Table 2.
Risk of Second Solid Cancers According to Time Since Diagnosis and Site Among 12,691 Survivors of Testicular Nonseminoma Managed With Surgery and/or Chemotherapy
| Time Since Diagnosis and Site | Surgery Only (no RT) (n = 6,678) |
Chemotherapy (no RT) (n = 6,013) |
||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| No. of Solid Tumors | SIR | 95% CI | AER | 95% CI | No. of Solid Tumors | SIR | 95% CI | AER | 95% CI | |
| All solid tumors* | 99 | 0.93 | 0.76 to 1.14 | −1.11 | −4.00 to 2.25 | 111 | 1.43† | 1.18 to 1.73 | 6.47 | 2.68 to 10.83 |
| Time since diagnosis of testicular nonseminoma, years | ||||||||||
| < 1 | 9 | 2.27† | 1.04 to 4.32 | 9.44 | 0.28 to 24.58 | 7‡ | 2.24 | 0.90 to 4.62 | 8.21 | −0.67 to 23.94 |
| 1-4 | 19 | 1.02 | 0.62 to 1.60 | 0.21 | −3.40 to 5.31 | 24§ | 1.77† | 1.13 to 2.63 | 6.02 | 1.04 to 12.78 |
| 5-9 | 22 | 1.00 | 0.62 to 1.51 | −0.05 | −4.92 to 6.66 | 12 | 0.74 | 0.38 to 1.30 | −3.01 | −7.25 to 3.55 |
| 10-14 | 17 | 0.78 | 0.45 to 1.25 | −4.53 | −11.21 to 5.07 | 21 | 1.35 | 0.83 to 2.06 | 6.40 | −3.08 to 19.56 |
| 15-19 | 12 | 0.60 | 0.31 to 1.06 | −12.37 | −21.51 to 1.75 | 25‖ | 1.70† | 1.10 to 2.51 | 20.76 | 2.98 to 44.74 |
| ≥ 20 | 20 | 1.01 | 0.62 to 1.56 | 0.41 | −19.25 to 27.89 | 22 | 1.54 | 0.96 to 2.33 | 27.22 | −1.78 to 67.13 |
| Site of solid tumor¶ | ||||||||||
| Oral cavity and pharynx | 5 | 0.89 | 0.29 to 2.09 | −0.09 | −0.62 to 0.95 | 5 | 1.18 | 0.38 to 2.76 | 0.15 | −0.50 to 1.43 |
| Esophagus | 1 | 0.60 | 0.01 to 3.36 | −0.10 | −0.26 to 0.61 | 1 | 0.83 | 0.01 to 4.60 | −0.04 | −0.23 to 0.84 |
| Stomach | 0 | 0 | 0 to 1.71 | −0.33 | 0 to 0.24 | 3 | 1.90 | 0.38 to 5.56 | 0.27 | −0.19 to 1.38 |
| Colon | 11 | 1.46 | 0.73 to 2.62 | 0.54 | −0.32 to 1.90 | 1 | 0.19 | 0.002 to 1.04 | −0.84 | −1.03 to 0.04 |
| Rectosigmoid junction | 1 | 0.84 | 0.01 to 4.69 | −0.03 | −0.18 to 0.68 | 1 | 1.16 | 0.02 to 6.46 | 0.03 | −0.16 to 0.90 |
| Rectum | 1 | 0.30 | 0.004 to 1.66 | −0.37 | −0.52 to 0.35 | 2 | 0.81 | 0.09 to 2.92 | −0.09 | −0.43 to 0.91 |
| Liver | 1 | 0.45 | 0.01 to 2.50 | −0.19 | −0.35 to 0.52 | 3 | 1.77 | 0.36 to 5.18 | 0.25 | −0.21 to 1.36 |
| Pancreas | 3 | 1.20 | 0.24 to 3.51 | 0.08 | −0.30 to 0.98 | 5 | 2.77 | 0.89 to 6.47 | 0.62 | −0.04 to 1.90 |
| Lung and bronchus | 10 | 0.81 | 0.39 to 1.49 | −0.37 | −1.18 to 0.94 | 14 | 1.63 | 0.89 to 2.73 | 1.04 | −0.18 to 2.87 |
| Melanoma | 11 | 0.96 | 0.48 to 1.72 | −0.07 | −0.93 to 1.29 | 10 | 1.14 | 0.55 to 2.10 | 0.24 | −0.76 to 1.85 |
| Prostate | 20 | 0.76 | 0.46 to 1.17 | −0.98 | −2.20 to 0.72 | 16 | 0.87 | 0.50 to 1.41 | −0.46 | −1.78 to 1.46 |
| Bladder | 7 | 1.13 | 0.45 to 2.33 | 0.13 | −0.53 to 1.29 | 8 | 1.86 | 0.80 to 3.66 | 0.71 | −0.17 to 2.20 |
| Kidney# | 11 | 2.14† | 1.07 to 3.84 | 0.92 | 0.05 to 2.27 | 13 | 3.37† | 1.79 to 5.77 | 1.76 | 0.59 to 3.54 |
| Thyroid | 5 | 1.58 | 0.51 to 3.69 | 0.29 | −0.24 to 1.33 | 11 | 4.40† | 2.19 to 7.88 | 1.64 | 0.57 to 3.31 |
| Kaposi sarcoma | 2 | 0.58 | 0.06 to 2.08 | −0.23 | −0.51 to 0.59 | 1 | 0.37 | 0.005 to 2.04 | −0.33 | −0.52 to 0.55 |
| Soft tissue including heart | 3 | 1.76 | 0.35 to 5.14 | 0.20 | −0.17 to 1.10 | 10 | 7.49† | 3.59 to 13.78 | 1.67 | 0.66 to 3.28 |
| Brain and nervous system | 4 | 1.07 | 0.29 to 2.74 | 0.04 | −0.41 to 1.02 | 6 | 2.07 | 0.76 to 4.50 | 0.60 | −0.14 to 1.96 |
Abbreviations: AER, absolute excess risk per 10,000 person-years; RT, radiotherapy; SIR, standardized incidence ratio.
