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. Cancer 2011;117:4219-30.

Retroperitoneal Lymph Node Dissection as First-Line Treatment of Node-Positive Seminoma

“…The use of RPLND to treat stage I NSGCT has been associated with a lower risk of secondary malignancy development. 32 The main long-term complications of RPLND are 30,[33][34][35] The risk of infertility increases with RPLND. 36 Compared with EBRT and CT, however, the fertility rates have been best in patients with testicular cancer who had undergone RPLND.…”

Estimating Preferences for Treatments in Patients With Localized Prostate Cancer

“…First, the main concern regarding observational studies is confounding by treatment selection bias (eg surgery is prescribed for younger patients and brachytherapy for patients at lower risk). Propensity score methods are being widely recommended in observational studies (41)(42)(43) to account for treatment selection bias and, thus, to identify the true treatment effects. It is worth pointing out that carrying out randomized clinical trials to compare different treatments presents considerable difficulties in these patients (44,45).…”

A Rare Tumor: Small Cell Prostate Carcinoma Case Report

“…compared to the normal population after BEP administration (26). Although Chamie et al (27) reported higher risk of secondary solid malignancy due to CT some studies report a 0.5-1% risk of hematological malignancy as a result of high-dose etoposide (28). The adverse effect of cisplatin-based CT on fertility and sexual function is not yet known (29).…”