Testicular Cancer in the Cisplatin Era: Causes of Death and Mortality Rates in a Population-Based Cohort.

Using complete information regarding testicular cancer (TC) treatment burden, this study aimed to investigate cause-specific non-TC mortality with impact on previous treatment with platinum-based chemotherapy (PBCT) or radiotherapy (RT).

Overall, 5,707 men identified by the Cancer Registry of Norway diagnosed with TC from 1980 to 2009 were included in this population-based cohort study. By linking data with the Norwegian Cause of Death Registry, standardized mortality ratios (SMRs), absolute excess risks (AERs; [(observed number of deaths - expected number of deaths)/person-years of observation] ×10,000), and adjusted hazard ratios (HRs) were calculated.

Median follow-up was 18.7 years, during which non-TC death was registered for 665 (12%) men. Overall excess non-TC mortality was 23% (SMR, 1.23; 95% CI, 1.14 to 1.33; AER, 11.14) compared with the general population, with increased risks after PBCT (SMR, 1.23; 95% CI, 1.07 to 1.43; AER, 7.68) and RT (SMR, 1.28; 95% CI, 1.15 to 1.43; AER, 19.55). The highest non-TC mortality was observed in those < 20 years at TC diagnosis (SMR, 2.27; 95% CI, 1.32 to 3.90; AER, 14.42). The most important cause of death was non-TC second cancer with an overall SMR of 1.53 (95% CI, 1.35 to 1.73; AER, 7.94), with increased risks after PBCT and RT. Overall noncancer mortality was increased by 15% (SMR, 1.15; 95% CI, 1.04 to 1.27; AER, 4.71). Excess suicides appeared after PBCT (SMR, 1.65; 95% CI, 1.01 to 2.69; AER, 1.39). Compared with surgery, increased non-TC mortality appeared after 3 (HR, 1.47; 95% CI, 0.91 to 2.39), 4 (HR, 1.41; 95% CI, 1.01 to 1.99), and more than four (HR, 2.04; 95% CI, 1.25 to 3.35) cisplatin-based chemotherapy cycles after > 10 years of follow-up.

TC treatment with PBCT or RT is associated with a significant excess risk of non-TC mortality, and increased risks emerged after more than two cisplatin-based chemotherapy cycles after > 10 years of follow-up.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2021 Aug 13 [Epub ahead of print]

Ragnhild Hellesnes, Tor Åge Myklebust, Sophie D Fosså, Roy M Bremnes, Ása Karlsdottir, Øivind Kvammen, Torgrim Tandstad, Tom Wilsgaard, Helene F S Negaard, Hege S Haugnes

Department of Oncology, University Hospital of North Norway, Tromsø, Norway., Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway., Department of Registration, Cancer Registry of Norway, Oslo, Norway., Department of Oncology, Haukeland University Hospital, Bergen, Norway., Department of Oncology, Ålesund Hospital, Ålesund, Norway., The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway., Department of Community Medicine, UiT The Arctic University, Tromsø, Norway., Department of Oncology, Oslo University Hospital, Oslo, Norway.

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