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© The Author 2007. Published by Oxford University Press.
ARTICLES |
Noncancer Causes of Death in Survivors of Testicular Cancer
Affiliations of authors: Department of Clinical Cancer Research, Rikshospitalet–Radiumhospitalet Trust, Faculty of Medicine, University of Oslo, Oslo, Norway (SDF); Division of Cancer Epidemiology and Genetics (EG, JC, KAM, SS, RC, LBT) and Division of Cancer Prevention (GMD), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Medical Epidemiology and Biostatistics, Danish Cancer Society, Copenhagen, Denmark (HS, MA); Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden (PH, MK); Cancer Care Ontario, Toronto, ON, Canada (EH); Cancer Registry of Norway, Oslo, Norway (AA); Helsinki University Central Hospital, Helsinki, Finland (HJ); The Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada (MG); Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland (EP)
Correspondence to: Sophie D. Fosså, VMD, PhD, Department of Clinical Cancer Research, Rikshospitalet–Radiumhospitalet Trust, Oslo, Norway (e-mail: s.d.fossa{at}medisin.uio.no).
Background: Although modern treatments for testicular cancer are associated with increased survival, the long-term health effects of these treatments are unclear. We conducted a population-based study to quantify the long-term risks of mortality from noncancer causes among men with testicular cancer.
Methods: We identified 38907 one-year survivors of testicular cancer within 14 population-based cancer registries in North America and Europe (from 1943 through 2002). We used data from these registries to calculate standardized mortality ratios (SMRs) for noncancer deaths and to evaluate associations between histology, age at testicular cancer diagnosis, calendar year of diagnosis, and initial treatment and the risk of noncancer mortality. All statistical tests were two-sided.
Results: A total of 2942 deaths from all noncancer causes were reported after a median follow-up of 10 years, exceeding the expected number of deaths from all noncancer causes in the general population by 6% (SMR = 1.06, 95% confidence interval [CI] = 1.02 to 1.10); the noncancer standardized mortality ratios did not differ statistically significantly between patients diagnosed before and after 1975, when cisplatin-based chemotherapy came into widespread use. Compared with the general population, testicular cancer survivors had higher mortality from infections (SMR = 1.28, 95% CI = 1.12 to 1.47) and from digestive diseases (SMR = 1.44, 95% CI = 1.26 to 1.64). Mortality from all circulatory diseases was statistically significantly elevated in men diagnosed with testicular cancer before age 35 years (1.23, 95% CI = 1.09 to 1.39) but not in men diagnosed at older ages (SMR = 0.94; 95% CI = 0.89 to 1.00). Men treated with chemotherapy (with or without radiotherapy) in 1975 or later had higher mortality from all noncancer causes (SMR = 1.34, 95% CI = 1.15 to 1.55), all circulatory diseases (SMR = 1.58, 95% CI = 1.25 to 2.01), all infections (SMR = 2.48, 95% CI = 1.70 to 3.50), and all respiratory diseases (SMR = 2.53, 95% CI = 1.26 to 4.53). Testicular cancer patients who were younger than 35 years at diagnosis and were treated with radiotherapy alone in 1975 or later had higher mortality from all circulatory diseases (SMR = 1.70, 95% CI = 1.21 to 2.31) compared with the general population.
Conclusion: Men who have survived for at least 1 year after being diagnosed with testicular cancer have a slightly higher risk of dying from noncancer causes, including infections, digestive diseases, and circulatory diseases, than the general population. Men treated with chemotherapy in 1975 or later may be at particularly high risk.
| CONTEXT AND CAVEATS Prior knowledge Modern treatments have improved the survival of men diagnosed with testicular cancer, raising concerns about the long-term health effects of these therapies with respect to the risk of death from noncancer causes. Study design A population-based study using data from cancer registries in North America and Europe to evaluate long-term trends in noncancer–specific mortality among men who had survived for at least 1 year after being diagnosed with testicular cancer. Contribution Compared with the general population, testicular cancer patients treated with chemotherapy in 1975 or later had higher risks of death from all noncancer causes, infections, circulatory diseases, and respiratory diseases. Patients who were diagnosed before age 35 years (regardless of treatment) had higher risks of death from all noncancer causes, infections, and circulatory diseases. Implications Additional investigations that include detailed information on treatment and comorbid conditions are needed to assess the incidence of the late effects of testicular cancer and its treatment. In addition, evidence-based studies are needed to develop optimal guidelines for patient follow-up and possible interventions aimed at reducing death rates from infection, digestive diseases, and circulatory diseases. Limitations The registry data lacked detailed information on radiotherapy fields and chemotherapeutic regimens and had no information on relapse therapy. Misclassification of cause of death could limit mortality estimates for specific disease subcategories, such as human immunodeficiency virus or hypertensive disorders.
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Manuscript received March 28, 2006; revised January 19, 2007; accepted February 13, 2007.
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J Natl Cancer Inst 2007 99: 493.
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