Comparison of primary and secondary XXXX in adolescents and young adults.

@entity5 @entity1 @entity0
BACKGROUND: @entity0 is one of the most common @entity5 in adolescent and young adult (AYA) @entity1 (ages 15-39) and may develop de novo or in @entity1 previously treated for @entity5 . This study compares the demographic, @entity5 , treatment characteristics, and overall survival (OS) of primary versus secondary (SMN) @entity0 in female AYAs. METHODS: All cases of invasive female AYA @entity0 in the 1998-2010 American College of Surgeons National @entity5 Database were divided into 2 cohorts according to primary or secondary occurrence. Comparisons using appropriate statistical methods were performed. RESULTS: Of 106,771 @entity1 , 6241 (5.8%) had experienced a prior, histologically distinct @entity5 . Breast SMNs were more likely ER-/PR- (OR, 1.24; 95% CI, 1.15-1.34), <1 cm (OR, 1.86; 95% CI, 1.73-1.99) @entity5 and present at a lower T, N (OR, 1.43; 95% CI, 1.34-1.52), and summary stage but with more distant metastases (OR, 1.42; 95% CI, 1.21-1.67) compared with primary @entity5 . Adjusted by stage, SMN @entity1 underwent more total mastectomies and received less chemotherapy, radiation, and hormonal therapy. However, SMN @entity1 received definitive surgical treatment almost twice as fast compared with primary @entity5 (36.12 vs 67.26 days, P   <   .001). @entity1 with SMNs had a significantly decreased 3-year OS (79% vs 88.5%, P   <   .001), with SMN status an independent risk factor for increased mortality (HR, 1.58; 95% CI, 1.41-1.77). CONCLUSIONS: Nonprimary @entity0 in AYAs has different @entity5 characteristics, presents at a lower stage, and receives less adjuvant therapy than primary @entity5 . SMN status is an independent risk factor for decreased OS, with an almost 10% decrease at 3 years. Whether the outcome disparity results from previous @entity5 treatment or differences in biology, environment, or access to care needs further investigation. @entity5 2014.    2014 American @entity5 Society.