Second malignant neoplasms risks by calendar year (1980 to 1994 or 1995 to 2008) of testicular nonseminoma diagnoses were as follows: for patients treated with surgery only (no RT), 1980 to 1994: SIR, 0.83; 95% CI, 0.64 to 1.06; n = 65; 38,752 person-years of follow-up; for 1995 to 2008: SIR, 1.22; 95% CI, 0.85 to 1.71; n = 34; 25,354 person-years of follow-up; for patients treated with chemotherapy (no RT), 1980 to 1994: SIR, 1.40; 95% CI, 1.11 to 1.75; n = 79; 31,219 person-years of follow-up; for 1995 to 2008: SIR, 1.52; 95% CI, 1.04 to 2.14; n = 32; 20,748 person-years of follow-up. Increased risks of second solid cancers after chemotherapy occurred after localized (SIR, 1.26; 95% CI, 0.81 to 1.88), regional (SIR, 1.45; 95% CI, 1.09 to 1.91), and distant (SIR, 1.62; 95% CI, 1.12 to 2.26) testicular cancer.
SIRs with P < .05.
Second malignant neoplasms include cancers of stomach (n = 2; SIR, 29.70; 95% CI, 3.34 to 107.23), prostate (n = 2; SIR, 4.37; 95% CI, 0.49 to 15.76), kidney (n = 1; SIR, 6.91; 95% CI, 0.09 to 38.44), and brain and nervous system (n = 2; SIR, 10.37; 95% CI, 1.16 to 37.44).
Second malignant neoplasms include cancers of rectosigmoid (n = 1; SIR, 6.66; 95% CI, 0.09 to 37.05), rectum (n = 1; SIR, 2.33; 95% CI, 0.03 to 12.98), pancreas (n = 1; SIR, 3.64; 95% CI, 0.05 to 20.27), melanoma (n = 5; SIR, 2.60; 95% CI, 0.84 to 6.07), prostate (n = 4; SIR, 1.95; 95% CI, 0.52 to 4.99), kidney (n = 2; SIR, 3.01; 95% CI, 0.34 to 10.87), thyroid (n = 3; SIR, 4.91; 95% CI, 0.99 to 14.34), Kaposi sarcoma (n = 1; SIR, 1.08; 95% CI, 0.01 to 6.00), and soft tissue including heart (n = 6; SIR, 16.73; 95% CI, 6.11 to 36.42).
Second malignant neoplasms include cancers of oral cavity and pharynx (n = 3; SIR, 3.74; 95% CI, 0.75 to 10.93), esophagus (n = 1; SIR, 3.94; 95% CI, 0.05 to 21.91), pancreas (n = 2; SIR, 5.40; 95% CI, 0.61 to 19.51), lung and bronchus (n = 4; SIR, 2.29; 95% CI, 0.62 to 5.86), melanoma (n = 1; SIR, 0.70; 95% CI, 0.01 to 3.91), prostate (n = 2; SIR, 0.47; 95% CI, 0.05 to 1.69), bladder (n = 2; SIR, 2.34; 95% CI, 0.26 to 8.46), kidney (n = 5; SIR, 6.67; 95% CI, 2.15 to 15.57), brain and nervous system (n = 1; SIR, 2.58; 95% CI, 0.03 to 14.38), thyroid (n = 2; SIR, 5.42; 95% CI, 0.61 to 19.58), and soft tissue including heart (n = 2; SIR, 11.27; 95% CI, 1.27 to 40.70).
Four cancers are not itemized in Table 2. In the surgery cohort, these included one cancer designated only as a cancer of other digestive organs, one mesothelioma, and one breast cancer. In the chemotherapy cohort, one cancer of the small intestine was observed.
All cancers occurred in renal parenchyma, with no cancers of the renal pelvis observed in either treatment group.