Clinical observations indicate a higher prevalence of psychiatric disorders, in particular neurodevelopmental disorders, among testicular germ cell cancer (TGCC) patients. Our aim was to investigate if history of specific psychiatric disorders is associated with increased risk of TGCC and/or increased mortality.
We conducted a nested case-control study including 6,250 TGCC patients diagnosed 1992-2014, individually matched to 62,500 controls. Using conditional logistic regression, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between history of psychiatric diagnoses and TGCC risk. Among the cases only, we used a cohort study design and Cox regression to calculate hazard ratios (HRs) with 95% CIs of the association between psychiatric diagnosis and all-cause and TGCC-specific mortality.
History of a neurodevelopmental disorder (i.e., attention deficit hyperactivity disorder, autism spectrum disorder and intellectual disabilities) was associated with an increased risk of seminoma (OR 1.54; 95% CI 1.09-2.19). Seminoma patients with neurodevelopmental disorders were also younger (34 versus 38 years, p=0.004) and more often presented with stage IV disease (5.4% versus 1.2%) than those without. A decreased risk of seminoma was seen for patients with psychotic disorders (OR 0.62; 95% CI 0.40-0.96). Psychiatric history overall was not associated with TGCC. Patient history of any psychiatric disorder was associated with an increased all-cause mortality (HR 2.91; 95% CI 2.11-4.02) and an increased TGCC-specific mortality (HR 1.79; 95% CI 1.04-3.08).
We report, for the first time, an association between neurodevelopmental disorders and testicular seminoma. Furthermore, we found an increased TGCC-specific mortality for TGCC-patients with psychiatric disorders.
Clinical trial identification
Legal entity responsible for the study
Uppsala University, Research group Ingrid Glimelius.
Swedish Cancer Society (CAN 19 0123 Pj).
A. Pettersson: Financial Interests, Personal, Other, Honoraria: Capio St. Göran; Financial Interests, Personal, Other, Honararia: Astellas Pharma; Financial Interests, Personal, Other, Honoraria: Mediahuset i Göteborg; Financial Interests, Personal, Other, Advisor: Janssen-Cilag; Financial Interests, Personal, Other, Grants: Merck & Co.; Financial Interests, Personal, Other, CEO and Co-Founder: Levo Prevention AB. I. Glimelius: Financial Interests, Institutional, Other, I participate as Scientific Board on an Educational Event: Janssen-Cilag; Financial Interests, Personal, Other, I participate in a Real-World Initiative to Study Register-Based Data Supported by: Takeda; Financial Interests, Personal, Other, Safety Board for Evaluation of Side-Effects from the Viral Vector Developed within the Company: Lokon Pharma. All other authors have declared no conflicts of interest.