Department of Urology, University of California, Los Angeles, Los Angeles, California 90024, USA.
Cancer. 2011 Sep 15;117(18):4219-30. doi: 10.1002/cncr.26038. Epub 2011 Mar 15.
Men on active surveillance for clinical stage I nonseminomatous germ cell tumor (NSGCT) undergo frequent computed tomography imaging to avoid delayed detection of disease. Irradiation from frequent imaging and chemotherapy upon progression may place patients at increased risk of a second malignancy. In this study, the authors sought to identify such an increased risk among men who chose initial surveillance for NSGCT.
The authors utilized data from the Surveillance, Epidemiology and End Results Program and stratified the cohort based on whether they underwent retroperitoneal lymph node dissection (RPLND). A propensity-score model was used to adjust for covariates, and a competing-risks regression analysis was performed to estimate cumulative incidence rates of second malignancy. Incidence risk ratios were predicted by using the cumulative incidence rates per 10,000 patients.
There was no statistically significant increase in the incidence of a secondary malignancy for the entire cohort of testicular cancer survivors. However, when the analysis was restricted to patients with clinical stage I NSGCT, nonsurgical management only in those aged >45 years was an independent predictor of developing a second malignancy. For every 10,000 patients with stage I NSGCT who chose to forego RPLND, an absolute excess incidence of 22, 52, and 73 secondary malignancies would be diagnosed at 5 years, 10 years, and 15 years, respectively.
The current results indicated that patients aged >45 years who forego RPLND for T1 or T2 clinical stage I NSGCT are more likely to develop a second malignancy than those who do undergo RPLND. Nonsurgical management of NSGCT may be associated with more long-term health risks than primary RPLND.
接受临床 I 期非精原细胞瘤生殖细胞肿瘤（NSGCT）主动监测的男性为避免疾病的延迟发现而频繁进行计算机断层扫描成像。频繁成像和进展时化疗的辐射可能会增加患者发生第二种恶性肿瘤的风险。在这项研究中，作者试图确定选择 NSGCT 初始监测的男性中是否存在这种风险增加的情况。
作者利用监测、流行病学和最终结果计划的数据，并根据他们是否接受腹膜后淋巴结清扫术（RPLND）对队列进行分层。使用倾向评分模型调整协变量，并进行竞争风险回归分析以估计第二种恶性肿瘤的累积发病率。通过使用每 10,000 名患者的累积发病率来预测发病率风险比。
在整个睾丸癌幸存者队列中，第二种恶性肿瘤的发病率没有统计学意义的增加。然而，当分析仅限于临床 I 期 NSGCT 患者时，仅对年龄 >45 岁的患者进行非手术治疗是发生第二种恶性肿瘤的独立预测因素。对于每 10,000 名选择放弃 RPLND 的 I 期 NSGCT 患者，分别在 5 年、10 年和 15 年时将诊断出 22、52 和 73 例第二种恶性肿瘤的绝对超额发病率。
目前的结果表明，与接受 RPLND 的患者相比，年龄 >45 岁的患者因 T1 或 T2 临床 I 期 NSGCT 而放弃 RPLND 的患者更有可能患上第二种恶性肿瘤。与原发性 RPLND 相比，NSGCT 的非手术治疗可能与更多的长期健康风险相关。
