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Risk of second malignant neoplasms among long-term survivors of testicular cancer
Journal article   Peer reviewed

Risk of second malignant neoplasms among long-term survivors of testicular cancer

Lois B Travis, Rochelle E Curtis, Hans Storm, Per Hall, Eric Holowaty, Flora E van Leeuwen, Betsy A Kohler, Eero Pukkala, Charles F Lynch, Michael Andersson, …
JNCI : Journal of the National Cancer Institute, Vol.89(19), pp.1429-1439
10/01/1997
DOI: 10.1093/jnci/89.19.1429
PMID: 9326912

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Abstract

We have quantified the site-specific risk of second malignant neoplasms among nearly 29,000 survivors (> or = 1 year) of testicular cancer, taking into account the histologic type of initial cancer and the primary therapy used to treat it. The study cohort consisted of 28,843 men identified within 16 population-based tumor registries in North America and Europe; over 3300 men had survived more than 20 years. New invasive cancers were identified through a search of registry files. Second cancers were reported in 1406 men (observed-to-expected ratio [O/E] = 1.43; 95% confidence interval = 1.36-1.51), with statistically significant excesses noted for acute lymphoblastic leukemia (O/E = 5.20), acute nonlymphocytic leukemia (O/E = 3.07), melanoma (O/E = 1.69), non-Hodgkin's lymphoma (O/E = 1.88), and cancers of the stomach (O/E = 1.95), colon (O/E = 1.27), rectum (O/E = 1.41), pancreas (O/E = 2.21), prostate (O/E = 1.26), kidney (O/E = 1.50), bladder (O/E = 2.02), thyroid (O/E = 2.92), and connective tissue (O/E = 3.16). Overall risk was similar after seminomas (O/E = 1.42) or nonseminomatous tumors (O/E = 1.50). Risk of solid tumors increased with time since the diagnosis of testicular cancer, yielding an O/E = 1.54 (O = 369) among 20-year survivors (two-sided P for trend = .00002). Secondary leukemia was associated with both radiotherapy and chemotherapy, whereas excess cancers of the stomach, bladder, and, possibly, pancreas were associated mainly with radiotherapy. Men with testicular cancer continue to be at significantly elevated risk of second malignant neoplasms for more than two decades following initial diagnosis. Patterns of excess second cancers suggest that many factors may be involved, although the precise roles of treatment, natural history, diagnostic surveillance, and other influences are yet to be clarified.
 Registries United States Melanoma - epidemiology Confidence Intervals Kidney Neoplasms - epidemiology Pancreatic Neoplasms - epidemiology Precursor Cell Lymphoblastic Leukemia-Lymphoma - epidemiology Seminoma - therapy Humans Leukemia, Myeloid, Acute - epidemiology Male Stomach Neoplasms - pathology Radiotherapy - adverse effects Rectal Neoplasms - epidemiology Antineoplastic Agents - adverse effects Urinary Bladder Neoplasms - epidemiology Testicular Neoplasms - therapy SEER Program Neoplasms, Connective Tissue - epidemiology Risk Factors Colonic Neoplasms - epidemiology Survival Rate Lymphoma, Non-Hodgkin - epidemiology Neoplasms, Second Primary - epidemiology Prostatic Neoplasms - epidemiology

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