Second malignancies among survivors of germ-cell testicular cancer: a pooled analysis between 13 cancer registries.
We investigated the risk of second malignancies among 29,511 survivors of germ-cell testicular cancer recorded in 13 cancer registries. Standardized incidence ratios (SIRs) were estimated comparing the observed numbers of second malignancies with the expected numbers obtained from sex-, age-, period- and population-specific incidence rates. Seminomas and nonseminomas, the 2 main histological groups of testicular cancer, were analyzed separately. During a median follow-up period of 8.3 years (0-35 years), we observed 1,811 second tumors, with a corresponding SIR of 1.65 (95% confidence interval (CI): 1.57-1.73). Statistically significant increased risks were found for fifteen cancer types, including SIRs of 2.0 or higher for cancers of the stomach, gallbladder and bile ducts, pancreas, bladder, kidney, thyroid, and for soft-tissue sarcoma, nonmelanoma skin cancer and myeloid leukemia. The SIR for myeloid leukemia was 2.39 (95% CI: 1.41-3.77) after seminomas, and 6.77 (95% CI: 4.14-10.5) after nonseminomas. It increased to 37.9 (95% CI: 18.9-67.8; based on 11 observed cases of leukemia) among nonseminoma patients diagnosed since 1990. SIRs for most solid cancers increased with follow-up duration, whereas they did not change with year of testicular cancer diagnosis. Among subjects diagnosed before 1980, 20 year survivors of seminoma had a cumulative risk of solid cancer of 9.6% (95% CI: 8.7-10.5%) vs. 6.5% expected, whereas 20 years survivors of nonseminoma had a risk of 5.0% (95% CI: 4.2-6.0%) vs. 3.1% expected. In conclusion, survivors of testicular cancers have an increased risk of several second primaries, where the effect of the treatment seems to play a major role.
Richiardi
Lorenzo
L
Unit of Cancer Epidemiology, CeRMS and Center for Oncology Prevention, University of Turin, Italy. lorenzo.richiardi@unito.it
Scélo
Ghislaine
G
Boffetta
Paolo
P
Hemminki
Kari
K
Pukkala
Eero
E
Olsen
Jorgen H
JH
Weiderpass
Elisabete
E
Tracey
Elizabeth
E
Brewster
David H
DH
McBride
Mary L
ML
Kliewer
Erich V
EV
Tonita
Jon M
JM
Pompe-Kirn
Vera
V
Kee-Seng
Chia
C
Jonasson
Jon G
JG
Martos
Carmen
C
Brennan
Paul
P
D000328:Adult; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000150:complications / Q000453:epidemiology*; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000209:etiology; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D017741:Survivors / Q000706:statistics & numerical data; D013736:Testicular Neoplasms / Q000150:complications / Q000453:epidemiology*