Fosså S D, Aass N, Harvei S, Tretli S
The Norwegian Radium Hospital, Department of Clinical Research, Montebello, N-0310 Oslo, Norway.
Br J Cancer. 2004 Feb 9;90(3):607-12. doi: 10.1038/sj.bjc.6601558.
Cisplatin-based chemotherapy of malignant germ cell tumours (MGCT) has been reported to increase the risk of cardiovascular morbidity. A high incidence of second nongerm cell malignancies is well documented in MGCT survivors. The death risk due to these conditions is, however, more unknown in MGCT patients. Standard mortality rates (SMRs) were established in 3378 Norwegian MGCT patients treated from 1962 to 1997 aged <or=55 years. The patients represented three principal treatment strategies: 1962/1969 (period 1): radiotherapy only; 1970/1979 (period 2): radiotherapy with or without noncisplatin-containing chemotherapy; 1980/1997 (period 3): surgery only or radiotherapy or cisplatin-based chemotherapy. Patients were censored when they reached the age of 60 years. Patients not dying from MGCT displayed significantly increased SMRs for respectively diseases of the circulatory system (SMR: 1.2, 95% confidence interval (CI): 1.0-1.5), benign gastrointestinal disorders (SMR: 2.1, 95% CI: 1.1-3.5) and nongerm cell malignancies (SMR: 2.0, 95% CI: 1.7-2.4). The SMRs for diseases of the circulatory system were similar in the three observation periods, whereas the highest SMR for benign gastrointestinal disorders was observed in patients from period 2. The risk of dying from a nongerm cell malignancy was increased both in periods 2 and 3. In conclusion, although the overall SMR for diseases of the circulatory system is increased in MCGT survivors, the introduction of cisplatin-based chemotherapy into the treatment of MGCT has so far not resulted in increased death rates due to these conditions. Patients with MGCT have a significantly increased relative death risk due to a second nongerm cell cancer, even after the introduction of modern treatment principles with overall reduction of radiotherapy. The increased death risk due to benign gastrointestinal disorders, probably related to radiotherapy, requires future in-depth analysis.
据报道，基于顺铂的恶性生殖细胞肿瘤（MGCT）化疗会增加心血管疾病的发病风险。MGCT幸存者中二次非生殖细胞恶性肿瘤的高发病率已有充分记录。然而，这些疾病导致的死亡风险在MGCT患者中更不为人所知。对1962年至1997年期间接受治疗、年龄≤55岁的3378例挪威MGCT患者确定了标准死亡率（SMR）。这些患者代表了三种主要治疗策略：1962/1969年（第1阶段）：仅放疗；1970/1979年（第2阶段）：放疗联合或不联合不含顺铂的化疗；1980/1997年（第3阶段）：仅手术、放疗或基于顺铂的化疗。患者在60岁时进行截尾。未死于MGCT的患者循环系统疾病（SMR：1.2，95%置信区间（CI）：1.0 - 1.5）、良性胃肠道疾病（SMR：2.1，95%CI：1.1 - 3.5）和非生殖细胞恶性肿瘤（SMR：2.0，95%CI：1.7 - 2.4）的SMR显著升高。循环系统疾病的SMR在三个观察期相似，而良性胃肠道疾病的最高SMR出现在第2阶段的患者中。第2阶段和第3阶段死于非生殖细胞恶性肿瘤的风险均增加。总之，虽然MGCT幸存者循环系统疾病的总体SMR增加，但到目前为止，在MGCT治疗中引入基于顺铂的化疗尚未导致因这些疾病而增加死亡率。即使采用了总体减少放疗的现代治疗原则，MGCT患者因二次非生殖细胞癌症导致的相对死亡风险仍显著增加。良性胃肠道疾病导致的死亡风险增加，可能与放疗有关，需要未来进行深入分析。
