Overall and Cause-Specific Late Mortality in Long-Term Survivors of Early Onset Solid Cancer After Surgery: A Population-Based Retrospective Cohort Study.

Abstract

Late mortality of early onset solid cancer survivors remains poorly characterized. We quantified the late mortality among 5-year survivors of early onset solid cancers following surgery. This retrospective cohort study analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database, including 5-year survivors of solid cancer at age 20-49 years following surgery during 1975-2017. We estimated the cumulative mortality probabilities, standardized mortality ratios (SMRs), and absolute excess risks (AERs) for all-cause and cause-specific mortality compared with the general population. A total of 294,994 survivors (median age 42 years, IQR 35-46 years) were included, with median follow-up of 17.8 years (IQR 10.7-26.8 years). At 40 years post-diagnosis, cumulative all-cause mortality reached 50.0% (95% CI 49.6-50.4%). While recurrence or progression dominated mortality initially, non-cancer health-related causes ultimately became the leading contributor to death. Overall, survivors exhibited significantly elevated all-cause mortality compared with the general population (SMR 1.77, 95% CI 1.76-1.79). On the basis of non-cancer health-related mortality, two distinct survivor groups emerged: 13 cancers with increased mortality (SMR 1.41, 95% CI 1.38-1.44) and 6 cancers with decreased mortality (SMR 0.78, 95% CI 0.77-0.80) relative to the general population. Long-term early onset solid cancer survivors after surgery face substantial late mortality burden, with non-cancer health-related causes ultimately surpassing recurrence or progression as the leading cause of death. On the basis of non-cancer health-related mortality, increased-risk and decreased-risk cancer types can be distinguished.