Relapse and Mortality Risk of Stage I Testicular Cancer

Objectives. – To assess the medical insurance risk for patients with stage I testicular cancer (TC), by calculating the overall mortality risk with and without relapse, and compare it to men from the Danish population. Background. – Testicular cancer is the most common malignancy in young males. Outcomes of a Danish cohort of 3366 patients with stage I TC (1366 non-seminomas (NSTC) and 2000 Seminomas (STC)), were analyzed. Method. – The data were analyzed by the “illness-death” model. For the analysis of the transitions between diagnosis, relapse and death we adopted a parametric approach, where the relationship between the intensities and the effect of covariates were specified by Poisson regression models for NSTC and STC individually. Results. – In the NSTC group, 422 patients relapsed. Six relapses (1.4%) occurred after 5 years of follow-up. In the STC group, 389 relapsed. The relapse rate after 5 years was 4.1%. The overall mortality analyses showed that the standardized mortality ratio (SMR) for men with NSTC without relapse, was slightly lower than in the matched general population of Danish men (SMR = 0.9). In STC patients without relapse, SMR was 0.80. Relapse raised the overall mortality by a factor 2.0 for NSTC and 1.5 for STC. Conclusions. – The fact that few relapses occur 5 years after diagnosis is an important finding for risk assessment in life insurance. It makes it possible to insure men diagnosed with stage I TC, who have not experienced relapse 5 years after diagnosis, on normal terms.

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Association of Heavy Metals with Overall Mortality in a Taiwanese Population

10.21203/rs.3.rs-277882/v1 ◽

2021 ◽

Author(s):

Yi-hsueh Liu ◽

Chih-Wen Wang ◽

Da-Wei Wu ◽

Wen-Hsien Lee ◽

Ying-Chih Chen ◽

...

Keyword(s):

Heavy Metals ◽

Multivariate Analysis ◽

General Population ◽

Confidence Interval ◽

Health Issues ◽

Taiwanese Population ◽

Southern Taiwan ◽

The Relationship ◽

Overall Mortality

Abstract Previous studies have shown links between heavy metals and many health issues. However, data on the association between heavy metals and mortality in the general population are still limited. Therefore, the aim of this study was to investigate the relationship between heavy metals and overall mortality in the general population. We enrolled 2,497 participants (1,001 males and 1,496 females) living in southern Taiwan, and measured levels of seven heavy metals: lead (Pb) in blood and cadmium (Cd), nickel (Ni), copper (Cu), chromium (Cr), manganese (Mn) and arsenic (As) in urine. The median follow-up period was 41.8 (4-50) months, during which 40 (1.6%) patients died. Compared to the participants who survived, those who died had higher urine Cd, higher urine Cu and lower urine Mn levels. Multivariate analysis showed that high urine Cd (per 1 mg/L; hazard ratio [HR], 1.352; 95% confidence interval [CI], 1.089-1.680; p = 0.006), high urine Cu (per 1 mg/dL; HR, 1.350; 95% CI, 1.151-1.583; p < 0.001), and low urine Mn (per 1 mg/L; HR, 0.717; 95% CI, 0.557-0.923; p = 0.010) were associated with increased overall mortality. In conclusion, our results demonstrated that high levels of urine Cd and Cu and low urine Mn level were associated with increased overall mortality in general population.

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THE STUDY OF RUSSIAN CIVILIAN AVIATION PILOTS’ MORTALITY

10.31089/978-5-6042929-2-1-2021-1-82-86 ◽

2021 ◽

Author(s):

I.V. Bukhtiyarov ◽

◽

E.V. Zibarev ◽

K.V. Betts

Keyword(s):

