Risk and prognostic significance of metachronous contralateral testicular germ cell tumours

M. Schaapveld, A. W. van den Belt-Dusebout, J. A. Gietema, R. de Wit, S. Horenblas, J. A. Witjes, H. J. Hoekstra, L. A. L. M. Kiemeney, W. J. Louwman, G. M. Ouwens, B. M. P. Aleman, F. E. van Leeuwen*

*Corresponding author for this work

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Abstract

BACKGROUND: Testicular germ cell tumour (TGCT) patients are at increased risk of developing a contralateral testicular germ cell tumour (CTGCT). It is unclear whether TGCT treatment affects CTGCT risk. METHODS: The risk of developing a metachronous CTGCT (a CTGCT diagnosed >= 6 months after a primary TGCT) and its impact on patient's prognosis was assessed in a nationwide cohort comprising 3749 TGCT patients treated in the Netherlands during 1965-1995. Standardised incidence ratios (SIRs), comparing CTGCT incidence with TGCT incidence in the general population, and cumulative CTGCT incidence were estimated and CTGCT risk factors assessed, accounting for competing risks.

RESULTS: Median follow-up was 18.5 years. Seventy-seven metachronous CTGCTs were diagnosed. The SIR for metachronous CTGCTs was 17.6 (95% confidence interval (95% CI) 13.9-22.0). Standardised incidence ratios remained elevated for up to 20 years, while the 20-year cumulative incidence was 2.2% (95% CI 1.8-2.8%). Platinum-based chemotherapy was associated with a lower CTGCT risk among non-seminoma patients (hazard ratio 0.37, 95% CI 0.18-0.72). The CTGCT patients had a 2.3- fold (95% CI 1.3-4.1) increased risk to develop a subsequent non-TGCT cancer and, consequently, a 1.8-fold (95% CI 1.1-2.9) higher risk of death than patients without a CTGCT.

CONCLUSION: The TGCT patients remain at increased risk of a CTGCT for up to 20 years. Treatment with platinum-based chemotherapy reduces this risk. British Journal of Cancer (2012) 107, 1637-1643. doi:10.1038/bjc.2012.448 www.bjcancer.com Published online 11 October 2012 (c) 2012 Cancer Research UK

Original languageEnglish
Pages (from-to)1637-1643
Number of pages7
JournalBritish Jounal of Cancer
Volume107
Issue number9
DOIs
Publication statusPublished - 23-Oct-2012

Keywords

  • contralateral testicular germ cell tumour
  • chemotherapy
  • platinum
  • cumulative incidence
  • prognosis
  • CARCINOMA IN-SITU
  • COMPETING RISKS
  • CANCER
  • CHEMOTHERAPY
  • EXPERIENCE
  • TESTIS

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