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

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Abstract

Background

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.

Patients and Methods

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.

Results

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.

Conclusions

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.

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Data Availability

Data, protocols, and other details of the SEER database are available online at https://seer.cancer.gov/.

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Acknowledgments

We gratefully acknowledge the participants and investigators of the SEER study for their willingness to contribute their data. We also gratefully thanks researchers for their work in online database building and data sharing.

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Authors and Affiliations

  1. Department of General Surgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China

    Jian Li MA.Sc

  2. Department of Hematology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China

    Xiaohong Kuang BMed

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Contributions

Jian Li: conceptualization, methodology, supervision, formal analysis, visualization, writing—original draft, and writing—review and editing. Xiaohong Kuang: formal analysis and writing—original draft.

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Correspondence to Jian Li MA.Sc.

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Li, J., Kuang, X. Overall and Cause-Specific Late Mortality in Long-Term Survivors of Early Onset Solid Cancer After Surgery: A Population-Based Retrospective Cohort Study. Ann Surg Oncol (2026). https://doi.org/10.1245/s10434-026-20389-7

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