Mortality after cure of testicular seminoma
Mortality after cure of testicular seminoma
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DOI：
10.1200/jco.2004.05.205
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发表时间：
2004-02-15
影响因子：
45.3
通讯作者：
Strom, SS
中科院分区：
文献类型：
--
作者：
Zagars, GK;Ballo, MT;Strom, SS
目的探讨睾丸精原细胞瘤经睾丸切除术和放射治疗（XRT）的长期存活患者的潜在治疗相关死亡率。1951年至1999年间，在德克萨斯大学安德森癌症中心（Houston， TX）接受睾丸切除术后超电压XRT治疗的477例I期或II期睾丸精原细胞瘤患者中，453例从未复发。采用人年法评估这453名男性的长期生存率，以确定标准化死亡率（SMR）。使用美国男性标准数据计算所有死因、心脏死亡和癌症死亡的smr。结果中位随访13.3年，10年、20年、30年和40年精算生存率分别为93%、79%、59%和26%。全因SMR在整个观察区间内为1.59 （99% Cl, 1.21 ~ 2.04）。在前15年的随访中，SMR并不过高：SMR为1.30 (95% Cl, 0.93 ~ 1.77)；15年以上的SMR为1.85 （99% Cl, 1.30 ~ 2.55）。总体心脏特异性SMR为1.61 （95% Cl， 1.21至2.24）。心脏SMR仅在15岁以上显著升高（P < 0.01）。总体癌症特异性SMR为1.91 （99% Cl， 1.14至2.98）。随访15年后，肿瘤SMR也有显著性差异（P < 0.01）。在接受和不接受纵隔放射治疗的患者中，死亡率明显增加。结论精原细胞瘤术后XRT治疗的长期存活者因心脏病或继发性癌症而死亡的风险显著增加。需要积极寻求将这些风险降至最低，但保持迄今观察到的良好治愈率的管理策略。(C) 2004年由美国临床肿瘤学会出版。
Purpose To determine the incidence of potentially treatment-related mortality in long-term survivors of testicular seminoma treated by orchiectomy and radiation therapy (XRT).Patients and Methods From all 477 men with stage I or II testicular seminoma treated at The University of Texas M.D. Anderson Cancer Center (Houston, TX) with postorchiectomy megavoltage XRT between 1951 and 1999, 453 never sustained relapse of their disease. Long-term survival for these 453 men was evaluated with the person-years method to determine the standardized mortality ratio (SMR). SMRs were calculated for all causes of death, cardiac deaths, and cancer deaths using standard US data for males.Results After a median follow-up of 13.3 years, the 10-, 20-, 30-, and 40-year actuarial survival rates were 93%, 79%, 59%, and 26%, respectively. The all-cause SMR over the entire observation interval was 1.59 (99% Cl, 1.21 to 2.04). The SMR was not excessive for the first 15 years of follow-up: SMR, 1.30 (95% Cl, 0.93 to 1.77); but beyond 15 years the SMR was 1.85 (99% Cl, 1.30 to 2.55). The overall cardiac-specific SMR was 1.61 (95% Cl, 1.21 to 2.24). The cardiac SMR was significantly elevated only beyond 15 years (P < .01). The overall cancer-specific SMR was 1.91 (99% Cl, 1.14 to 2.98). The cancer SMR was also significant only after 15 years of follow-up (P < .01). An increased mortality was evident in patients treated with and without mediastinal XRT.Conclusion Long-term survivors of seminoma treated with postorchiectomy XRT are at significant excess risk of death as a result of cardiac disease or second cancer. Management strategies that minimize these risks but maintain the excellent hitherto observed cure rates need to be actively pursued. (C) 2004 by American Society of Clinical Oncology.