Working Conditions ◽

Mortality Risk ◽

Age Groups ◽

Mortality Rates ◽

Russian Population ◽

Standardized Mortality Ratio ◽

Long Term Effects ◽

Specific Mortality ◽

Aviation Pilots

Abstract. Introduction. The work of civilian aviation pilots is characterized by heavy psychological and emotional stress in combination with other occupational factors. Such complex of adverse working conditions appears to be a risk for functional and somatic disorders, which may subsequently be reflected in the causes and rates of mortality in the distant period. The aim of this work is to study the mortality of retired civilian aviation pilots. Methods. A prospective cohort epidemiological study of civilian aviation pilots’ mortality. The cohort included 4513 male civilian aviation pilots of Russia who completed their employment and received employment pension. The follow-up period was 10 years (01.01.2010-31.12.2019), with 22156.9 person-years obtained. The age-specific mortality rates were calculated for 5-year age groups, the mortality risk was assessed using standardized mortality ratio (SMR) with 95% confidence interval (95% CI). The comparison group was the male Russian population. Results. As of 31.12.2019, out of 4513 civilian aviation pilots, 150 people deceased (3.3%). The age-specific mortality rates in the retired pilots’ cohort were lower in all age groups compared to the male Russian population, except for the 35-39 age group. The all-cause mortality risk for civilian aviation pilots was significantly lower compared to the male Russian population, SMR=0.31 (95%CL 0.26-0.36). Conclusion. Further research is required to determine the long-term effects of working conditions on civilian aviation pilots’ health. The follow-up period for the pilots’ cohort should be increases to 20 years and more.

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Late relapse of testicular cancer.

Journal of Clinical Oncology ◽

10.1200/jco.1995.13.5.1170 ◽

1995 ◽

Vol 13 (5) ◽

pp. 1170-1176 ◽

Cited By ~ 234

Author(s):

J Baniel ◽

R S Foster ◽

R Gonin ◽

J E Messemer ◽

J P Donohue ◽

...

Keyword(s):

Testicular Cancer ◽

Germ Cell ◽

Cell Cancer ◽

Germ Cell Cancer ◽

Stage I ◽

Late Relapse ◽

Testicular Germ Cell ◽

Testicular Germ Cell Cancer ◽

Disease Free

PURPOSE This study analyzed a large group of patients with testicular germ cell cancer in complete remission, who relapsed more than 2 years after completion of treatment. PATIENTS AND METHODS A review of all patients treated at Indiana University Medical Center from 1979 through 1992 for late relapse was conducted. Eighty-one patients were treated for late relapse of testicular cancer. Forty-seven patients relapsed more than 5 years after successful management of their initial disease. RESULTS At initial diagnosis, 35 patients had clinical stage I, 18 stage II, and 28 stage III disease. Twenty-three of 35 stage I, all 18 stage II, and all 28 stage III patients were treated by chemotherapy before their late relapse. The median follow-up duration of patients post-management of late relapse was 4.8 years. Twenty-one patients (25.9%) are continuously disease-free. Nineteen of these 21 patients had surgical resection of carcinoma or teratoma as a component of their therapy. Of sixty-five patients treated for late relapse by chemotherapy, 17 (26.2%) had a complete response, but only two have been continuously disease-free with chemotherapy alone. These two never received prior chemotherapy. CONCLUSION Late relapse of testis cancer is more common than previously thought. Surgery is the preferred mode of therapy. Chemotherapy has only modest success in this entity, in contrast to the excellent results in de novo germ cell tumors. Patients treated for testicular germ cell cancer need annual follow-up evaluations throughout their life due to the possibility of late relapse.

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Prognostic factors for relapse in patients with clinical stage I testicular cancer: protocol for a Danish nationwide cohort study

BMJ Open ◽

10.1136/bmjopen-2019-033713 ◽

2019 ◽

Vol 9 (10) ◽

pp. e033713 ◽

Cited By ~ 2

Author(s):

Thomas Wagner ◽

Birgitte Grønkær Toft ◽

Birte Engvad ◽

Jakob Lauritsen ◽

Michael Kreiberg ◽

...

Keyword(s):

