Dose-Dependent Effect of Platinum-Based Chemotherapy on the Risk of Metachronous Contralateral Testicular Cancer
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Purpose
Patients with testicular germ cell tumor (TGCT) are at increased risk of developing a contralateral TGCT (CTGCT). Although some studies suggest that prior treatment with platinum-based chemotherapy affects CTGCT risk, a relationship between CTGCT risk and platinum dose has not previously been assessed. We analyzed the association between the number of platinum-based chemotherapy cycles and CTGCT risk.
Patients and Methods
The risk of developing a metachronous CTGCT was evaluated in a nationwide cohort of 4,755 patients diagnosed with primary TGCT in the Netherlands between 1989 and 2007. Standardized incidence ratios were computed to compare CTGCT incidence with expected TGCT on the basis of TGCT incidence in the general population. The cumulative incidence of CTGCT was estimated in the presence of death as competing risk. The effect of treatment with platinum-based chemotherapy on CTGCT risk was assessed using multivariable Cox proportional hazards regression models.
Results
CTGCT was diagnosed in 136 patients (standardized incidence ratio 14.6, 95% CI 12.2 to 17.2). The cumulative incidence increased up to 20 years after primary diagnosis, reaching 3.4% (95% CI 2.8% to 4.0%) after 20 years of follow-up. The risk of developing a CTGCT decreased with age (hazard ratio [HR] 0.93, 95% CI 0.90 to 0.96), was lower after nonseminomatous germ cell tumor (HR 0.58, 95% CI 0.35 to 0.96), and decreased with every additional cycle of chemotherapy (HRper cycle 0.74, 95% CI 0.64 to 0.85).
Conclusion
Approximately one in every 30 survivors of TGCT will develop a CTGCT, with CTGCT incidence increasing up to 20 years after a primary TGCT. Treatment with platinum-based chemotherapy shows a dose-dependent inverse association with CTGCT risk.
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Read the full article
Dose-Dependent Effect of Platinum-Based Chemotherapy on the Risk of Metachronous Contralateral Testicular Cancer
Primary Source
Journal of Clinical Oncology
Source Reference: