Richiardi Lorenzo, Scélo Ghislaine, Boffetta Paolo, Hemminki Kari, Pukkala Eero, Olsen Jorgen H, Weiderpass Elisabete, Tracey Elizabeth, Brewster David H, McBride Mary L, Kliewer Erich V, Tonita Jon M, Pompe-Kirn Vera, Kee-Seng Chia, Jonasson Jon G, Martos Carmen, Brennan Paul
Unit of Cancer Epidemiology, CeRMS and Center for Oncology Prevention, University of Turin, Italy.
Int J Cancer. 2007 Feb 1;120(3):623-31. doi: 10.1002/ijc.22345.
We investigated the risk of second malignancies among 29,511 survivors of germ-cell testicular cancer recorded in 13 cancer registries. Standardized incidence ratios (SIRs) were estimated comparing the observed numbers of second malignancies with the expected numbers obtained from sex-, age-, period- and population-specific incidence rates. Seminomas and nonseminomas, the 2 main histological groups of testicular cancer, were analyzed separately. During a median follow-up period of 8.3 years (0-35 years), we observed 1,811 second tumors, with a corresponding SIR of 1.65 (95% confidence interval (CI): 1.57-1.73). Statistically significant increased risks were found for fifteen cancer types, including SIRs of 2.0 or higher for cancers of the stomach, gallbladder and bile ducts, pancreas, bladder, kidney, thyroid, and for soft-tissue sarcoma, nonmelanoma skin cancer and myeloid leukemia. The SIR for myeloid leukemia was 2.39 (95% CI: 1.41-3.77) after seminomas, and 6.77 (95% CI: 4.14-10.5) after nonseminomas. It increased to 37.9 (95% CI: 18.9-67.8; based on 11 observed cases of leukemia) among nonseminoma patients diagnosed since 1990. SIRs for most solid cancers increased with follow-up duration, whereas they did not change with year of testicular cancer diagnosis. Among subjects diagnosed before 1980, 20 year survivors of seminoma had a cumulative risk of solid cancer of 9.6% (95% CI: 8.7-10.5%) vs. 6.5% expected, whereas 20 years survivors of nonseminoma had a risk of 5.0% (95% CI: 4.2-6.0%) vs. 3.1% expected. In conclusion, survivors of testicular cancers have an increased risk of several second primaries, where the effect of the treatment seems to play a major role.
我们调查了13个癌症登记处记录的29511例生殖细胞睾丸癌幸存者发生第二原发恶性肿瘤的风险。通过比较第二原发恶性肿瘤的观察病例数与根据性别、年龄、时期和人群特异性发病率得出的预期病例数，估算标准化发病比（SIR）。睾丸癌的2种主要组织学类型，精原细胞瘤和非精原细胞瘤，分别进行分析。在中位随访期8.3年（0至35年）内，我们观察到1811例第二肿瘤，相应的SIR为1.65（95%置信区间（CI）：1.57 - 1.73）。发现15种癌症类型的风险有统计学显著增加，包括胃癌、胆囊和胆管癌、胰腺癌、膀胱癌、肾癌、甲状腺癌以及软组织肉瘤、非黑色素瘤皮肤癌和髓系白血病的SIR达到或高于2.0。精原细胞瘤后髓系白血病的SIR为2.39（95%CI：1.41 - 3.77），非精原细胞瘤后为6.77（95%CI：4.14 - 10.5）。1990年以来诊断的非精原细胞瘤患者中，该比例增至37.9（95%CI：18.9 - 67.8；基于11例观察到的白血病病例）。大多数实体癌的SIR随随访时间延长而增加，而与睾丸癌诊断年份无关。在1980年前诊断的患者中，精原细胞瘤20年幸存者实体癌累积风险为9.6%（95%CI：8.7 - 10.5%），预期为6.5%；而非精原细胞瘤20年幸存者风险为5.0%（95%CI：4.2 - 6.0%），预期为3.1%。总之，睾丸癌幸存者发生几种第二原发肿瘤的风险增加，治疗的影响似乎起主要作用。
