Cardiovascular risk in long-term testicular cancer survivors.

Abstract

4533 Background: The aim was to evaluate the incidence of non-fatal cardiovascular disease (CVD) and risk profile in testicular cancer (TC) survivors (TCS). Methods: 990 men treated for unilateral TC (1980-1994) were included in this national follow-up study (2007-2008) including physical examination, blood samples and a questionnaire. Patients were categorized into four treatment groups: Surgery (n=206), radiotherapy only (RT, n=386), cisplatin-based chemotherapy only (chemo, n=364) and combined RT/chemotherapy (RT/chemo, n=34). Age-matched male controls from the general population (NORMs) were recruited from the Tromsø Study (n=990). Men diagnosed with CVD before or within two years after the TC diagnosis were excluded from analyses of CVD endpoints (age-adjusted Cox regression). CVD endpoints were 1) coronary heart disease (CHD) and 2) total CVD. All CVD diagnoses were validated by medical records (TCS). For comparisons to NORMs, the combination of stroke/myocardial infarction (MI) was the endpoint as only these diagnoses were validated. Results: Median observation time was 19 years (range 13-28). Overall 92 TCS (9.9%) experienced CVD events during follow-up. Compared with surgery group, the chemo (HR 2.6, 95% CI 1.0-6.9) and the RT/chemo group (HR 5.3, 95% CI 1.5-18.5) had increased risks for CHD. Increased risks for total CVD were observed after any cytotoxic treatment (RT: HR 2.3, 95% CI 1.1-4.7; chemo: HR 2.4, 95% CI 1.1-5.0; RT/chemo: HR 5.2, 95% CI 2.0-13.5). Compared with NORMs, TCS had 1.7 times higher risk (95% CI 1.0-2.8) for stroke/MI, with the highest risks for the RT (HR 2.0, 95% CI 1.2-3.5) and the RT/chemo group (HR 4.5, 95% CI 1.6-12.8). All treatment groups except surgery group had increased prevalence of antihypertensive medication compared to NORMS (22% vs. 13%), highest for the chemo (OR 3.3, 95% CI 2.4-4.5) and the RT/chemo group (OR 4.1, 95% CI 1.9-8.8). Survivors in the RT and RT/chemo group had higher levels of micro CRP (RT: β=0.38 mg/l, p<.001, RT/chemo: β=0.63 mg/l, p=0.014), and a higher prevalence of diabetes (RT: OR 2.3, 95% CI 1.5-3.6; RT/chemo: OR 3.9, 95% CI 1.4-10.9). Conclusions: Treatment with infradiaphragmatic RT and/or cisplatin-based chemotherapy, particularly when combined, increases the long-term risk for CVD. No significant financial relationships to disclose.