Solid and Hematologic Neoplasms After Testicular Cancer: A US Population-Based Study of 24?900 Survivors.

Milano MT, Dinh PC, Yang H, Zaid MA, Fossa SD, Feldman DR, Monahan PO, Travis LB, Fung C. Solid and Hematologic Neoplasms After Testicular Cancer: A US Population-Based Study of 24?900 Survivors. JNCI cancer spectrum. 2020 Jun 1; 4(3):pkaa017.

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Abstract:

BACKGROUND: No large US population-based study focusing on recent decades, to our knowledge, has comprehensively examined risks of second malignant solid and hematological neoplasms (solid-SMN and heme-SMN) after testicular cancer (TC), taking into account initial therapy and histological type. METHODS: Standardized incidence ratios (SIR) vs the general population and 95% confidence intervals (CI) for solid-SMN and heme-SMN were calculated for 24?900 TC survivors (TCS) reported to the National Cancer Institute's Surveillance, Epidemiology, and End Results registries (1973-2014). All statistical tests were two-sided. RESULTS: The median age at TC diagnosis was 33?years. Initial management comprised chemotherapy (n? = 6340), radiotherapy (n? = 9058), or surgery alone (n? = 8995). During 372 709 person-years of follow-up (mean? = 15?years), 1625 TCS developed solid-SMN and 228 (107 lymphomas, 92 leukemias, 29 plasma cell dyscrasias) developed heme-SMN. Solid-SMN risk was increased 1.06-fold (95% CI? = 1.01 to 1.12), with elevated risks following radiotherapy (SIR? = 1.13, 95% CI? = 1.06 to 1.21) and chemotherapy (SIR? = 1.36, 95% CI? = 1.12 to 1.41) but not surgery alone (SIR? = 0.83, 95% CI? = 0.75 to 0.92). Corresponding risks for seminoma were 1.13 (95% CI? = 1.06 to 1.21), 1.28 (95% CI? = 1.02 to 1.58), and 0.87 (95% CI? = 0.74 to 1.01) and for nonseminoma were 1.05 (95% CI? = 0.67 to 1.56), 1.25 (95% CI? = 1.08 to 1.43), and 0.80 (95% CI? = 0.70 to 0.92), respectively. Thirty-year cumulative incidences of solid-SMN after radiotherapy, chemotherapy, and surgery alone were 16.9% (95% CI? = 15.7% to 18.1%), 10.1% (95% CI? = 8.8% to 11.5%), and 8.8% (95% CI? = 7.8% to 9.9%), respectively (? < .0001). Increased leukemia risks after chemotherapy (SIR? = 2.68, 95% CI? = 1.70 to 4.01) were driven by statistically significant sevenfold excesses of acute myeloid leukemia 1 to 10?years after TC diagnosis. Risks for lymphoma and plasma cell dyscrasias were not elevated. CONCLUSIONS: We report statistically significant excesses of solid-SMN affecting 1 in 6 TCS 30?years after radiotherapy, and 2.7-fold risks of leukemias after chemotherapy, mostly acute myeloid leukemia. Efforts to minimize chemotherapy and radiotherapy exposures for TC should continue. TCS should be counseled about cancer prevention and screening.