Risk Factors ◽

Testicular Cancer ◽

Germ Cell ◽

Clinical Stage ◽

Cell Cancer ◽

Germ Cell Cancer ◽

Stage I ◽

Testicular Germ Cell ◽

Testicular Germ Cell Cancer

IntroductionApproximately one-fourth of patients with clinical stage I testicular germ cell cancer will relapse within 5 years of follow-up. Certain histopathological features in the primary tumour have been associated with an increased risk of relapse. The available evidence on the prognostic value of the risk factors, however, is hampered by heterogeneity of the study populations included and variable reporting of the histopathological features. The aim of this study is to identify pathological risk factors for relapse in an unselected large nationwide cohort of patients with stage I disease.Methods and analysisAll incident cases of stage I testicular germ cell cancer diagnosed in Denmark between 2013 and 2018 will be identified using the nationwide prospective Danish Testicular Cancer (DaTeCa) database. Archived microscopic slides from the orchiectomy specimens will be retrieved through linkage to the Danish Pathology Data Bank and reviewed blinded to the clinical outcome. The DaTeCa database includes 960 stage I seminoma patients with expected 185 relapses and 480 patients with stage I non-seminoma with expected 150 relapses. A minimum follow-up period of 3 years of all patients will be ensured. Predefined prognostic variables will be investigated with regard to relapse in univariable and multivariable analysis using the Cox proportional hazards model.Ethics and disseminationThis study protocol has been approved by the Regional Ethics Committee (Region Zealand, Denmark) and the Danish Data Protection Agency. All data will be managed confidentially according to legislation. Study results will be presented at international conferences and published in peer-review journals.

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Non-breast cancer mortality after a breast cancer diagnosis: A retrospective population-based study

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.6619 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 6619-6619

Author(s):

G. F. Beadle ◽

N. J. McCarthy ◽

P. D. Baade

Keyword(s):

Breast Cancer ◽

Breast Cancer Mortality ◽

Breast Cancer Diagnosis ◽

Population Based ◽

Standardized Mortality Ratio ◽

First Year ◽

Female Population ◽

Risk Of Mortality ◽

Mortality Ratio

6619 Background: Survivorship research after a breast cancer (BC) diagnosis has identified psychosocial, functional and comorbidity outcomes that adversely influence daily life. Little is known, however, about non-breast cancer (NBC) mortality after a BC diagnosis. Methods: This retrospective cohort study included Australian women aged 30–79 years diagnosed with BC between January 1982 and December 2004, with mortality examined from January 1993 to December 2005. The age-standardized mortality ratio (SMR) was used to compare NBC causes of death in the BC cohort and the age-matched Australian female population between January 1993 and December 2005. Results: The median follow-up time for the cohort of 159,550 Australian women diagnosed with BC was 7.04 years (range 0–24.7 years). During the follow-up period, 30,819 (19.3%) died of BC, 5,403 (3.4%) died of other cancers (OC), 18,349 (11.5%) died of non-cancer (NC) causes, while 104,979 (65.8%) were still alive at the end of the follow-up period. Excluding the first year after diagnosis, women with a prior BC diagnosis had a higher risk of mortality (SMR = 328.6.95% CI = 324.8–332.3, p < 0.001) than the age matched female population. NBC mortality risk was elevated for OC (SMR = 103.7, CI = 100.1–107.5, p = 0.022) but reduced for NC causes (SMR = 94.9, CI = 92.3–97.5, p < 0.001). For the age groupings 30–49 years (n = 46,736), 50–69 years (n = 82,967), and 70–79 years (n = 29,847), SMR's for NC causes were 168.2 (CI = 144.1–195.1, p < 0.001), 100.9 (CI = 95.9–106.1, p = 0.355), and 90.5 (CI = 87.5–93.5, p < 0.001) respectively. Following the first year of diagnosis, the SMR for OC was non-significantly elevated with time after diagnosis. In comparison, the SMR for NC causes reduced with time after diagnosis; SMR = 96.4 (CI = 92.1–100.8, p = 0.055) at 2–5 years after diagnosis, 98.2 (CI = 93.7–102.8, p = 0.222) at 6–10 years, 92.8 (CI = 87.2–98.7, p = 0.008) at 11–15 years and 82.2 (CI = 74.8–90.2, p < 0.001) at more than 15 years. Conclusions: BC survivors have a higher risk of mortality from OC compared to the aged-matched Australian female population, but a reduced risk from NC causes. Although NC mortality is lower in older women and as time from BC diagnosis increases, women less than 50 years have a higher risk of NC mortality. No significant financial relationships to disclose.

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Long-term survival and competing causes of death in men with stage I seminoma.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.226 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 226-226 ◽

Cited By ~ 3

Author(s):

C. Beard ◽

M. Chen ◽

N. D. Arvold ◽

P. L. Nguyen ◽

A. K. Ng ◽

...

