Presented in part at the 2010 American Society for Radiation Oncology (ASTRO) Annual Meeting, San Diego, California, November 2, 2010, and at the 2011 Genitourinary Cancers Symposium, Orlando, Florida, February 19, 2011.
Outcomes in stage I testicular seminoma: A population-based study of 9193 patients
Article first published online: 30 APR 2013
© 2013 American Cancer Society
Volume 119, Issue 15, pages 2771–2777, 1 August 2013
How to Cite
Beard, C. J., Travis, L. B., Chen, M.-H., Arvold, N. D., Nguyen, P. L., Martin, N. E., Kuban, D. A., Ng, A. K. and Hoffman, K. E. (2013), Outcomes in stage I testicular seminoma: A population-based study of 9193 patients. Cancer, 119: 2771–2777. doi: 10.1002/cncr.28086
- Issue published online: 18 JUL 2013
- Article first published online: 30 APR 2013
- Manuscript Accepted: 25 FEB 2013
- Manuscript Revised: 21 FEB 2013
- Manuscript Received: 10 JAN 2013
- testicular cancer;
- second malignant neoplasm;
- cardiovascular disease;
- all-cause mortality
Few studies have quantified temporal patterns of cause-specific mortality in contemporary cohorts of men with early-stage seminoma. Given that several management strategies can be applied in these patients, each resulting in excellent long-term survival, it is important to evaluate associated long-term sequelae. In particular, data describing long-term risks of cardiovascular disease (CVD) are conflicting.
We identified 9193 men diagnosed with stage I seminoma (ages 15-70 years) in the population-based SEER registries (1973-2001). We calculated survival estimates, standardized mortality ratios (SMRs), and adjusted hazard rates (AHRs).
During 121,037 person-years of follow-up (median, 12.3 years), 915 deaths (SMR, 1.23; 95% CI, 1.16-1.32) were reported, with significant excesses for suicide (n = 39; SMR, 1.45; 95% CI, 1.06-1.98), infection (n = 58; SMR, 2.32; 95% CI, 1.80-3.00), and second malignant neoplasms (SMNs; n = 291; SMR, 1.81; 95% CI, 1.61-2.03), but not CVD (n = 201; SMR, 0.91; 95% CI, 0.80-1.05). After radiotherapy (78% patients), CVD deaths were not increased (n = 158; SMR, 0.89; 95% CI, 0.76-1.04), in contrast to SMN deaths (n = 246; SMR, 1.89; 95% CI, 1.67-2.14). SMN mortality was higher among patients administered radiotherapy than among those not given radiotherapy (AHR, 1.36; 95% CI, 0.99-1.88; P = .059), with a cumulative 15-year risk of 2.64% (95% CI, 2.19-3.16). Suicide, although rare, accounted for 1 in 230 deaths.
Modern radiotherapy as applied in this large population-based study is not associated with excess CVD mortality. Although increased all-cause mortality exists, cumulative SMN risk is considerably smaller than reported in historical series, but additional follow-up will be required to characterize long-term trends. The increased risk of suicide, previously unreported in men with stage I seminoma, requires confirmation. Cancer 2013;119:2771–2777. © 2013 American Cancer Society.