Solid and Hematologic Neoplasms After Testicular Cancer: A US Population-Based Study of 24 900 Survivors.
Journal
JNCI cancer spectrum
ISSN: 2515-5091
Titre abrégé: JNCI Cancer Spectr
Pays: England
ID NLM: 101721827
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
received:
20
05
2019
revised:
17
12
2019
accepted:
19
02
2020
entrez:
27
5
2020
pubmed:
27
5
2020
medline:
27
5
2020
Statut:
epublish
Résumé
No large US population-based study focusing on recent decades, to our knowledge, has comprehensively examined risks of second malignant solid and hematological neoplasms (solid-SMN and heme-SMN) after testicular cancer (TC), taking into account initial therapy and histological type. Standardized incidence ratios (SIR) vs the general population and 95% confidence intervals (CI) for solid-SMN and heme-SMN were calculated for 24 900 TC survivors (TCS) reported to the National Cancer Institute's Surveillance, Epidemiology, and End Results registries (1973-2014). All statistical tests were two-sided. The median age at TC diagnosis was 33 years. Initial management comprised chemotherapy (n = 6340), radiotherapy (n = 9058), or surgery alone (n = 8995). During 372 709 person-years of follow-up (mean = 15 years), 1625 TCS developed solid-SMN and 228 (107 lymphomas, 92 leukemias, 29 plasma cell dyscrasias) developed heme-SMN. Solid-SMN risk was increased 1.06-fold (95% CI = 1.01 to 1.12), with elevated risks following radiotherapy (SIR = 1.13, 95% CI = 1.06 to 1.21) and chemotherapy (SIR = 1.36, 95% CI = 1.12 to 1.41) but not surgery alone (SIR = 0.83, 95% CI = 0.75 to 0.92). Corresponding risks for seminoma were 1.13 (95% CI = 1.06 to 1.21), 1.28 (95% CI = 1.02 to 1.58), and 0.87 (95% CI = 0.74 to 1.01) and for nonseminoma were 1.05 (95% CI = 0.67 to 1.56), 1.25 (95% CI = 1.08 to 1.43), and 0.80 (95% CI = 0.70 to 0.92), respectively. Thirty-year cumulative incidences of solid-SMN after radiotherapy, chemotherapy, and surgery alone were 16.9% (95% CI = 15.7% to 18.1%), 10.1% (95% CI = 8.8% to 11.5%), and 8.8% (95% CI = 7.8% to 9.9%), respectively ( We report statistically significant excesses of solid-SMN affecting 1 in 6 TCS 30 years after radiotherapy, and 2.7-fold risks of leukemias after chemotherapy, mostly acute myeloid leukemia. Efforts to minimize chemotherapy and radiotherapy exposures for TC should continue. TCS should be counseled about cancer prevention and screening.
Sections du résumé
BACKGROUND
BACKGROUND
No large US population-based study focusing on recent decades, to our knowledge, has comprehensively examined risks of second malignant solid and hematological neoplasms (solid-SMN and heme-SMN) after testicular cancer (TC), taking into account initial therapy and histological type.
METHODS
METHODS
Standardized incidence ratios (SIR) vs the general population and 95% confidence intervals (CI) for solid-SMN and heme-SMN were calculated for 24 900 TC survivors (TCS) reported to the National Cancer Institute's Surveillance, Epidemiology, and End Results registries (1973-2014). All statistical tests were two-sided.
RESULTS
RESULTS
The median age at TC diagnosis was 33 years. Initial management comprised chemotherapy (n = 6340), radiotherapy (n = 9058), or surgery alone (n = 8995). During 372 709 person-years of follow-up (mean = 15 years), 1625 TCS developed solid-SMN and 228 (107 lymphomas, 92 leukemias, 29 plasma cell dyscrasias) developed heme-SMN. Solid-SMN risk was increased 1.06-fold (95% CI = 1.01 to 1.12), with elevated risks following radiotherapy (SIR = 1.13, 95% CI = 1.06 to 1.21) and chemotherapy (SIR = 1.36, 95% CI = 1.12 to 1.41) but not surgery alone (SIR = 0.83, 95% CI = 0.75 to 0.92). Corresponding risks for seminoma were 1.13 (95% CI = 1.06 to 1.21), 1.28 (95% CI = 1.02 to 1.58), and 0.87 (95% CI = 0.74 to 1.01) and for nonseminoma were 1.05 (95% CI = 0.67 to 1.56), 1.25 (95% CI = 1.08 to 1.43), and 0.80 (95% CI = 0.70 to 0.92), respectively. Thirty-year cumulative incidences of solid-SMN after radiotherapy, chemotherapy, and surgery alone were 16.9% (95% CI = 15.7% to 18.1%), 10.1% (95% CI = 8.8% to 11.5%), and 8.8% (95% CI = 7.8% to 9.9%), respectively (
CONCLUSIONS
CONCLUSIONS
We report statistically significant excesses of solid-SMN affecting 1 in 6 TCS 30 years after radiotherapy, and 2.7-fold risks of leukemias after chemotherapy, mostly acute myeloid leukemia. Efforts to minimize chemotherapy and radiotherapy exposures for TC should continue. TCS should be counseled about cancer prevention and screening.
