Department of Oncology and First Faculty of Medicine, Thomayer University Hospital and Charles University, Prague, Czech Republic.
Cancer. 2011 Sep 15;117(18):4212-8. doi: 10.1002/cncr.26039. Epub 2011 Apr 8.
Second cancers are an important cause of mortality and morbidity in long-term survivors of testicular germ cell tumors (TGCTs). Studies on the impact of follow-up for the first tumor on the outcome of second malignancies are lacking. The aim of this study was to study the details of diagnosis of second cancers and the role of focused oncology follow-up.
Medical records and the electronic database of a tertiary referral center for germ cell neoplasms were searched for second cancers diagnosed in TGCT survivors. In a database of 1057 patients, 63 cases of metachronous second malignancies (26 contralateral testicular cancers and 37 nontesticular cancers) were found in 57 patients. Long-term oncology follow-up consisted of yearly history, physical examination, germ cell tumor markers, and imaging including abdominal computed tomography (CT) scans and chest x-ray.
The second malignancies occurred after a medium follow-up of 9.9 years (range, 1.1-33 years) after the diagnosis of the first tumor. Only 17 (27%) of the 63 second tumors were detected by oncology follow-up investigations, and a further 12 (29%) were detected by nononcology physicians during a preplanned clinical visit. In 34 (54%) cases, patients themselves or their relatives initiated a clinical appointment because of symptoms. Follow-up investigations all had low yields for the detection of second malignancies, although CT imaging did detect several cases of cancer at an early stage.
In this retrospective study, most second cancers occurring in long-term TGCT survivors were missed by regular oncology follow-up that included yearly physical examination, tumor marker, and imaging.
第二原发癌是睾丸生殖细胞肿瘤（TGCT）长期幸存者死亡和发病的重要原因。关于随访首次肿瘤对第二恶性肿瘤结局影响的研究较少。本研究旨在研究第二癌诊断的细节和重点肿瘤随访的作用。
检索一家三级生殖细胞肿瘤转诊中心的病历和电子数据库，以确定 TGCT 幸存者中诊断出的第二癌。在 1057 例患者的数据库中，在 57 例患者中发现了 63 例异时性第二恶性肿瘤（26 例对侧睾丸癌和 37 例非睾丸癌）。长期肿瘤随访包括每年的病史、体检、生殖细胞瘤标志物和影像学检查，包括腹部计算机断层扫描（CT）和胸部 X 线检查。
第二次癌症发生在首次肿瘤诊断后中位随访 9.9 年（范围 1.1-33 年）后。仅 17 例（27%）的 63 例第二肿瘤通过肿瘤随访调查发现，另有 12 例（29%）在计划临床就诊时由非肿瘤医生发现。在 34 例（54%）病例中，患者本人或其亲属因症状而主动就诊。尽管 CT 成像确实发现了几例早期癌症，但随访调查对第二恶性肿瘤的检出率均较低。
在这项回顾性研究中，大多数发生在长期 TGCT 幸存者中的第二癌症被包括每年体检、肿瘤标志物和影像学检查在内的常规肿瘤随访所遗漏。
