Long-term non-cancer mortality among 39,657 one-year testicular cancer survivors (TCSs)

Abstract

4508 Background: Multiple reports address the incidence of second cancer (SC) and long-term morbidity in TCSs, yet few data analyze the impact of non-malignant late sequelae on mortality. Methods: 39,657 one-year TCSs were identified in 14 population-based cancer registries in North America and Europe, with 17,856, 13,084 and 6,298 men followed for 10, 20 and 30 years, respectively. Standardized mortality ratios (SMRs), comparing TCSs to the general population, were calculated for deaths due to all non-cancer causes (n = 2,942) and specific sites. Further, absolute mortality due to TC, non-TC SC and all non-cancer disorders was estimated. Results: The SMR for all non-malignant diseases combined was 0.99 (95% CI: 0.95–1.02), with a significant reduction of deaths due to circulatory diseases (SMR: 0.92, n = 1,117). However, following initial treatment with chemotherapy and radiotherapy, the SMR for circulatory diseases was significantly elevated (SMR: 1.76), with a non-significant 29% excess after chemotherapy alone. Mortality due to digestive diseases was significantly increased (SMR: 1.32, n = 222), including gastric and duodenal ulcers (SMR = 1.52; excess deaths were observed between 10 and 25 years after initial radiotherapy). For the first 20 years after TC diagnosis, deaths due to infection were significantly elevated (SMR: 1.52, n=211). Absolute mortality due to non-cancer disorders always exceeded that due to SC, and was 15% after 30 years in a TCS diagnosed at age 35 compared with about 11% for SC. Conclusions: Compared with the general population, the overall risk of mortality due to all non-cancer causes combined does not appear to be increased in TCSs. However, they experience excess non-cancer deaths due to infection and digestive diseases, but not circulatory diseases. Additional analytic studies with detailed data on treatment and co-morbidities are required to further evaluate associations with specific causes of death. No significant financial relationships to disclose.