Mousa Ahmad, Amiri Ali, Kaushal Sanchit, Wilson Emma, Jayalath Viranda, Nguyen David-Dan, Tan Isabelle, Hamilton Robert J
Division of Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Library Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
J Natl Cancer Inst. 2025 Apr 12. doi: 10.1093/jnci/djaf099.
Testicular germ cell tumours (TGCTs) are the most common malignancy in men 15-35 years of age. Management options for men with TGCTs include surgery, radiation and/or chemotherapy. Given TGCTs' excellent survival, most patients live long enough to experience delayed treatment toxicities, warranting careful consideration of therapeutic decisions. An important outcome of interest is the development of secondary malignant neoplasms (SMNs).
A systematic literature search was conducted through a combination of database searches (Medline, EMBASE, and Cochrane library) and manual review. Studies evaluating the incidence of SMNs in patients following treatment for TGCTs were identified. Our primary outcome was the diagnosis of any non-germ cell SMN following treatment, compared to the general population. Meta-analyses were performed using random-effects models, with outcomes reported as standardized incidence ratios (SIR). Strength of evidence was evaluated using the GRADE framework.
Twenty-one studies including 88,863 patients with 5,180 SMNs were included. Median follow-up was 12.5 years. The incidence of non-germ cell SMNs following definitive treatment of TGCTs varied by treatment modality. Surgery alone was not associated with an increased risk (SIR: 0.99, 95% CI: 0.84-1.17); radiation (SIR: 1.66, 95% CI: 1.43-1.93), chemotherapy (SIR: 1.65, 95% CI: 1.39-1.96), and combined chemotherapy and radiation (SIR: 2.73, 95% CI: 2.23-3.33) were associated with a moderate to large increase in risk. There was low to moderate certainty in quality of evidence by GRADE framework.
Chemotherapy, radiation, and their combination are associated with an increased risk of non-germ cell SMNs after the treatment of TGCTs.
睾丸生殖细胞肿瘤（TGCTs）是15至35岁男性中最常见的恶性肿瘤。TGCTs男性患者的治疗选择包括手术、放疗和/或化疗。鉴于TGCTs患者生存率高，大多数患者存活时间足够长，会经历延迟的治疗毒性，因此需要仔细考虑治疗决策。一个重要的关注结果是继发性恶性肿瘤（SMNs）的发生。
通过数据库搜索（Medline、EMBASE和Cochrane图书馆）和人工检索相结合的方式进行系统的文献检索。确定评估TGCTs治疗后患者SMNs发生率的研究。我们的主要结果是与普通人群相比，治疗后任何非生殖细胞SMN的诊断。使用随机效应模型进行荟萃分析，结果以标准化发病率比（SIR）报告。使用GRADE框架评估证据强度。
纳入21项研究，共88,863例患者，其中5,180例发生SMNs。中位随访时间为12.5年。TGCTs确定性治疗后非生殖细胞SMNs的发生率因治疗方式而异。单纯手术与风险增加无关（SIR：0.99，95%CI：0.84 - 1.17）；放疗（SIR：1.66，95%CI：1.43 - 1.93）、化疗（SIR：1.65，95%CI：1.39 - 1.96）以及化疗联合放疗（SIR：2.73，95%CI：2.23 - 3.33）与风险中度至大幅增加相关。根据GRADE框架，证据质量为低至中度确定性。
化疗、放疗及其联合治疗与TGCTs治疗后非生殖细胞SMNs风险增加相关。
