735P - Causes of death in a complete cohort of testicular cancer patients diagnosed in Norway 1980-2009, with detailed treatment information

Background

Testicular germ cell tumors (TGCT) have an excellent prognosis. This study aimed to provide population-based clinical data on cause-specific deaths with detailed treatment information, as such data are scarce.

Methods

From the Cancer Registry of Norway we identified 6167 men with testicular cancer diagnosed 1980-2009, of whom 714 died before 2011. Excluding non-TGCT, clinical or post-mortem diagnoses, 588 were included. Information on Royal Marsden clinical stage (CS), comorbidity, treatment, follow-up and cause of death was obtained from patient journals.

Results

Of 588 deceased patients, 311, 191 and 86 were diagnosed in the 1980s, 90s and 00s, respectively. Most had seminoma (55%), and 48% were concurrent smokers. Median time to death (MTD) of TGCT, treatment complications or other causes was 1.5, 0.4 and 12.1 years, respectively. Of 315 deceased patients with initial CS1, 4% died of relapsed TGCT or treatment complications, while 35% died of non-TGCT cancer. Of 273 deceased patients with initial metastatic TGCT, 149 (55%) died of TCGT or treatment complications. Most had nonseminoma (77%). The primary treatment in these 149 patients was a combination of chemotherapy and surgery in 41%, chemotherapy alone in 33%, radiotherapy alone in 3%, trimodal treatment in 11%, radiotherapy and chemotherapy in 7%, while 4% received no treatment. Of the 149 patients, 95 (64 %) had CS4: pulmonary metastases, non-pulmonary visceral metastases or both were reported in 84, 42 and 34 patients, respectively. According to IGCCCG, 61%, 27% and 4% belonged to the poor, intermediate and good prognosis groups, respectively. Most (58%) died in primary treatment before entering follow-up. Of all 273 patients, 14 % died of non-TGCT cancer.

Conclusions

In this complete three-decade cohort, cause-specific death of TGCT was exceedingly rare in CS1 or good prognosis metastatic disease. TGCT death was rare if patients went into follow-up after primary treatment. Cause-specific mortality was most pronounced in patients receiving chemotherapy following post-chemotherapy surgery, in patients with nonseminoma or with visceral metastases.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Central Norway Regional Health Authority.

Disclosure

All authors have declared no conflicts of interest.