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Disparity in Outcomes for Adolescent and Young Adult Patients Diagnosed With Pediatric Solid Tumors Across 4 Decades

Chen, Ishita, PhD*; Pasalic, Dario, BS*; Fischer-Valuck, Benjamin, MD*; Frangoul, Haydar, MD; DeWees, Todd, PhD*; Shinohara, Eric, T., MD; Perkins, Stephanie, M., MD*

American Journal of Clinical Oncology: May 2018 - Volume 41 - Issue 5 - p 471–475
doi: 10.1097/COC.0000000000000304
Original Articles: Pediatric

Objective: Cancer mortality is a leading cause of disease-related death in the adolescent and young adult (AYA) population. Compared with older and younger patients, AYA patients often experience worse cancer-specific outcomes. Here, we compare AYA and pediatric overall survival (OS) in the most common pediatric extracranial solid tumors.

Materials and Methods: Using the US Surveillance, Epidemiology, and End Results database, we studied patients (age, 0 to 39 y) diagnosed with Ewing sarcoma, neuroblastoma, osteosarcoma, rhabdomyosarcoma, and Wilms tumor.

Results: A total of 12,375 patients (age, 0 to 39 y) were diagnosed between 1973 and 2010 (8247 pediatric and 4128 AYA patients). AYA patients with rhabdomyosarcoma and Ewing sarcoma were more likely to present with metastatic disease. OS was significantly worse in the AYA cohort for all tumor types (P<0.001) with the exception of osteosarcoma (P=0.29). Across 2 treatment time periods (1973 to 1989 and 1990 to 2010), there was significant improvement in 5-year OS in all tumor types with the exception of rhabdomyosarcoma; however, AYA patients continued to experience worse OS in the modern treatment cohort with the exception of osteosarcoma patients. There was no improvement in OS among AYA patients with Ewing sarcoma, neuroblastoma, rhabdomyosarcoma, or Wilms tumor over the 2 treatment eras.

Conclusions: For the most common pediatric extracranial solid tumors, AYA patients experience significantly worse OS compared with pediatric patients. Although improvements in therapy have led to gain in survival for pediatric patients, with the exception of osteosarcoma, AYA experienced no increase in survival over the study period. This investigation demonstrates the importance for further research in the AYA population.

*Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO

The Children’s Hospital at TriStar Centennial and Sarah Cannon Research Institute

Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TN

I.C. and D.P. are co-first authors.

The authors declare no conflicts of interest.

Reprints: Stephanie M. Perkins, MD, 4921 Parkview Place, CAM LL, Campus Box 8224, Saint Louis, MO 63110. E-mail:

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