BACKGROUND
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.
METHODS
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).
RESULTS
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.
CONCLUSIONS
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.