Survivorship After Testicular Cancer in Adolescents and Young Adults: What is Causing Death and When?
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INTRODUCTION: Testicular germ cell tumor (GCT) is the most common malignancy among male adolescents and young adults (AYAs), yet long-term causes of death beyond primary cancer are not well defined. We evaluated cause-specific mortality in AYA survivors of testicular GCT to identify patterns across histology, across stage, and throughout survivorship. METHODS: This is a population-based analysis using SEER data. Standardized mortality ratios (SMRs) compared observed causes of death among AYA patients with GCT with expected rates in age-matched, sex-matched, and year-matched controls. RESULTS: Of 1870 deaths, 52% were from primary GCT, 15% from nontestis cancers (SMR 4.13), and 32% from noncancer causes (SMR 1.11). Noncancer deaths occurred at higher-than-expected rates for chronic liver disease/cirrhosis but were lower for heart disease. Nonseminoma was associated with higher GCT mortality and modestly elevated mortality from liver disease and diabetes. Stage I patients most often died of accidents/suicide/homicide, whereas stage III patients experienced markedly elevated secondary cancer mortality. Mortality patterns shifted over time: GCT deaths predominated in years 0 to 5; accidents/suicide/homicide, cardiovascular diseases, and liver disease were elevated early. After 10 years, noncancer deaths predominated but were below expected rates. Limitations include retrospective design, potential misclassification of cause of death, and inability to assess treatment-specific exposures. CONCLUSIONS: AYA testicular GCT survivors experience substantial noncancer and secondary malignancy mortality, with risks varying by histology, stage, and time since diagnosis. Survivorship care should incorporate behavioral health support, comprehensive health monitoring, and secondary cancer surveillance.