评估美国所有 5 个联邦政府定义种族的青少年 (AYA) 癌症患者的诊断分期和死亡风险的研究有限。旨在确定 AYA 癌症患者诊断分期和生存期的种族差异。回顾性队列研究使用了美国国家医院肿瘤学数据库中年龄为 15 至 39 岁的 AYA 患者的数据，在 2004 年 1 月 1 日至 2017 年 12 月 31 日期间诊断出的 AYA 患者中，有 10 种最致命的癌症，其中 6 例为 AYA 患者。几个月或更长时间的随访。按种族进行的分析按美国联邦定义的 5 个种族进行分类：美洲印第安人或阿拉斯加原住民、亚洲人、黑人、夏威夷原住民或其他太平洋岛民以及非西班牙裔白人（以下简称白人）。白人患者作为主要参考组。统计分析于 2022 年 11 月至 2023 年 9 月进行。主要终点为诊断晚期（调整比值比 [AOR] 和 95% CI 的逻辑回归）和总生存期（调整后的对数秩检验和 Cox 比例风险回归）风险比 [AHR] 和 95% CI）。总共 291899 名 AYA 患者（中位年龄 33 岁 [IQR，28-37 岁]；186549 名女性患者 [64%]；189812 名分期患者 [65%] I 型或 II 型癌症）进行了评估。该队列包括 1457 名美洲印第安人或阿拉斯加原住民患者 (1%)、8412 名亚洲患者 (3%)、40851 名黑人患者 (14%)、987 名夏威夷原住民或其他太平洋岛民患者 (0.3%) 和 240192 名白人患者(82%)。癌症包括乳腺癌 (n = 79195 [27%])、淋巴瘤 (n = 45500 [16%])、黑色素瘤 (n = 36724 [13%])、睾丸 (n = 31413 [11%])、中枢神经系统 (n = 26070 [9%])、结肠或直肠 (n = 22545 [8%])、子宫颈 (n = 2092​​3 [7%])、肉瘤 (n = 14951 [5%]) ）、卵巢（n = 8982 [3%]）和肺（n = 5596 [2%]）。亚洲人（AOR，1.20；95% CI，1.14-1.26）、黑人（AOR，1.40；95% CI，1.36-1.43）和夏威夷原住民或其他太平洋岛民（AOR，1.34）的晚期诊断风险较高; 95% CI, 1.16-1.55) 患者与白人患者相比。除中枢神经系统癌症和卵巢癌外，所有癌症部位的总体生存率因种族而异。美洲印第安人或阿拉斯加原住民（AHR，1.15；95% CI，1.02-1.30）、黑人（AHR，1.22；95% CI，1.19-1.26）以及夏威夷原住民或其他太平洋岛民（AHR， 1.25；95% CI，1.09-1.44）患者，但与白人患者相比，亚洲患者较低（AHR，0.90；95% CI，0.85-0.95）。这项针对 AYA 患者的队列研究表明，不同种族的诊断阶段和生存期存在差异。 10 种最致命的 AYA 癌症。这些结果支持需要采取量身定制的干预措施和知情的公共政策，以实现所有种族的癌症护理公平。

There are limited studies assessing stage at diagnosis and risk of death among all 5 federally defined races in the US among adolescent and young adult (AYA) patients with cancer.To identify racial disparities in stage at diagnosis and survival among AYA patients with cancer.This retrospective cohort study used data from a US national hospital-based oncology database on AYA patients, aged 15 to 39 years, with the 10 deadliest cancers among AYA patients who received a diagnosis from January 1, 2004, to December 31, 2017, with 6 months or more of follow-up. Analyses by race were categorized by the 5 federally defined races in the US: American Indian or Alaska Native, Asian, Black, Native Hawaiian or Other Pacific Islander, and non-Hispanic White (hereafter, White). White patients served as the majority reference group. Statistical analysis was performed from November 2022 to September 2023.The primary end points were late stage at diagnosis (logistic regression with adjusted odds ratios [AORs] and 95% CIs) and overall survival (log-rank tests and Cox proportional hazards regression with adjusted hazard ratios [AHRs] and 95% CIs).A total of 291 899 AYA patients (median age, 33 years [IQR, 28-37 years]; 186 549 female patients [64%]; 189 812 [65%] with stage I or II cancers) were evaluated. The cohort included 1457 American Indian or Alaska Native patients (1%), 8412 Asian patients (3%), 40 851 Black patients (14%), 987 Native Hawaiian or Other Pacific Islander patients (0.3%), and 240 192 White patients (82%). Cancers included breast (n = 79 195 [27%]), lymphoma (n = 45 500 [16%]), melanoma (n = 36 724 [13%]), testis (n = 31 413 [11%]), central nervous system (n = 26 070 [9%]), colon or rectum (n = 22 545 [8%]), cervix (n = 20 923 [7%]), sarcoma (n = 14 951 [5%]), ovary (n = 8982 [3%]), and lung (n = 5596 [2%]). Risk of late-stage diagnosis was higher for Asian (AOR, 1.20; 95% CI, 1.14-1.26), Black (AOR, 1.40; 95% CI, 1.36-1.43), and Native Hawaiian or Other Pacific Islander (AOR, 1.34; 95% CI, 1.16-1.55) patients compared with White patients. Overall survival differed by race for all cancer sites, except cancers of the central nervous system and ovary. Risk of death was higher for American Indian or Alaska Native (AHR, 1.15; 95% CI, 1.02-1.30), Black (AHR, 1.22; 95% CI, 1.19-1.26), and Native Hawaiian or Other Pacific Islander (AHR, 1.25; 95% CI, 1.09-1.44) patients but lower for Asian patients (AHR, 0.90; 95% CI, 0.85-0.95) compared with White patients.This cohort study of AYA patients suggests that stage at diagnosis and survival varied across races for the 10 deadliest AYA cancers. These results support the need for tailored interventions and informed public policy to achieve cancer care equity for all races.