Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Department of Urology, Urological Research Institute, Vita Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Martiniclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Eur J Surg Oncol. 2014 Jan;40(1):103-12. doi: 10.1016/j.ejso.2013.09.019. Epub 2013 Sep 25.
Incidence of secondary malignancies and cardiovascular diseases among testicular germ cell tumor (TGCT) survivors is higher compared to the general population. We sought to describe the rates of other-cancer (OCM), non-cancer related (NCRM), and cancer-specific mortality (CSM) among men with TGCT.
Using the Surveillance, Epidemiology, and End Results (SEER) database, 31,330 patients with a primary diagnosis of TGCT between 1973 and 2009 were identified. The primary endpoints comprised of 15-year CSM, OCM, and NCRM rates. Survival rates were stratified according to histology (seminoma vs. non-seminoma), median age (<34 vs. ≥34 years old), and disease stage (localized vs. regional vs. distant). Competing-risks Poisson regression methodologies were performed.
For seminoma patients, the rates of CSM at 15 years increased with advancing stage (0.4-12.6%; P < 0.001), but varies little with age. In contrast, the rates of OCM (0.4-7.9%) and NCRM (2.9-8.9%) at 15 years increased with advancing stage and age (all P < 0.001). For non-seminoma patients, the 15-year CSM rates increased with advancing stage and age (1.9-24.4%; all P < 0.001). For the same time point, the rates of OCM (0.3-11.4%) and NCRM (2.4-8.0%) also increased with age and stage (all P ≤ 0.001).
The risk of dying from secondary malignancies or other causes significantly increases with advancing stage and age at diagnosis among TGCT survivors. Such information can help provide patients and physicians with better screening strategies, follow-up protocols, and mental preparedness for such undesirable effects.
与普通人群相比，睾丸生殖细胞肿瘤 (TGCT) 幸存者的继发性恶性肿瘤和心血管疾病的发病率更高。我们旨在描述 TGCT 男性的其他癌症 (OCM)、非癌症相关 (NCRM) 和癌症特异性死亡率 (CSM) 的发生率。
使用监测、流行病学和最终结果 (SEER) 数据库，确定了 1973 年至 2009 年间患有原发性 TGCT 的 31,330 名患者。主要终点包括 15 年 CSM、OCM 和 NCRM 发生率。生存率根据组织学 (精原细胞瘤与非精原细胞瘤)、中位年龄 (<34 岁与 ≥34 岁) 和疾病分期 (局限性与区域性与远处) 进行分层。采用竞争风险泊松回归方法。
对于精原细胞瘤患者，15 年 CSM 率随着分期的进展而增加 (0.4-12.6%；P < 0.001)，但随年龄变化不大。相比之下，15 年 OCM (0.4-7.9%) 和 NCRM (2.9-8.9%) 率随着分期和年龄的增加而增加 (均 P < 0.001)。对于非精原细胞瘤患者，15 年 CSM 率随着分期和年龄的增加而增加 (1.9-24.4%；均 P < 0.001)。对于同一时间点，OCM (0.3-11.4%) 和 NCRM (2.4-8.0%) 率也随着年龄和分期的增加而增加 (均 P ≤ 0.001)。
在 TGCT 幸存者中，随着疾病分期和诊断时年龄的增加，死于继发性恶性肿瘤或其他原因的风险显著增加。这些信息可以帮助患者和医生制定更好的筛查策略、随访方案，并为这些不良后果做好心理准备。
