Testicular germ cell tumor (GCT) is the most common malignancy among adolescent and young adult (AYA) males, 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, stage, and throughout survivorship.
This is a population-based analysis using SEER data. Standardized mortality ratios (SMRs) compared observed causes of death among AYA patients with GCT to expected rates in age-, sex-, and year-matched controls.
Of 1,870 deaths, 52% were from primary GCT, 15% from non-testis cancers (SMR 4.13), and 32% from non-cancer causes (SMR 1.11). Non-cancer deaths occurred at higher-than-expected rates for chronic liver disease/cirrhosis but were lower for heart disease. Non-seminoma was associated with higher GCT mortality and modestly elevated mortality from liver disease and diabetes.Stage I patients most often died from accidents/suicide/homicide, whereas stage III patients experienced markedly elevated secondary cancer mortality. Mortality patterns shifted over time: GCT deaths predominated in years 0-5; accidents/suicide/homicide, cardiovascular, and liver disease were elevated early. After 10 years, non-cancer deaths predominated but were below expected rates. Limitations include retrospective design, potential misclassification of cause of death, and inability to assess treatment-specific exposures.
AYA testicular GCT survivors experience substantial non-cancer 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.
The Journal of urology. 2026 Apr 28 [Epub ahead of print]
Kimberly Toumazos, Yana Feygin, Naveen Gupta, Jonathan Walker, Will Cranford, Jennifer Zack, Sydney E Strup, Kathleen Kieran, Nicholas G Cost, Caryn Sorge, Patrick Hensley, Christopher McLouth, Amanda F Buchanan
University of Kentucky, Department of Urology, Lexington, KY., University of Kentucky, Department of Biostatistics, Lexington, KY., University of Toronto, Department of Urology, Toronto, ON, Canada., Atrium Health, Levine Children's Urology Department, Charlotte, NC., Georgetown University Hospital, Department of Urology, Washington, DC., Seattle Children's Hospital, Department of Pediatric Urology Seattle, WA., Children's Hospital Colorado, Department of Pediatric Urology and the Surgical Oncology Program, Aurora, CO., University of Kentucky, Department of Pediatrics, Division of Hematology/Oncology, Lexington, KY.