Cytotoxic treatment for testicular cancer increased the long-term risk of atherosclerotic disease compared with surgery alone (chemotherapy HR 2.6; 95% CI 1.1-5.9).
Cohort (n=1,980)
Yes
Do cytotoxic treatments for testicular cancer increase the long-term risk of cardiovascular disease compared to surgery alone or general population controls?
Long-term survivors of testicular cancer treated with radiotherapy or cisplatin-based chemotherapy have a significantly increased risk of cardiovascular disease and cardiovascular risk factors compared to those treated with surgery alone or the general population.
Effect estimate: HR 2.6 (95% CI 1.1 to 5.9)
PURPOSE: To evaluate the prevalence of cardiovascular risk factors and long-term incidence of cardiovascular disease (CVD) in survivors of testicular cancer (TC). METHODS: Overall, 990 men treated for unilateral TC (1980 to 1994) were included in this national follow-up study (2007 to 2008). They were categorized into four treatment groups: surgery (n = 206), radiotherapy only (RT; n = 386), chemotherapy only (n = 364), and combined RT/chemotherapy (n = 34). Age-matched male controls from the general population (ie, NORMs) were included (n = 990). Survivors of TC who were diagnosed with CVD before or within 2 years after the TC diagnosis were excluded from analyses of CVD end points. RESULTS: Median observation time was 19 years (range, 13 to 28 years). All cytotoxic treatment groups had significantly increased prevalences of antihypertensive medication, and survivors in the RT and RT/chemotherapy groups had higher prevalences of diabetes (RT: odds ratio OR, 2.3; 95% CI, 1.5 to 3.7; RT/chemotherapy: OR, 3.9; 95% CI, 1.4 to 10.9) compared with NORMs. Overall 74 survivors of TC (8.0%) experienced atherosclerotic disease during follow-up. Increased risks for atherosclerotic disease were observed in age-adjusted Cox regression analyses after any cytotoxic treatment when compared with surgery only (RT: hazard ratio HR, 2.3; 95% CI, 1.04 to 5.3; chemotherapy: HR, 2.6; 95% CI, 1.1 to 5.9; RT/chemotherapy: HR, 4.8; 95% CI, 1.6 to 14.4). Treatment with cisplatin, bleomycin, and etoposide (BEP) alone had a 5.7-fold higher risk (95% CI, 1.9 to 17.1 fold) for coronary artery disease compared with surgery only and a 3.1-fold higher risk (95% CI, 1.2 to 7.7 fold) for myocardial infarction compared with NORMs. CONCLUSION: Treatment with infradiaphragmatic RT and/or cisplatin-based chemotherapy, particularly the BEP regimen, increases the long-term risk for CVD in survivors of TC.
Haugnes et al. (Tue,) conducted a cohort in Testicular cancer (n=1,980). Cytotoxic treatment (radiotherapy and/or chemotherapy) vs. Surgery only or general population controls was evaluated on Atherosclerotic disease (HR 2.6, 95% CI 1.1 to 5.9). Cytotoxic treatment for testicular cancer increased the long-term risk of atherosclerotic disease compared with surgery alone (chemotherapy HR 2.6; 95% CI 1.1-5.9).