Keyword(s):

General Population ◽

Testicular Cancer ◽

Cancer Mortality ◽

Stage I ◽

Second Malignancy ◽

Term Survival ◽

All Cause Mortality ◽

Stage I Seminoma

226 Background: To better understand the impact of RT on mortality, we analyzed long-term survival and patterns of excess mortality in men with stage I seminoma. Methods: 9,045 men with stage I seminoma were identified in the Surveillance Epidemiology and End Results database. Time to testicular-cancer mortality (TCM), death from second malignancy (SM), cardiovascular mortality (CVM) or suicide (SUIC) and all-cause mortality (ACM) were calculated. Survival estimates were calculated using the Kaplan-Meier method. Gender- and age-adjusted standardized mortality ratios (SMR) were calculated using U.S. population data. Cox and Fine and Gray multivariable analysis were used to evaluate the effect of RT on mortality outcomes. Results: 7,025 men (78%) received RT. After a median follow-up of 11.7 years, 869 men (9.6%) had died: sixty-five from TCM, 279 from SM, 169 from CVM and 37 from SUIC. 10-year rates of ACM and TCM were 4.24% and 0.52% among men who received RT and 7.14% and 1.22% among men who did not. Compared to the adjusted general population, men with seminoma had increased risk of ACM (SMR 1.12; 95% confidence interval [CI] 1.12-1.28), SM (SMR 1.78; 95% CI 1.58-2.00) and SUIC (SMR 1.40; 95% CI 1.02-1.94) and decreased risk of CVM (SMR 0.73; 95% CI 0.62-0.84). Rates of ACM, SM and SUIC (SMR, all p < 0.05) were increased whether RT was used or not. Men who received RT were less likely to die (adjusted hazard ratio [AHR] 0.76; 95% CI 0.65-0.89; p < 0.001) and had a lower risk of TCM (AHR 0.39; 95% CI 0.24-0.65; p < 0.001). There was no difference in CVM between men who did and did not receive RT (AHR 0.89; 95% CI 0.60-1.15; p = 0.230) and a numerical increase in SM in men who received RT as compared to others (AHR 1.25; 95% CI 0.90-1.72; p=0.180). Conclusions: Compared to the general population, men with a history of stage I seminoma had increased risks of all-cause mortality, death from second malignancies, and suicide. Our data suggest that 15 years after diagnosis, men who did receive RT may be more likely to die from a second malignancy than men who did not. Although not receiving RT was associated with higher testicular-cancer mortality, the results may reflect decreased access to care or follow-up as active surveillance protocols were not common during the study era. No significant financial relationships to disclose.

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Excellent outcomes in bilateral testicular germ cell tumors over four decades.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.523 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 523-523

Author(s):

Ning-Ning Lu ◽

Aaron Richard Hansen ◽

Philippe L. Bedard ◽

Padraig Richard Warde ◽

Joan Sweet ◽

...

Keyword(s):

Testicular Cancer ◽

Germ Cell ◽

Germ Cell Tumors ◽

Patient Characteristics ◽

Stage I ◽

Second Primary ◽

Time Interval ◽

Testicular Germ Cell ◽

Prior Therapy

523 Background: Bilateral testicular germ cell tumours (BTC) form a small minority of testicular cancer and detailed management data are sparse. Methods: Bilateral testicular cancer (BTC) patients managed at a single cancer centre were retrospectively analyzed. Synchronous BTC was defined as uni+contralateral presentation within 3 months. Patient characteristics, treatment and outcomes were collected. Kaplan-Meier method was used to calculate the overall survival (OS) and relapse-free survival (RFS). Results: Between Jan 1971 to Jun 2018, 118 pts were included. Nine patients (7.6%) had cryptorchidism. Twenty-two patients (18.6%) had synchronous BTC at median age of 30(21-54) years, 11 presented with concordant histology (10-seminoma). Median follow-up time was 96(1-220) months. Two of 14 patients (14%) with stage I disease on surveillance had retroperitoneal nodal recurrence, other 3 (21%) had testicular recurrence after partial orchiectomy alone. No recurrence occurred for 8 stage II/III patients (36%) who received stage-appropriate treatment. All patients were alive without disease at last follow-up. For metachronous BTC, the median age was 27(16-68) and 37(19-78) years for first and second diagnosis, respectively. The median time interval was 88 (8-352) months, with shorter interval when second primary was non-seminoma, median 69 vs. 92 months. Concordant histology was present in 58 (38-seminoma) patients and discordant in 38 patients. There were 66, 23, 7 and 84, 9, 3 patients with stage I, II, III disease for first and second testicular cancer (TC), respectively. For all stage I disease, 69% of non-seminoma (n = 33) and 79% of seminoma (n = 81) were on surveillance, of whom the crude relapse rate was 15%. The median follow-up time after second diagnosis was 87 months. In all, 35 patients (30%) with recurrence except 1 were successfully salvaged. The 10-year OS and RFS for whole cohort was 99% and 69.8%, respectively. Conclusions: In our series, seminoma was the more common pathology, and management based on pathology and stage yielded excellent outcomes regardless of prior therapy. Metachronous BTC may occur at extremely long time intervals such that longer follow-up is needed to capture the majority of contralateral primary TC.

