Lavi Arnon, Clark Roderick, Ly Tina Luu, Nair Shiva M, Hetou Khalil, Haan Michael, Power Nicholas E
Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.
Department of Sociology, Western University, London, Ontario, Canada.
Eur Urol Open Sci. 2020 Nov 20;22:54-60. doi: 10.1016/j.euros.2020.10.005. eCollection 2020 Dec.
Testis cancer (TC) patients are young with excellent cancer prognosis. Hence, the risk of late-onset treatment-related morbidity and mortality is of concern due to longer survival after treatment.
We set to characterize long-term survival of TC patients through a Canadian population dataset.
We used a population-based dataset, the Canadian Census Health and Environment Cohort (CanCHEC), to identify individuals diagnosed with TC between 1991 and 2010. We compared them with all other male individuals without TC.
The primary outcome was mortality due to cardiovascular disease (CVD) or nontesticular malignancy. Mann-Whitney or chi-square test was used where applicable. Data were analyzed using a Cox proportional hazard model with and without matching.
We identified 1950 individuals with TC. We compared them with 1 300 295 men with no TC. There were 335 deaths in the study group during the study period (17.2%) with a mean follow-up of 19.6 yr. TC patients were at increased risk of death from secondary malignancies (hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.39-1.91; < 0.0001) with specific risks for hematologic neoplasms (HR 3.86, 95% CI 2.78-5.37; < 0.001) and other malignancies (HR 2.41, 95% CI 1.76-3.29; < 0.001). Gastrointestinal, hematologic, and respiratory toxicities were the most common secondary malignancies leading to death. When stratified according to histology, nonseminoma (NS) patients were at significantly increased risk of death from CVD (HR 2.03, 95% CI 1.27-3.25; = 0.0032). Individuals with seminoma were at increased risk of death from other nontestis neoplasms (HR 1.46, 95% CI 1.17-1.82; = 0.0007), specifically hematologic neoplasms (HR 2.09, 95% CI 1.18-3.72; = 0.0118).
NS patients are at increased risk of CVD-related death, whereas seminoma patients are at increased risk of death from non-testis-related malignancies.
We report long-term mortality following diagnosis of testis cancer. Nonseminoma patients have an increased risk of death from cardiovascular disease, while seminoma patients have an increased risk of death from secondary malignancies.
睾丸癌（TC）患者较为年轻，癌症预后良好。因此，由于治疗后生存期延长，迟发性治疗相关发病和死亡风险备受关注。
我们旨在通过加拿大人群数据集描述TC患者的长期生存情况。
设计、地点和参与者：我们使用了基于人群的数据集——加拿大人口普查健康与环境队列（CanCHEC），以识别1991年至2010年间被诊断为TC的个体。我们将他们与所有其他未患TC的男性个体进行比较。
主要结局是心血管疾病（CVD）或非睾丸恶性肿瘤导致的死亡。在适用的情况下使用曼-惠特尼检验或卡方检验。使用Cox比例风险模型对数据进行分析，包括匹配和不匹配的情况。
我们识别出1950例TC患者。我们将他们与1300295例未患TC的男性进行比较。在研究期间，研究组有335例死亡（17.2%），平均随访19.6年。TC患者死于继发性恶性肿瘤的风险增加（风险比[HR]1.63，95%置信区间[CI]1.39 - 1.91；P < 0.0001），血液系统肿瘤（HR 3.86，95% CI 2.78 - 5.37；P < 0.001）和其他恶性肿瘤（HR 2.41，95% CI 1.76 - 3.29；P < 0.001）有特定风险。胃肠道、血液系统和呼吸系统毒性是导致死亡的最常见继发性恶性肿瘤。根据组织学分层时，非精原细胞瘤（NS）患者死于CVD的风险显著增加（HR 2.03，95% CI 1.27 - 3.25；P = 0.0032）。精原细胞瘤患者死于其他非睾丸肿瘤的风险增加（HR 1.46，95% CI 1.17 - 1.82；P = 0.0007），特别是血液系统肿瘤（HR 2.09，95% CI 1.18 - 3.72；P = 0.0118）。
NS患者死于CVD相关疾病的风险增加，而精原细胞瘤患者死于非睾丸相关恶性肿瘤的风险增加。
我们报告了睾丸癌诊断后的长期死亡率。非精原细胞瘤患者死于心血管疾病的风险增加，而精原细胞瘤患者死于继发性恶性肿瘤的风险增加。