Identifiants
pubmed: 32455335
doi: 10.1093/jncics/pkaa017
pii: pkaa017
pmc: PMC7236780
doi:
Types de publication
Journal Article
Langues
eng
Pagination
pkaa017Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press.
Références
J Clin Oncol. 2008 Jun 20;26(18):2966-72
pubmed: 18458040
J Clin Oncol. 1992 Nov;10(11):1762-8
pubmed: 1403057
Br J Cancer. 2016 Sep 27;115(7):901-8
pubmed: 27599043
N Engl J Med. 2014 Nov 20;371(21):2005-16
pubmed: 25409373
J Natl Cancer Inst. 2005 Sep 21;97(18):1354-65
pubmed: 16174857
BJU Int. 2012 Mar;109(5):706-12
pubmed: 21883828
Eur Urol. 2004 Aug;46(2):209-14; discussion 214-5
pubmed: 15245815
Br J Cancer. 2014 Jan 7;110(1):256-63
pubmed: 24263066
N Engl J Med. 1997 Jul 24;337(4):242-53
pubmed: 9227931
Int J Cancer. 1999 Dec 10;83(6):860-3
pubmed: 10597212
J Clin Oncol. 2012 Oct 20;30(30):3734-45
pubmed: 23008293
Urol Oncol. 2017 Oct;35(10):606.e1-606.e7
pubmed: 28712791
Ann Intern Med. 2012 Jun 5;156(11):757-66, W-260
pubmed: 22665813
Br J Cancer. 1990 Apr;61(4):639-43
pubmed: 2109999
JAMA Oncol. 2016 Dec 1;2(12):1624-1627
pubmed: 27711914
Int J Radiat Oncol Biol Phys. 2016 Jan 1;94(1):75-84
pubmed: 26700704
J Natl Cancer Inst. 2013 Apr 3;105(7):504-8
pubmed: 23515901
APMIS. 2003 Jan;111(1):76-83; discussion 83-5
pubmed: 12752240
J Clin Oncol. 2005 Feb 20;23(6):1200-8
pubmed: 15718317
Arch Intern Med. 2009 Dec 14;169(22):2071-7
pubmed: 20008689
Br J Cancer. 2007 Sep 3;97(5):695-9
pubmed: 17653071
Ann Oncol. 2010 Jul;21(7):1546-51
pubmed: 20019089
Med Care. 2016 Sep;54(9):e55-64
pubmed: 24638121
J Clin Oncol. 2013 Oct 20;31(30):3807-14
pubmed: 24043737
Leuk Res. 2016 Apr;43:9-12
pubmed: 26922774
J Urol. 1998 Jan;159(1):133-8
pubmed: 9400455
Cancer. 2013 Aug 1;119(15):2771-7
pubmed: 23633409
CA Cancer J Clin. 2012 Jul-Aug;62(4):220-41
pubmed: 22700443
J Natl Cancer Inst. 2010 Aug 4;102(15):1114-30
pubmed: 20585105
J Clin Oncol. 2011 Mar 10;29(8):957-62
pubmed: 21282539
J Natl Cancer Inst. 2006 Jan 4;98(1):15-25
pubmed: 16391368
J Natl Cancer Inst. 2012 Mar 7;104(5):357-70
pubmed: 22312134
Acta Oncol. 2000;39(4):519-22
pubmed: 11041115
J Clin Oncol. 2015 Jan 1;33(1):51-7
pubmed: 25135991
J Clin Oncol. 2018 Aug 20;36(24):2504-2513
pubmed: 29989856
J Urol. 2003 Jul;170(1):5-11
pubmed: 12796635
Br J Cancer. 2015 Jan 6;112(1):44-51
pubmed: 25349972
Int J Radiat Oncol Biol Phys. 2001 Nov 1;51(3):643-9
pubmed: 11597804
J Clin Oncol. 1999 Apr;17(4):1146
pubmed: 10561173
JAMA Oncol. 2019 Mar 1;5(3):318-325
pubmed: 30570657
Lancet Oncol. 2007 Sep;8(9):784-96
pubmed: 17714993
Ann Intern Med. 1977 Sep;87(3):293-8
pubmed: 71004
J Natl Cancer Inst. 2005 May 18;97(10):715-23
pubmed: 15900041
J Natl Cancer Inst. 2000 Jul 19;92(14):1165-71
pubmed: 10904090
Br J Cancer. 2007 Feb 12;96(3):529-33
pubmed: 17262080