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Predictors of morbidity and mortality in acromegaly: an Italian survey

Acta Endocrinologica ◽

10.1530/eje-12-0084 ◽

2012 ◽

Vol 167 (2) ◽

pp. 189-198 ◽

Cited By ~ 111

Author(s):

M Arosio ◽

G Reimondo ◽

E Malchiodi ◽

P Berchialla ◽

A Borraccino ◽

...

Keyword(s):

Diabetes Mellitus ◽

Vascular Diseases ◽

Nationwide Survey ◽

Hormonal Control ◽

Older Age ◽

Morbidity And Mortality ◽

Standardized Mortality Ratio ◽

Therapeutic Procedures ◽

Mortality Ratio

ObjectiveTo describe demographic and hormonal characteristics, comorbidities (diabetes mellitus and hypertension), therapeutic procedures and their effectiveness, as well as predictors of morbidity and mortality in a nationwide survey of Italian acromegalic patients.DesignRetrospective multicenter epidemiological study endorsed by the Italian Society of Endocrinology and performed in 24 tertiary referral Italian centers. The mean follow-up time was 120 months.ResultsA total of 1512 patients, 41% male, mean age: 45±13 years, mean GH: 31±37 μg/l, IGF1: 744±318 ng/ml, were included. Diabetes mellitus was reported in 16% of cases and hypertension in 33%. Older age and higher IGF1 levels at diagnosis were significant predictors of diabetes and hypertension. At the last follow-up, 65% of patients had a controlled disease, of whom 55% were off medical therapy. Observed deaths were 61, with a standardized mortality ratio of 1.13 95% (confidence interval (CI): 0.87–1.46). Mortality was significantly higher in the patients with persistently active disease (1.93; 95% CI: 1.34–2.70). Main causes of death were vascular diseases and malignancies with similar prevalence. A multivariate analysis showed that older age, higher GH at the last follow-up, higher IGF1 levels at diagnosis, malignancy, and radiotherapy were independent predictors of mortality.ConclusionsPretreatment IGF1 levels are important predictors of morbidity and mortality in acromegaly. The full hormonal control of the disease, nowadays reached in the majority of patients with modern management, reduces greatly the disease-related mortality.

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Dissecting the Evolving Risk of Relapse over Time in Surveillance for Testicular Cancer

Advances in Urology ◽

10.1155/2018/7182014 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Madhur Nayan ◽

Robert J. Hamilton

Keyword(s):

Testicular Cancer ◽

Management Strategy ◽

Clinical Stage ◽

Stage I ◽

Risk Estimate ◽

Conditional Survival ◽

Common Malignancy ◽

Over Time ◽

Risk Of Relapse

Testicular cancer is the most common malignancy in young men, and the incidence is increasing in most countries worldwide. The vast majority of patients present with clinical stage I disease, and surveillance is being increasingly adopted as the preferred management strategy. At the time of diagnosis, patients on surveillance are often counselled about their risk of relapse based on risk factors present at diagnosis, but this risk estimate becomes less informative in patients that have survived a period of time without experiencing relapse. Conditional survival estimates, on the other hand, provide information on a patient’s evolving risk of relapse over time. In this review, we describe the concept of conditional survival and its applications for surveillance of clinical stage I seminoma and nonseminoma germ cell tumours. These estimates can be used to tailor surveillance protocols based on future risk of relapse within risk subgroups of seminoma and nonseminoma, which may reduce the burden of follow-up for some patients, physicians, and the health care system. Furthermore, conditional survival estimates provide patients with a meaningful, evolving risk estimate and may be helpful to reassure patients and reduce potential anxiety of being on surveillance.

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