Noncancer causes of death in survivors of testicular cancer

被引:143
作者
Fossa, Sophie D. [1 ]
Gilbert, Ethel
Dores, Graca M.
Chen, Jinbo
McGlynn, Katherine A.
Schonfeld, Sara
Storm, Hans
Hall, Per
Holowaty, Eric
Andersen, Aage
Joensuu, Heikki
Andersson, Michael
Kaijser, Magnus
Gospodarowicz, Mary
Cohen, Randi
Pukkala, Eero
Travis, Lois B.
机构
[1] Univ Oslo, Rikshosp, Radiumhosp, Dept Clin Canc Res,Fac Med, Oslo, Norway
[2] Natl Canc Inst, Div Canc Epidemiol & Genet, NIH, Bethesda, MD USA
[3] Natl Canc Inst, Div Canc Prevent, NIH, Bethesda, MD USA
[4] Danish Canc Soc, Dept Med Epidemiol & Biostat, Copenhagen, Denmark
[5] Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden
[6] Canc Care Ontario, Toronto, ON, Canada
[7] Canc Reg Norway, Oslo, Norway
[8] Univ Helsinki, Cent Hosp, Helsinki, Finland
[9] Univ Toronto, Princess Margaret Hosp, Toronto, ON, Canada
[10] Inst Stat & Epidemiol Canc Res, Finnish Canc Reg, Helsinki, Finland
来源
JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE | 2007年 / 99卷 / 07期
关键词
D O I
10.1093/jnci/djk111
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background Although modern treatments for testicular cancer are associated with increased survival, the long-term health effects of these treatments are unclear. We conducted a population-based study to quantify the long-term risks of mortality from noncancer causes among men with testicular cancer. Methods We identified 38907 one-year survivors of testicular cancer within 14 population-based cancer registries in North America and Europe (from 1943 through 2002). We used data from these registries to calculate standardized mortality ratios (SMRs) for noncancer deaths and to evaluate associations between histology, age at testicular cancer diagnosis, calendar year of diagnosis, and initial treatment and the risk of noncancer mortality. All statistical tests were two-sided. Results A total of 2942 deaths from all noncancer causes were reported after a median follow-up of 10 years, exceeding the expected number of deaths from all noncancer causes in the general population by 6% (SMR = 1.06, 95% confidence interval [Cl] = 1.02 to 1.10); the noncancer standardized mortality ratios did not differ statistically significantly between patients diagnosed before and after 1975, when cisplatin-based chemotherapy came into widespread use. Compared with the general population, testicular cancer survivors had higher mortality from infections (SMR = 1.28, 95% Cl = 1.12 to 1.47) and from digestive diseases (SMR = 1.44, 95% Cl = 1.26 to 1.64). Mortality from all circulatory diseases was statistically significantly elevated in men diagnosed with testicular cancer before age 35 years (1.23, 95% C1 = 1.09 to 1.39) but not in men diagnosed at older ages (SMR = 0.94; 95% Cl = 0.89 to 1.00). Men treated with chemotherapy (with or without radiotherapy) in 1975 or later had higher mortality from all noncancer causes (SMR = 1.34, 95% Cl = 1.15 to 1.55), all circulatory diseases (SMR = 1.58, 95% Cl = 1.25 to 2.01), all infections (SMR = 2.48, 95% Cl = 1.70 to 3.50), and all respiratory diseases (SMR = 2.53, 95% C1 = 1.26 to 4.53). Testicular cancer patients who were younger than 35 years at diagnosis and were treated with radiotherapy alone in 1975 or later had higher mortality from all circulatory diseases (SMR = 1.70, 95% Cl = 1.21 to 2.31) compared with the general population. Conclusion Men who have survived for at least 1 year after being diagnosed with testicular cancer have a slightly higher risk of dying from noncancer causes, including infections, digestive diseases, and circulatory diseases, than the general population. Men treated with chemotherapy in 1975 or later may be at particularly high risk.
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收藏
页码:533 / 544
页数:12
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