• In the US alone, there are over 2 million adolescent and young adult cancer survivors. Metastatic recurrence remains a leading cause of morbidity and mortality for those treated for solid tumors, but population-based data on incidence and outcomes are limited.
• Researchers conducted a retrospective cohort study of 48,406 adolescents and young adults diagnosed with cancer between 2006 and 2018, using the California Cancer Registry and linked data related to statewide hospitalization, emergency department, and ambulatory surgery.
• Cancer types included melanoma, sarcoma, breast, cervical, colorectal, testicular, and thyroid cancers. Just over 9% of the study group had metastatic disease at diagnosis.
• Metastatic recurrence was identified using the International Classification of Diseases (ICD) metastatic diagnosis codes at least 6 months after diagnosis or by cancer listed as the underlying cause of death. Cumulative incidence of metastatic recurrence was estimated using the Fine-Gray competing risk method. The median follow-up was 6.7 years.

TAKEAWAY:

• Overall, 9.5% of patients had metastatic recurrence. Among patients initially diagnosed with nonmetastatic disease, the 5-year cumulative incidence of metastatic recurrence was highest among those with sarcoma (24.5%) and those with colorectal cancer (21.8%), followed by patients with cervical (16.3%) and breast (14.7%) cancers.
• Metastatic recurrence incidence changed over time for some cancers: For cervical cancer, the 5-year cumulative incidence rose from 12.7% in 2006-2009 to 20.4% in 2015-2018; in contrast, metastatic recurrence after colorectal cancer declined from 24.4% to 19.2% during the same period. By stage, the increase was most evident for stage I cervical cancer, rising from 6.3% in 2006-2009 to 10.1% in 2015-2018. The incidence of recurrence after stage III melanoma declined from 36% to 21.5% over the same interval — likely reflecting the introduction of immunotherapy and targeted therapies, the authors of the study noted.
• Survival after metastatic recurrence was worse than survival after metastatic disease at diagnosis for patients with all cancer types except testicular and thyroid cancers: Patients with breast cancer with metastatic recurrence had a nearly threefold higher risk for death (hazard ratio, 2.87), with similar patterns seen for cervical cancer (HR, 2.10), melanoma (HR, 1.61), sarcoma (HR, 1.57), and colorectal cancer (HR, 1.53).
• Late metastatic recurrence (at least 24 months after diagnosis) was associated with better prognosis than early recurrence in patients with breast cancer (HR, 0.62) and those with cervical cancer (HR, 0.74), but with worse prognosis in patients with testicular cancer (HR, 1.84) and those with thyroid cancer (HR, 2.89).

IN PRACTICE:

“Findings of this cohort study highlight the substantial burden of metastatic disease (both at diagnosis and as a recurrence) among adolescents and young adults,” the authors of the study wrote. A linked editorial said the study has “important implications” for treatment planning, disease surveillance, and survivorship care.

“Despite a 5-year overall survival of 86% for cancer in adolescents and young adults, a critical unmet need remains for those who do not reach long-term survival,” wrote Amy Berkman, MD, St. Jude Children’s Research Hospital, Memphis, Tennessee, and colleagues. They stressed the ongoing need to understand how cancer biology, treatment adherence, and access to follow-up care affect young patients with cancer’s risk for metastatic recurrence.

SOURCE:

The study, led by Ann Brunson, MS, Center for Oncology Hematology Outcomes Research and Training, University of California Davis Comprehensive Cancer Center, Sacramento, California, was published online in JAMA Oncology.

LIMITATIONS:

The study lacked data on patients diagnosed with metastatic recurrence in outpatient settings, and the use of ICD codes and cause of death codes could have resulted in some misclassification of metastatic recurrence. Additionally, the cohort was limited to California and excluded patients with missing linkage identifiers or stage, which could have affected generalizability.

DISCLOSURES:

The study received support from the National Cancer Institute, National Institutes of Health, and the California Department of Public Health. One author reported receiving personal fees from Pfizer outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.