title: Secondary malignancies among nonseminomatous germ cell tumor cancer survivors.
abstract: BACKGROUND
  Men on active surveillance for clinical stage I nonseminomatous germ cell tumor (NSGCT) undergo frequent computed tomography imaging to avoid delayed detection of disease. Irradiation from frequent imaging and chemotherapy upon progression may place patients at increased risk of a second malignancy. In this study, the authors sought to identify such an increased risk among men who chose initial surveillance for NSGCT.
  
  
  METHODS
  The authors utilized data from the Surveillance, Epidemiology and End Results Program and stratified the cohort based on whether they underwent retroperitoneal lymph node dissection (RPLND). A propensity-score model was used to adjust for covariates, and a competing-risks regression analysis was performed to estimate cumulative incidence rates of second malignancy. Incidence risk ratios were predicted by using the cumulative incidence rates per 10,000 patients.
  
  
  RESULTS
  There was no statistically significant increase in the incidence of a secondary malignancy for the entire cohort of testicular cancer survivors. However, when the analysis was restricted to patients with clinical stage I NSGCT, nonsurgical management only in those aged >45 years was an independent predictor of developing a second malignancy. For every 10,000 patients with stage I NSGCT who chose to forego RPLND, an absolute excess incidence of 22, 52, and 73 secondary malignancies would be diagnosed at 5 years, 10 years, and 15 years, respectively.
  
  
  CONCLUSIONS
  The current results indicated that patients aged >45 years who forego RPLND for T1 or T2 clinical stage I NSGCT are more likely to develop a second malignancy than those who do undergo RPLND. Nonsurgical management of NSGCT may be associated with more long-term health risks than primary RPLND.
authors.affiliation: Department of Urology, University of California, Los Angeles, Los Angeles, California 90024, USA. kchamie@mednet.ucla.edu
authors.forename: Karim
authors.initials: K
authors.lastname: Chamie
authors.forename: Eric A
authors.initials: EA
authors.lastname: Kurzrock
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Evans
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Koppie
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wootton-Gorges
authors.forename: John M
authors.initials: JM
authors.lastname: Boone
authors.forename: Primo N
authors.initials: PN
authors.lastname: Lara
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Devere White
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology* / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D012187:Retroperitoneal Space / Q000473:pathology; D012306:Risk; D017741:Survivors; D013736:Testicular Neoplasms / Q000473:pathology* / Q000601:surgery