Background:Survival among children and adolescents and young adults (AYA) with cancer has improved substantially over recent decades; however, dominant survivorship models remain reactive—activated post-treatment and anchored to static exposure- and organ-based screening. This design underuses the anticipatory window at diagnosis and overlooks environmental and social determinants that modulate outcomes across the life course.Methods:We narratively reviewed international frameworks including the Children’s Oncology Group (COG), the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG), the Pan-European Network for Care of Survivors after Childhood and Adolescent Cancer (PanCare) and the National Comprehensive Cancer Network (NCCN), and synthesized evidence on environmental determinants, exposomics, toxicogenomics, and implementation. Building on two decades of real-world practice, we describe the evolution from the Pediatric Environmental History (PEHis) to the Ambiomic Health Compass (AHC), integrating genomic, exposomic, geospatial, clinical, and biomonitoring layers into routine care. In this framework, survivorship is conceptualized as beginning at the time of cancer diagnosis (“day 0”).Results:PEHis operationalizes guideline-based care with structured environmental and social assessment, personalized plans, and community integration, contributing to improved survival, healthier behaviors, reduced treatment-related mortality and stronger oncology–primary-care coordination. AHC extends PEHis with dynamic risk recalibration, contextual alerts, targeted biomonitoring, and toxicogenomic interpretation, enabling anticipatory decisions from day 0. The manuscript summarizes the paradigm shift (current vs. Ambiomic models), the domain-specific expansion over existing guidelines, the core clinical/system tools, and time-bound metrics (12, 24, 60 months) to support implementation and evaluation.Conclusions:Survivorship should move upstream—from late surveillance to ambiomic, exposure-aware care beginning at diagnosis. Integrating advanced exposomics, mutational epidemiology, and explainable analytics can reduce preventable events and chronicity, enhance equity, and align pediatric oncology with planetary health. The PEHis–AHC continuum offers a scalable blueprint for next-generation survivorship programs in Europe and beyond. Ambiomic medicine does not replace precision medicine—it completes and extends it by integrating exposomics, social context, and anticipatory analytics from day 0.
背景：近几十年来，儿童、青少年及年轻成人癌症患者的生存率显著提高；然而，当前主流的生存照护模式仍以被动反应为主——即治疗结束后启动，并固守于基于静态暴露因素和器官功能的筛查方案。这种设计未能充分利用诊断初期的预见性干预窗口，且忽视了影响患者全生命周期结局的环境与社会决定因素。 方法：我们系统评述了国际相关框架，包括儿童肿瘤协作组、国际儿童癌症远期效应指南协调组、泛欧儿童及青少年癌症生存者照护网络以及美国国家综合癌症网络，并综合了环境决定因素、暴露组学、毒理基因组学及实施科学方面的证据。基于二十年的临床实践，我们描述了从儿科环境史评估工具向环境基因组健康指南的演进过程，该指南将基因组、暴露组、地理空间、临床及生物监测等多维度数据整合至常规诊疗中。在此框架下，生存照护被重新定义为从癌症确诊之时即开始启动。 结果：儿科环境史评估工具通过结构化环境与社会评估、个性化干预方案及社区资源整合，实现了基于指南的规范化照护，有助于提高生存率、促进健康行为、降低治疗相关死亡率并加强肿瘤专科与初级医疗的协同合作。环境基因组健康指南在此基础上进一步拓展，通过动态风险再评估、情境化预警、靶向生物监测及毒理基因组学解读，实现了从确诊首日起的预见性临床决策。本文系统阐述了该模式的范式转变、相较于现有指南的领域拓展、核心临床工具与系统支持，并提出了分阶段实施评估指标。 结论：生存照护应实现前瞻性转变——从后期监测转向自诊断起始即开展的、关注环境暴露的全维度照护模式。整合前沿暴露组学、突变流行病学及可解释性分析技术，可减少可预防的远期事件与慢性病变，促进健康公平，推动儿科肿瘤学与星球健康理念的融合。儿科环境史评估工具-环境基因组健康指南连续体为欧洲乃至全球的新一代生存照护项目提供了可推广的实施蓝图。环境基因组医学并非取代精准医学，而是通过整合暴露组学、社会情境及预见性分析，从治疗起点完善和拓展了精准医学的内涵。
Beyond Precision: Ambiomic Survivorship in Childhood and AYA Cancer
肿瘤(癌症)患者之家