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Identification of risk factors and prediction models for secondary malignant neoplasms (SMNs)-free survival and SMNs-specific survival in testicular cancer survivors

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Abstract

Objective

This research endeavored to determine the key demographic and pathological factors tied to secondary malignant neoplasms (SMNs) in survivors of testicular cancer and to develop a predictive model.

Method

A total of 53,309 testicular cancer patients from the SEER national database (1975–2016) were included in our analysis. The primary outcome measured was SMNs-free survival, defined as the duration from testicular cancer diagnosis to the detection of a non-testicular malignancy. The secondary outcome was SMN-specific survival, defined as the period from testicular cancer diagnosis until the patient's death due to SMNs.

Findings

Of the patients in the SEER cohort, 2978 (5.6%) developed non-testicular cancer SMNs. Higher age, receipt of chemotherapy, and radiation treatment were all significantly associated with the development of SMNs in survivors of testicular cancer (all p < 0.001). Kaplan–Meier analysis revealed a worse SMNs-free survival and poor SMN-specific survival in patients who underwent radiation therapy (both p < 0.001). Multivariable Cox regression analysis found non-Hispanic Black ethnicity, higher age, chemotherapy, and radiation therapy to be significantly associated with worse SMNs-free survival (p = 0.002, p < 0.001, p < 0.001, and p < 0.001, respectively), while lymphoma histology was associated with better SMNs-free survival (p < 0.001). The most common SMN types in patients receiving radiation therapy were prostate, lung, and bladder cancers. Predictive nomograms for SMNs-free survival and SMNs-specific survival were developed, with a C-index of 0.776 and 0.824, respectively.

Conclusion

The age of diagnosis, non-Hispanic Black ethnicity, lymphoma histology, and treatment history with chemotherapy and radiation therapy were identified as prognostic factors for SMNs-free survival.

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Authors and Affiliations

  1. Department of Urology, University of Louisville School of Medicine, Louisville, KY, 40217, USA

    Hangcheng Fu, Sriharsha Talluri, Samarpit Rai & Murali K. Ankem

  2. Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA

    Lifan Liang

  3. Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY, USA

    Jaimin Trivedi

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  1. Hangcheng Fu
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  2. Sriharsha Talluri
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  4. Lifan Liang
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  6. Murali K. Ankem
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Contributions

HF for the study concept and design, acquisition of data, analysis and interpretation of data, statistical analysis, and drafting of the manuscript; ST, LL, and JT for drafting and revising the manuscript. SR for technical and material support; MA for study concept and design and study supervision. All authors read and approved the final manuscript.

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Correspondence to Murali K. Ankem.

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Conflict of interest

The authors declare no potential conflicts of interest.

Research involving human participants and/or animals and informed consent

The Human Subjects Office/Institutional Review Board (IRB) reviewed our study. The Ethics Committee clearance was obtained. Informed consent from patients were obtained as documented from the SEER official website.

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Supplementary Information

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345_2023_4515_MOESM1_ESM.tif

Supplementary file1 Figure S2. Kaplan-Meier Suvival Curves of SMNs-free survival and SMN-specific survival between patients diagnosed before 2005 and patients diagnosed after 2006. (A) Patients with radiation showed worse SMNs-free survival from patients without radiation in the subgroup of patient diagnosed before 2005 (median follow-up 201 months). (B) Patients with radiation showed no difference of SMNs-free survival from patients without radiation in the subgroup of patients diagnosed after 2006 (median follow-up 53 months). (C) Patients with radiation showed worse SMNs-specific survival from patients without radiation in the subgroup of patient diagnosed before 2005 (median follow-up 201 months). (D) Patients with radiation showed no difference of SMNs-specific survival from patients without radiation in the subgroup of patients diagnosed after 2006 (median follow-up 53 months) (TIF 17192 KB)

Supplementary file2 (DOCX 19 KB)

Supplementary file3 (DOCX 18 KB)

Supplementary file4 (DOCX 17 KB)

345_2023_4515_MOESM5_ESM.jpeg

Supplementary file5 Figure S1. Study Design. SEER database containing all the registrated patients data from 1975 to 2016, 58,255 testicular survivors were included with the initial inclusion criteria. After excluding testicular cancer not being the first primary malignancy, unknown follow-up time and patients within 3 months of diagnosis. We eventually included 53,309 patients with 2,978 patients diagnosed with non-testicular cancer SMNs after their initial testicular cancer diagnosis (JPEG 283 KB)

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Fu, H., Talluri, S., Rai, S. et al. Identification of risk factors and prediction models for secondary malignant neoplasms (SMNs)-free survival and SMNs-specific survival in testicular cancer survivors. World J Urol 41, 2413–2420 (2023). https://doi.org/10.1007/s00345-023-04515-8

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  • DOI: https://doi.org/10.1007/s00345-023-04515-8

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