Secondary malignancies among nonseminomatous germ cell tumor cancer survivors

Karim Chamie, Eric A Kurzrock, Christopher P Evans, Mark S. Litwin, Theresa M. Koppie, Sandra L. Wootton-Gorges, John M Boone, Primo N Lara, Ralph W deVere White

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

BACKGROUND: Men on active surveillance for clinical stage I nonseminomatous germ cell tumor (NSGCT) undergo frequent computed tomography imaging to avoid delayed detection of disease. Irradiation from frequent imaging and chemotherapy upon progression may place patients at increased risk of a second malignancy. In this study, the authors sought to identify such an increased risk among men who chose initial surveillance for NSGCT. METHODS: The authors utilized data from the Surveillance, Epidemiology and End Results Program and stratified the cohort based on whether they underwent retroperitoneal lymph node dissection (RPLND). A propensity-score model was used to adjust for covariates, and a competing-risks regression analysis was performed to estimate cumulative incidence rates of second malignancy. Incidence risk ratios were predicted by using the cumulative incidence rates per 10,000 patients. RESULTS: There was no statistically significant increase in the incidence of a secondary malignancy for the entire cohort of testicular cancer survivors. However, when the analysis was restricted to patients with clinical stage I NSGCT, nonsurgical management only in those aged >45 years was an independent predictor of developing a second malignancy. For every 10,000 patients with stage I NSGCT who chose to forego RPLND, an absolute excess incidence of 22, 52, and 73 secondary malignancies would be diagnosed at 5 years, 10 years, and 15 years, respectively. CONCLUSIONS: The current results indicated that patients aged >45 years who forego RPLND for T1 or T2 clinical stage I NSGCT are more likely to develop a second malignancy than those who do undergo RPLND. Nonsurgical management of NSGCT may be associated with more long-term health risks than primary RPLND.

Original languageEnglish (US)
Pages (from-to)4219-4230
Number of pages12
JournalCancer
Volume117
Issue number18
DOIs
StatePublished - Sep 15 2011

Fingerprint

Germ Cell and Embryonal Neoplasms
Survivors
Lymph Node Excision
Second Primary Neoplasms
Incidence
Neoplasms
SEER Program
Propensity Score
Testicular Neoplasms
Nonseminomatous germ cell tumor
Odds Ratio
Tomography
Regression Analysis
Drug Therapy
Health

Keywords

  • active surveillance
  • computed tomography
  • lymph node excision
  • neoplasms
  • retroperitoneal lymph node dissection
  • secondary
  • testis

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Secondary malignancies among nonseminomatous germ cell tumor cancer survivors. / Chamie, Karim; Kurzrock, Eric A; Evans, Christopher P; Litwin, Mark S.; Koppie, Theresa M.; Wootton-Gorges, Sandra L.; Boone, John M; Lara, Primo N; deVere White, Ralph W.

In: Cancer, Vol. 117, No. 18, 15.09.2011, p. 4219-4230.

Research output: Contribution to journalArticle

Chamie, Karim ; Kurzrock, Eric A ; Evans, Christopher P ; Litwin, Mark S. ; Koppie, Theresa M. ; Wootton-Gorges, Sandra L. ; Boone, John M ; Lara, Primo N ; deVere White, Ralph W. / Secondary malignancies among nonseminomatous germ cell tumor cancer survivors. In: Cancer. 2011 ; Vol. 117, No. 18. pp. 4219-4230.
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AU - Kurzrock, Eric A

AU - Evans, Christopher P

AU - Litwin, Mark S.

AU - Koppie, Theresa M.

AU - Wootton-Gorges, Sandra L.

AU - Boone, John M

AU - Lara, Primo N

AU - deVere White, Ralph W

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N2 - BACKGROUND: Men on active surveillance for clinical stage I nonseminomatous germ cell tumor (NSGCT) undergo frequent computed tomography imaging to avoid delayed detection of disease. Irradiation from frequent imaging and chemotherapy upon progression may place patients at increased risk of a second malignancy. In this study, the authors sought to identify such an increased risk among men who chose initial surveillance for NSGCT. METHODS: The authors utilized data from the Surveillance, Epidemiology and End Results Program and stratified the cohort based on whether they underwent retroperitoneal lymph node dissection (RPLND). A propensity-score model was used to adjust for covariates, and a competing-risks regression analysis was performed to estimate cumulative incidence rates of second malignancy. Incidence risk ratios were predicted by using the cumulative incidence rates per 10,000 patients. RESULTS: There was no statistically significant increase in the incidence of a secondary malignancy for the entire cohort of testicular cancer survivors. However, when the analysis was restricted to patients with clinical stage I NSGCT, nonsurgical management only in those aged >45 years was an independent predictor of developing a second malignancy. For every 10,000 patients with stage I NSGCT who chose to forego RPLND, an absolute excess incidence of 22, 52, and 73 secondary malignancies would be diagnosed at 5 years, 10 years, and 15 years, respectively. CONCLUSIONS: The current results indicated that patients aged >45 years who forego RPLND for T1 or T2 clinical stage I NSGCT are more likely to develop a second malignancy than those who do undergo RPLND. Nonsurgical management of NSGCT may be associated with more long-term health risks than primary RPLND.

AB - BACKGROUND: Men on active surveillance for clinical stage I nonseminomatous germ cell tumor (NSGCT) undergo frequent computed tomography imaging to avoid delayed detection of disease. Irradiation from frequent imaging and chemotherapy upon progression may place patients at increased risk of a second malignancy. In this study, the authors sought to identify such an increased risk among men who chose initial surveillance for NSGCT. METHODS: The authors utilized data from the Surveillance, Epidemiology and End Results Program and stratified the cohort based on whether they underwent retroperitoneal lymph node dissection (RPLND). A propensity-score model was used to adjust for covariates, and a competing-risks regression analysis was performed to estimate cumulative incidence rates of second malignancy. Incidence risk ratios were predicted by using the cumulative incidence rates per 10,000 patients. RESULTS: There was no statistically significant increase in the incidence of a secondary malignancy for the entire cohort of testicular cancer survivors. However, when the analysis was restricted to patients with clinical stage I NSGCT, nonsurgical management only in those aged >45 years was an independent predictor of developing a second malignancy. For every 10,000 patients with stage I NSGCT who chose to forego RPLND, an absolute excess incidence of 22, 52, and 73 secondary malignancies would be diagnosed at 5 years, 10 years, and 15 years, respectively. CONCLUSIONS: The current results indicated that patients aged >45 years who forego RPLND for T1 or T2 clinical stage I NSGCT are more likely to develop a second malignancy than those who do undergo RPLND. Nonsurgical management of NSGCT may be associated with more long-term health risks than primary RPLND.

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