Kvammen Øivind, Myklebust Tor Å, Solberg Arne, Møller Bjørn, Klepp Olbjørn H, Fosså Sophie D, Tandstad Torgrim
The Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway.
Department of Registration, Cancer Registry of Norway, Oslo, Norway.
Cancer Epidemiol Biomarkers Prev. 2016 May;25(5):773-9. doi: 10.1158/1055-9965.EPI-15-1153. Epub 2016 Feb 11.
Long-term relative survival (RS) data for testicular germ cell tumor (TGCT) patients are scarce. We aimed to analyze long-term RS among TGCT patients diagnosed in Norway, between 1953 and 2012.
Data sources were the Cancer Registry of Norway and the Norwegian Cause of Death Registry. TGCT patients diagnosed during 1953 to 2012 were classified by time of diagnosis, histology, age, and disease extent at diagnosis. Estimates for RS were obtained, and a test comparing overall RS was performed. Corresponding data were obtained for men diagnosed with localized malignant melanoma before age 50.
A total of 8,736 TGCT patients were included. RS generally continued to decline with increasing follow-up time, particularly beyond 15 to 30 years, unlike in localized malignant melanoma. Although RS was generally higher for seminomas, the continuing decline was more pronounced than for nonseminomas, even when diagnosed with localized disease. TGCT patients diagnosed before 1980 or after age 40 had lower RS.
Although TGCT RS has improved in recent decades, it continues to decline even beyond 30 years of follow-up, regardless of disease extent at diagnosis. The main cause is probably treatment-induced late effects, particularly affecting seminoma patients. The continued use of adjuvant radiotherapy in seminomas until year 2000 is suspected as a culprit.
Long-term TGCT survivors should be closely monitored for the development of late comorbidity. The challenge is to reduce negative consequences of previous and current TGCT treatment on RS while maintaining the excellent cure rates. Further research on causes of long-term morbidity and mortality among TGCT survivors is warranted. Cancer Epidemiol Biomarkers Prev; 25(5); 773-9. ©2016 AACR.
睾丸生殖细胞肿瘤（TGCT）患者的长期相对生存率（RS）数据稀缺。我们旨在分析1953年至2012年在挪威诊断出的TGCT患者的长期RS。
数据来源为挪威癌症登记处和挪威死亡原因登记处。1953年至2012年期间诊断出的TGCT患者按诊断时间、组织学、年龄和诊断时的疾病范围进行分类。获得RS估计值，并进行比较总体RS的检验。为50岁之前诊断为局限性恶性黑色素瘤的男性获取了相应数据。
共纳入8736例TGCT患者。与局限性恶性黑色素瘤不同，RS通常随着随访时间的增加而持续下降，尤其是在15至30年之后。虽然精原细胞瘤的RS总体较高，但持续下降比非精原细胞瘤更明显，即使是诊断为局限性疾病时也是如此。1980年之前或40岁之后诊断出的TGCT患者RS较低。
尽管近几十年来TGCT的RS有所改善，但即使在随访30年后仍持续下降，无论诊断时的疾病范围如何。主要原因可能是治疗引起的晚期效应，尤其影响精原细胞瘤患者。怀疑直到2000年精原细胞瘤中持续使用辅助放疗是一个罪魁祸首。
应密切监测TGCT长期幸存者晚期合并症的发生情况。挑战在于在保持优异治愈率的同时，减少既往和当前TGCT治疗对RS的负面影响。有必要对TGCT幸存者长期发病和死亡的原因进行进一步研究。《癌症流行病学、生物标志物与预防》；25(5)；773 - 779。©2016美国癌症研究协会。
