Excess deaths among seminoma patients persist
medwireNews: US research shows that men diagnosed with stage I seminoma since the advent of contemporary radiotherapy have a significantly increased risk for all-cause mortality compared with the overall population, despite being unlikely to die from testicular cancer itself.
The large, population-based study found significant excess mortality from suicide, second malignant neoplasms (SMNs), and infection in seminoma patients. However, the authors found no evidence for elevated cardiovascular disease incidence or mortality, which has historically been a risk following radiotherapy.
The study, published in Cancer, included 9193 men aged 15-70 years who were diagnosed with stage I seminoma between 1973 and 2001.
Overall, 7179 (78.0%) men received initial radiotherapy and, over 12.7 years of follow up for men treated with radiotherapy, and 10.9 years of follow up among those who did not, 915 (10.0%) men died.
Compared with the age-adjusted US male population, men with stage I seminoma were significantly more likely to die from SNMs (n=291), with a standardized mortality ratio of 1.23, report Clair Beard (Dana-Farber Cancer Institute, Boston, Massachusetts) and colleagues.
Men who underwent radiotherapy were significantly more likely to die from SNMs than men with stage I seminoma who did not, with a 15-year cumulative risk of 2.64% and 1.77%, respectively. However, the authors say that this risk is still markedly lower than that observed in historical cohorts who may have received larger doses of radiation, with greater exposure to normal tissues.
They also found significant excess of death from infections (n=58) and suicide (n=39) among men diagnosed with stage I seminoma compared with the general male population, with increased adjusted mortality risks of 132% and 45%, respectively.
"This finding is especially disturbing in view of the otherwise excellent prognosis for these patients," the authors write. Further research into this finding is required, they add.
"In the interim, in view of the known psychological distress reported among testicular cancer survivors, clinicians should continue to be attentive to patients' psychosocial needs."
Contrary to some prior reports, the authors found no excess cardiovascular mortality among patients whether or not they had received radiotherapy. Previous studies have shown conflicting results regarding this issue, and the authors say results may have been confounded by the inclusion of patients treated in the 1950s and 1960s.
Beard and colleagues also note that patients who were not given radiotherapy were more likely to die from testicular cancer than patients who were (10.72 vs 9.74%). This is important because men from poorer socioeconomic groups are less likely to receive radiotherapy, a finding which the authors also confirmed in their study.
"Additional study of the role of health disparities in outcomes in stage I seminoma patients should also be addressed in analytic studies that take into consideration detailed treatment information and patient demographic factors," they conclude.
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Kirsty Oswald, medwireNews Reporter