Risk of Second Malignant Neoplasms Among Long-term Survivors of Testicular Cancer

• Published in: JNCI : Journal of the National Cancer Institute 1997-10, Vol.89 (19), p.1429-1439
• Main Authors: Travis, Lois B., Curtis, Rochelle E., Fraumeni, Joseph F., Boice, John D., Storm, Hans, Andersson, Michael, Hall, Per, Bergfeldt, Kjell, Holowaty, Eric, Clarke, E. Aileen, Van Leeuwen, Flora E., Kohler, Betsy A., Pukkala, Eero, Wiklund, Tom, Stoter, Gerritt, Gospodarowicz, Mary, Sturgeon, Jeremy
• Format: Article
• Language: English
• Subjects: Antineoplastic Agents - adverse effects; Biological and medical sciences; Cancer; Colonic Neoplasms - epidemiology; Confidence Intervals; Gynecology. Andrology. Obstetrics; Humans; Kidney Neoplasms - epidemiology; Leukemia, Myeloid, Acute - epidemiology; Lymphoma, Non-Hodgkin - epidemiology; Male; Male genital diseases; Medical sciences; Medicin och hälsovetenskap; Melanoma - epidemiology; Men; Neoplasms, Connective Tissue - epidemiology; Neoplasms, Second Primary - epidemiology; Pancreatic Neoplasms - epidemiology; Precursor Cell Lymphoblastic Leukemia-Lymphoma - epidemiology; Prostatic Neoplasms - epidemiology; Radiotherapy - adverse effects; Rectal Neoplasms - epidemiology; Registries; Reproductive system; Risk Factors; SEER Program; Seminoma - therapy; Stomach Neoplasms - pathology; Survival Rate; Testicular Neoplasms - therapy; Tumors; United States; Urinary Bladder Neoplasms - epidemiology
• ISSN: 0027-8874; 1460-2105
• DOI: 10.1093/jnci/89.19.1429

Background: We have quantified the site-specific risk of second malignant neoplasms among nearly 29 000 survivors (⩾1 year) of testicular cancer, taking into account the histologic type of initial cancer and the primary therapy used to treat it. Methods: 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. Results: 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. Conclusions: 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.