Ragnhild Hellesnes1,2, Tor Åge Myklebust3,4, Roy M Bremnes1,2, Ása Karlsdottir5, Øivind Kvammen6, Helene F S Negaard7, Torgrim Tandstad8,9, Tom Wilsgaard10, Sophie D Fosså4,7,11, Hege S Haugnes1,2. 1. Department of Oncology, University Hospital of North Norway, Tromsø, Norway. 2. Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway. 3. Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway. 4. Department of Registration, Cancer Registry of Norway, Oslo, Norway. 5. Department of Oncology, Haukeland University Hospital, Bergen, Norway. 6. Department of Oncology, Ålesund Hospital, Ålesund, Norway. 7. Department of Oncology, Oslo University Hospital, Oslo, Norway. 8. The Cancer Clinic, St. Olav's University Hospital, Trondheim, Norway. 9. Department of Clinical and Molecular Medicine, The Norwegian University of Science and Technology, Trondheim, Norway. 10. Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway. 11. Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Abstract
PURPOSE: It is hypothesized that cisplatin-based chemotherapy (CBCT) reduces the occurrence of metachronous contralateral (second) germ cell testicular cancer (TC). However, studies including treatment details are lacking. The aim of this study was to assess the second TC risk, emphasizing the impact of previous TC treatment. PATIENTS AND METHODS: Based on the Cancer Registry of Norway, 5,620 men were diagnosed with first TC between 1980 and 2009. Treatment data regarding TC were retrieved from medical records. Cumulative incidences of second TC were estimated, and standardized incidence ratios were calculated. The effect of treatment intensity was investigated using Cox proportional hazard regression. RESULTS: Median follow-up was 18.0 years, during which 218 men were diagnosed with a second TC after median 6.2 years. Overall, the 20-year crude cumulative incidence was 4.0% (95% CI, 3.5 to 4.6), with lower incidence after chemotherapy (CT) (3.2%; 95% CI, 2.5 to 4.0) than after surgery only (5.4%; 95% CI, 4.2 to 6.8). The second TC incidence was also lower for those age ≥ 30 years (2.8%; 95% CI, 2.3 to 3.4) at first TC diagnosis than those age < 30 years (6.0%; 95% CI, 5.0 to 7.1). Overall, the second TC risk was 13-fold higher compared with the risk of developing TC in the general male population (standardized incidence ratio, 13.1; 95% CI, 11.5 to 15.0). With surgery only as reference, treatment with CT significantly reduced the second TC risk (hazard ratio [HR], 0.55). For each additional CBCT cycle administered, the second TC risk decreased significantly after three, four, and more than four cycles (HRs, 0.53, 0.41, and 0.21, respectively). CONCLUSION: Age at first TC diagnosis and treatment intensity influenced the second TC risk, with significantly reduced risks after more than two CBCT cycles.
PURPOSE: It is hypothesized that cisplatin-based chemotherapy (CBCT) reduces the occurrence of metachronous contralateral (second) germ cell testicular cancer (TC). However, studies including treatment details are lacking. The aim of this study was to assess the second TC risk, emphasizing the impact of previous TC treatment. PATIENTS AND METHODS: Based on the Cancer Registry of Norway, 5,620 men were diagnosed with first TC between 1980 and 2009. Treatment data regarding TC were retrieved from medical records. Cumulative incidences of second TC were estimated, and standardized incidence ratios were calculated. The effect of treatment intensity was investigated using Cox proportional hazard regression. RESULTS: Median follow-up was 18.0 years, during which 218 men were diagnosed with a second TC after median 6.2 years. Overall, the 20-year crude cumulative incidence was 4.0% (95% CI, 3.5 to 4.6), with lower incidence after chemotherapy (CT) (3.2%; 95% CI, 2.5 to 4.0) than after surgery only (5.4%; 95% CI, 4.2 to 6.8). The second TC incidence was also lower for those age ≥ 30 years (2.8%; 95% CI, 2.3 to 3.4) at first TC diagnosis than those age < 30 years (6.0%; 95% CI, 5.0 to 7.1). Overall, the second TC risk was 13-fold higher compared with the risk of developing TC in the general male population (standardized incidence ratio, 13.1; 95% CI, 11.5 to 15.0). With surgery only as reference, treatment with CT significantly reduced the second TC risk (hazard ratio [HR], 0.55). For each additional CBCT cycle administered, the second TC risk decreased significantly after three, four, and more than four cycles (HRs, 0.53, 0.41, and 0.21, respectively). CONCLUSION:Age at first TC diagnosis and treatment intensity influenced the second TC risk, with significantly reduced risks after more than two CBCT cycles.
Authors: Noa Shani Shrem; Lori Wood; Robert J Hamilton; Kopika Kuhathaas; Piotr Czaykowski; Matthew Roberts; Andrew Matthew; Jason P Izard; Peter Chung; Lucia Nappi; Jennifer Jones; Denis Soulières; Armen Aprikian; Nicholas Power; Christina Canil Journal: Can Urol Assoc J Date: 2022-08 Impact factor: 2.052
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