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. 2022 Oct 8;14(19):4932.
doi: 10.3390/cancers14194932.

Risk of Presenting with Poor-Prognosis Metastatic Cancer in Adolescents and Young Adults: A Population-Based Study

Jessica K Sheth Bhutada  1   2 , Amie E Hwang  3   4   5 , Lihua Liu  3   4   5 , Kai-Ya Tsai  4   5 , Dennis Deapen  3   4   5 , David R Freyer  1   2   3   5   6
Affiliations

Risk of Presenting with Poor-Prognosis Metastatic Cancer in Adolescents and Young Adults: A Population-Based Study

Jessica K Sheth Bhutada et al. Cancers (Basel). .

Abstract

Having metastatic disease at diagnosis poses the great risk of death among AYAs with cancer from all sociodemographic subgroups. This “landscape” study utilized United States Surveillance, Epidemiology, and End Results Program data from 2000−2016 to identify subgroups of AYAs at highest risk for presenting with metastases across twelve cancer sites having a poor-prognosis (5-year survival <50% with metastases). Adjusted odds ratios for risk of metastatic disease presentation were compared for AYAs in aggregate and by sociodemographic subgroup (race/ethnicity, sex, socioeconomic status [SES]). In general, AYAs who were male, racial/ethnic minorities, or low SES were at consistently greatest risk of metastases. Strikingly, having metastatic melanoma was independently associated with multiple AYA sociodemographic subgroups, including males (aOR 3.11 [95% CI 2.64−3.66]), non-Hispanic Blacks (4.04 [2.32−7.04]), Asian Pacific Islanders (2.99 [1.75−5.12]), Hispanics (2.37 [1.85−3.04]), and low SES (2.30 [1.89−2.80]). Non-Hispanic Blacks were more likely to present with metastatic cancer in all sites, except for bone, rhabdomyosarcoma, and stomach. Low SES AYAs are more likely to present with metastatic melanoma, bone tumors, soft tissue sarcomas, breast, cervical, lung, and stomach carcinomas. Building on these results, future cancer-specific studies should investigate the connection between sociodemographic risk factors and biological drivers of metastases. This line of research has potential to inform targeted public health and screening efforts to facilitate risk reduction and earlier detection of these deadly diseases.

Keywords: AYAs; Adolescents; incidence; metastatic cancer; metastatic disease; race/ethnicity; sex; socioeconomic status; young adults.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
(a) Stage distribution for poor-prognosis metastatic cancers in aggregate. (b) Proportion of metastatic disease by cancer site. Total percentage in Figure 1A is greater than 100 due to rounding to nearest whole number.
Figure 2
Figure 2
Risk of metastatic disease by sociodemographic subgroup for poor-prognosis cancers in aggregate.
Figure 3
Figure 3
Risk of metastatic disease for younger AYAs by cancer site. Reference group: older AYAs (30–39 years).
Figure 4
Figure 4
Risk of metastatic disease for male AYAs by cancer site. Reference group: female AYAs.
Figure 5
Figure 5
Risk of metastatic disease for racial/ethnic minority AYAs by cancer site. Reference group: non-Hispanic Whites.
Figure 6
Figure 6
Risk of metastatic disease for low SES AYAs by cancer site. Reference group: high SES.
See this image and copyright information in PMC

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