Table 2.
Relative risks of second malignant neoplasms (SMN) in testicular cancer survivors.
| No. of patients | Calendar years of testicular cancer diagnosis | Duration of follow-up (years) | Treatment | Obs. | RR | (95% CI) | |
|---|---|---|---|---|---|---|---|
| Study populations a | |||||||
| All SMNs | |||||||
| Norwegian radium hospital [66] | 2006 | 1952–1990 | Mean = 12.5 | Any | 153b | 1.7 | 1.4–1.9 |
| RT | 130 | 1.6 | 1.3–1.9 | ||||
| CT | 4 | 1.3 | 0.4–3.4 | ||||
| RT + CT | 15 | 3.5 | 2.0–5.8 | ||||
| Fourteen population-based tumor registries in Europe and North America [55] | 40,576 | 1943–2001 | Mean = 11.3 | Any | 1694 | 1.9 | 1.8–2.1 |
| RT | 892 | 2.0 | 1.9–2.2 | ||||
| CT | 35 | 1.8 | 1.3–2.5 | ||||
| RT + CT | 25 | 2.9 | 1.9–4.2 | ||||
| Thirteen International Cancer Registries [164] | 29,511 | 1943–2000 | Median = 8.3 | Any | 1811c | 1.7 | 1.6–1.7 |
| Netherlands testicular cancer survivor cohort [46] | 2707 | 1965–1995 | Median = 17.6 | Any | 270d | 1.7 | 1.5–1.9 |
| RT | 199 | 1.7 | 1.5–2.0 | ||||
| CT | 23 | 1.4 | 0.9–2.1 | ||||
| RT + CT | 29 | 3.0 | 2.0–4.4 | ||||
| SDRT | N/A | 2.6g | 1.7–4.0 | ||||
| SDRT + MRT | N/A | 3.6g | 2.1–6.0 | ||||
| PVB/BEP | N/A | 2.1g | 1.4–3.1 | ||||
| SDRT (26–35 Gy) | N/A | 2.3g | 1.5–3.6 | ||||
| SDRT (40–50 Gy) | N/A | 3.2g | 2.1–5.1 | ||||
| Swedish family cancer database [165] | 5533 | 1980–2006 | N/A | Any | 274e | 2.0 | 1.8–2.2 |
| Second solid cancers | 12,691 | 1980–2008 | Median = 7.0 | Initial surgery only | 99 | 0.9 | 0.8–1.1 |
| Sixteen population-based registries within the SEER program [67] | Initial CT (no RT) | 111f | 1.4 | 1.2–1.7 | |||
| Therapy-associated leukemia | |||||||
| Nested case-control study of leukemia in 8 population-based tumor registries in Europe and North America [56] | 18,567 | 1970–1993 | N/A | No RT/CT | 4 | 1.0 | — |
| RT | 22 | 3.1 | 0.7–2.2 | ||||
| CT | 8 | 5.0 | 1.1–40 | ||||
| RT + CT | 2 | 5.1 | 0.5–28 |
∗Adapted with permission from Fung et al. J Natl Compr Canc Netw 2012; 10:545-56 (Table 2). RR: relative risk; CI: confidence interval; Obs.: observed number of cases; RT: any radiation treatment; CT: chemotherapy; IDRT: infradiaphragmatic radiation; SDRT: supradiaphragmatic radiation; MRT: mediastinal radiation; PVB: cisplatin, vinblastine, bleomycin; BEP: bleomycin, etoposide, cisplatin; N/A: not available (data not provided). (a) There was overlap in the cancer registries included in the cohort studies by Richiardi et al. [164] and Travis et al. [55], with the following countries contributing patients to both studies: Denmark, Finland, Norway, and Sweden; (b) six cases of leukemia were observed with a RR of 1.9 (95% CI: 0.7–4.1); (c) thirty-eight cases of myeloid leukemia were observed with a RR of 3.6 (95% CI: 2.6–5.0); thirteen cases of lymphoid leukemia were observed with a RR of 1.0 (95% CI: 0.5–1.7); twenty-three cases of other types of leukemia were observed with a RR of 3.5 (95% CI: 2.2–5.2); (d) six cases of leukemia were observed with a RR of 1.6 (95% CI: 0.6–3.5); (e) hazard ratios are shown, with the referent group consisting of patients treated with surgery alone (HR = 1.0). Twelve cases of leukemia were observed with a RR of 3.8 (95% CI: 2.0–6.7); (f) significantly increased risks occurred for cancers of the kidney (SIR = 3.4; 95% CI 1.8–5.7; n = 13); thyroid (SIR = 4.4; 95% CI: 2.2–7.9; n = 11); and soft tissue (SIR = 7.5; 95% CI: 3.6–13.8; n = 10).