Department of Oncology, University Hospital of North Norway, Tromsø, Norway.
Department of Clinical Medicine, UiT The Arctic University, Tromsø, Norway.
J Clin Oncol. 2021 Nov 10;39(32):3561-3573. doi: 10.1200/JCO.21.00637. Epub 2021 Aug 13.
Using complete information regarding testicular cancer (TC) treatment burden, this study aimed to investigate cause-specific non-TC mortality with impact on previous treatment with platinum-based chemotherapy (PBCT) or radiotherapy (RT).
Overall, 5,707 men identified by the Cancer Registry of Norway diagnosed with TC from 1980 to 2009 were included in this population-based cohort study. By linking data with the Norwegian Cause of Death Registry, standardized mortality ratios (SMRs), absolute excess risks (AERs; [(observed number of deaths - expected number of deaths)/person-years of observation] ×10,000), and adjusted hazard ratios (HRs) were calculated.
Median follow-up was 18.7 years, during which non-TC death was registered for 665 (12%) men. Overall excess non-TC mortality was 23% (SMR, 1.23; 95% CI, 1.14 to 1.33; AER, 11.14) compared with the general population, with increased risks after PBCT (SMR, 1.23; 95% CI, 1.07 to 1.43; AER, 7.68) and RT (SMR, 1.28; 95% CI, 1.15 to 1.43; AER, 19.55). The highest non-TC mortality was observed in those < 20 years at TC diagnosis (SMR, 2.27; 95% CI, 1.32 to 3.90; AER, 14.42). The most important cause of death was non-TC second cancer with an overall SMR of 1.53 (95% CI, 1.35 to 1.73; AER, 7.94), with increased risks after PBCT and RT. Overall noncancer mortality was increased by 15% (SMR, 1.15; 95% CI, 1.04 to 1.27; AER, 4.71). Excess suicides appeared after PBCT (SMR, 1.65; 95% CI, 1.01 to 2.69; AER, 1.39). Compared with surgery, increased non-TC mortality appeared after 3 (HR, 1.47; 95% CI, 0.91 to 2.39), 4 (HR, 1.41; 95% CI, 1.01 to 1.99), and more than four (HR, 2.04; 95% CI, 1.25 to 3.35) cisplatin-based chemotherapy cycles after > 10 years of follow-up.
TC treatment with PBCT or RT is associated with a significant excess risk of non-TC mortality, and increased risks emerged after more than two cisplatin-based chemotherapy cycles after > 10 years of follow-up.
利用有关睾丸癌（TC）治疗负担的完整信息，本研究旨在调查特定于病因的非 TC 死亡率，并探讨其对以前接受铂类化疗（PBCT）或放疗（RT）治疗的影响。
本研究纳入了 1980 年至 2009 年间通过挪威癌症登记处确诊为 TC 的 5707 名男性。通过与挪威死因登记处的数据进行链接，计算了标准化死亡率比（SMR）、绝对超额风险（AER；[观察到的死亡人数-预期死亡人数/观察期间的人年数]×10000）和调整后的风险比（HR）。
中位随访时间为 18.7 年，在此期间有 665 名（12%）男性出现非 TC 死亡。与一般人群相比，整体非 TC 死亡率过高，为 23%（SMR，1.23；95%CI，1.14 至 1.33；AER，11.14），接受 PBCT（SMR，1.23；95%CI，1.07 至 1.43；AER，7.68）和 RT（SMR，1.28；95%CI，1.15 至 1.43；AER，19.55）后风险增加。在 TC 诊断时年龄<20 岁的患者中，非 TC 死亡率最高（SMR，2.27；95%CI，1.32 至 3.90；AER，14.42）。非 TC 第二癌症是最重要的死因，整体 SMR 为 1.53（95%CI，1.35 至 1.73；AER，7.94），在接受 PBCT 和 RT 后风险增加。非癌症死亡率总体增加 15%（SMR，1.15；95%CI，1.04 至 1.27；AER，4.71）。接受 PBCT 后自杀人数增加（SMR，1.65；95%CI，1.01 至 2.69；AER，1.39）。与手术相比，在接受>10 年随访后，接受 3（HR，1.47；95%CI，0.91 至 2.39）、4（HR，1.41；95%CI，1.01 至 1.99）和>4 个基于顺铂的化疗周期后（HR，2.04；95%CI，1.25 至 3.35）的非 TC 死亡率过高。
TC 治疗采用 PBCT 或 RT 与非 TC 死亡率显著过高相关，并且在接受>10 年随访后，超过两个基于顺铂的化疗周期后风险增加。
