Outcomes in stage I testicular seminoma: A population‐based study of 9193 patients

Abstract

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.

Clinicopathology Illustration Treatment Options and Survival in the Patients with Testicular Germ Cell Tumors in Kermanshah Province, Iran

“…Presence of rete testis invasion has been associated with post-orchiectomy relapse in patients with early stage GCTs (17). Although it has been shown recently that radiotherapy does not increase cardiovascular morbidity (6). Orchidectomy is curative in many early stage testicular cancers.…”

“…Among nations with the highest reported incidence are Scandinavia, Germany, and New Zealand (5). Adjuvant radiotherapy, single-agent carboplatin, or active surveillance can be applied following standard orchiectomy in TGCT patients (6). With modern therapeutic approaches, 5-year survival after the diagnosis of testicular cancer exceed 90% in many countries (7).…”

Surveillance des séminomes testiculaires de stade I : résultats oncologiques sur 20ans

“…Ainsi, selon l'analyse de Lewinsthein en 2012, ce risque augmente de 19 % par rapport à la population générale [7]. De plus, la radiothérapie est associée à une augmentation du risque de maladie cardiovasculaire [7] (même si ce risque ne se retrouve pas dans toutes les études [8]), d'atteinte rénale, de diabète et d'infertilité [9]. Du fait de ses inconvénients, l'utilisation de la radiothérapie a progressivement décliné au profit de la chimiothérapie et de la surveillance, avec des résultats superposables.…”

Recommendations for followup of stage I and II seminoma: The Princess Margaret Cancer Centre approach

“…28,29 Men with testicular cancer may have increased rates of anxiety and suicide compared to the general population. 30,31 We recommend the validated Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item scale (GAD-7) as screening tools, and at our institution, these are combined with other standardized validates measures of distress, and completed by patients prior to clinical review. Depending on their screened level of distress, interventions range from providing information on supportive services to referral to a specialist psychologist or psychiatrist for further assessment and management.…”