Risk of Cancer After Treatment of Testicular Germ Cell Cancer


Key Points

  • An increased platinum dose was found to be associated with an increased risk for subsequent malignant neoplasms vs surgery alone.
  • The risk of infradiaphragmatic subsequent malignant neoplasms was increased with an increasing infradiaphragmatic radiation dose.

In a Dutch study reported in the Journal of Clinical Oncology, Groot et al found that the risk of subsequent malignant neoplasms was increased in the long-term follow up of patients receiving cisplatin or radiotherapy for testicular germ cell cancer.

Risk vs General Population

The study involved 5,848 testicular cancer 1-year survivors treated before the age of 50 years between 1976 and 2007 in 13 Dutch hospitals. After a median follow-up of 14.1 years, 350 solid subsequent malignant neoplasms were observed, representing a 1.8-fold increased risk of solid cancers compared with the general population. Solid subsequent malignant neoplasm risk was increased in patients with seminoma (standardized incidence ratio = 1.52) and in those with nonseminoma (standardized incidence ratio = 2.21). Patients with nonseminoma had an increased risk of thyroid, lung, stomach, pancreatic, colon, and bladder cancers, as well as melanoma and soft-tissue sarcoma. Patients with seminoma had an increased risk of small intestine, pancreatic, and urinary bladder cancers. Overall, the 25-year cumulative incidence of solid subsequent malignant neoplasms was 10.3%.

Risk Factors

In a multivariable analysis, receipt of platinum-based chemotherapy was associated with an increased risk of any solid subsequent malignant neoplasm (hazard ratio [HR] = 2.40, 95% confidence interval [CI] = 1.58–3.62), colorectal subsequent malignant neoplasm (HR = 3.85, 95% CI = 1.67–8.92), and noncolorectal gastrointestinal (GI) subsequent malignant neoplasm (HR = 5.00, 95% CI = 2.28–10.95). Receipt of a platinum chemotherapy dose of 400 to 499 mg/m2 (HR = 2.43, 95% CI = 1.40–4.23) or ≥ 500 mg/m2 (HR = 2.42, 95% CI = 1.50–3.90) was associated with an increased risk of solid subsequent malignant neoplasm vs receipt of surgery alone; no increased risk of subsequent malignant neoplasm was associated with the use of lower platinum doses (HR = 1.75, 95% CI = 0.90–3.43). The hazard ratio for GI subsequent malignant neoplasms increased by 53% per 100 mg/m2 increase in platinum dose (P < .001 for trend). The hazard ratio for an infradiaphragmatic subsequent malignant neoplasms increased by 8% per Gy of infradiaphragmatic radiation dose vs no para-aortic radiation therapy (P < .001) for trend.

The investigators concluded, “Radiotherapy and platinum-containing chemotherapy are associated with increased solid [subsequent malignant neoplasm] risk, specifically with GI [subsequent malignant neoplasms].”

The study was supported by a grant from the Dutch Cancer Society.

Michael Schaapveld, PhD, of the Department of Epidemiology, Netherlands Cancer Institute, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.