Increased mortality rates in young and middle-aged patients with malignant germ cell tumours

Cisplatin-based chemotherapy of malignant germ cell tumours (MGCT) has been reported to increase the risk of cardiovascular morbidity. A high incidence of second nongerm cell malignancies is well documented in MGCT survivors. The death risk due to these conditions is, however, more unknown in MGCT patients. Standard mortality rates (SMRs) were established in 3378 Norwegian MGCT patients treated from 1962 to 1997 aged less than or equal to55 years. The patients represented three principal treatment strategies: 1962/1969 (period 1): radiotherapy only; 1970/1979 (period 2): radiotherapy with or without noncisplatin-containing chemotherapy; 1980/1997 (period 3): surgery only or radiotherapy or cisplatin-based chemotherapy. Patients were censored when they reached the age of 60 years. Patients not dying from MGCT displayed significantly increased SMRs for respectively diseases of the circulatory system (SMR: 1.2, 95% confidence interval (CI): 1.0-1.5), benign gastrointestinal disorders (SMR: 2.1, 95% CI: 1.1-3.5) and nongerm cell malignancies (SMR: 2.0, 95% CI: 1.7-2.4). The SMRs for diseases of the circulatory system were similar in the three observation periods, whereas the highest SMR for benign gastrointestinal disorders was observed in patients from period 2. The risk of dying from a nongerm cell malignancy was increased both in periods 2 and 3. In conclusion, although the overall SMR for diseases of the circulatory system is increased in MCGT survivors, the introduction of cisplatin-based chemotherapy into the treatment of MGCT has so far not resulted in increased death rates due to these conditions. Patients with MGCT have a significantly increased relative death risk due to a second nongerm cell cancer, even after the introduction of modern treatment principles with overall reduction of radiotherapy. The increased death risk due to benign gastrointestinal disorders, probably related to radiotherapy, requires future in-depth analysis.