Recent trends in cancer distribution and survival outcomes among adolescent and young adult patients: A national data analysis.

Abstract

10561 Background: Cancer distribution varies significantly among adolescents and young adults (AYAs) aged 15 to 39. Understanding these trends is essential for developing strategies to enhance early detection and improve survival outcomes. This study analyzes national data to assess time-bound changes in new cases and survival outcomes within the AYA population. Methods: A retrospective cohort study was performed using the National Cancer Database to analyze AYA patients diagnosed with the 20 most common cancer types by mortality from 2004 to 2021. Patients with confirmed malignant neoplasms, ≥6 months of follow-up, and known survival status were included. Descriptive statistical methods were used to evaluate demographic characteristics, while survival outcomes were analyzed using Kaplan-Meier estimates and multivariable Cox proportional hazard models. Linear regression models were used to analyze changes in new cases over time for each cancer group. Results: A total of 637,460 AYA cancer patients were included in the analysis. The median age was 33 years (IQR: 27-37). Most were female (61.5%) and White (79.6%). Breast cancer was the most common malignancy (21.3%), followed by central nervous system (CNS) tumors (11.6%), melanoma (9.3%), testicular cancer (8.5%) and colorectal cancer (CRC, 6.9%). Between 2004 and 2021, CRC, leukemia, liver, pancreatic, renal, stomach, and uterine cancers showed significant increases in new cases (P< 0.001), with CRC having the highest increase (annual rate change [β]:1.7, P< 0.001). Bladder, Hodgkin lymphoma (HL), melanoma, cervical and lung cancer significantly decreased (P< 0.001), with melanoma showing the largest decline (β: -1.83, P< 0.001). Breast, CNS, and ovarian cancers showed no significant trends. Among AYA cancer patients, the survival rate at 3 and 6 years were 89.2% and 83.9%, respectively. The overall survival rate at 12 years was 78.1%, with the highest survival rates observed in testicular cancer (93.1%), HL (91.4%) and melanoma (90.8%), and the lowest in liver (38.6%) and stomach cancer (41.3%). AYA cancer patients aged 35–39 (HR: 1.28, 95% CI:1.25-1.30, P< 0.001), Black (HR: 1.47, 95% CI: 1.45-1.5, P< 0.001), and Hispanic individuals (HR: 1.03, 95% CI: 1.01-1.05, P= 0.003) had worse survival outcomes. Conclusions: Our findings indicate that the proportion of AYAs diagnosed with certain cancers, such as colorectal, liver, renal and stomach cancers, has significantly increased over the past two decades. Prioritizing early detection and tailored treatment strategies are crucial to addressing this growing challenge. Further research is needed to understand the underlying factors contributing to these trends. Annual rate changes in cancer distribution. Cancer group β P ↑Trends CRC Renal Uterus 1.70.630.53 <0.001<0.001<0.001 ↓Trends Melanoma HL Cervical -1.83-0.84-0.66 <0.001<0.001<0.001