Predicted cardiovascular mortality and reported cardiovascular morbidity in testicular cancer survivors
We examined if testicular cancer (TC) treatment is associated with any risk for cardiovascular morbidity or predicted mortality according to the SCORE model, in which a 10-year future risk of ≥5% for developing a fatal cardiovascular event qualify for high-risk status.
One thousand one hundred thirty-four TC survivors treated 1980–1994 participated in this study (1998–2002). Patients were categorised in four treatment groups: surgery (n = 225), radiotherapy (n = 445), and two chemotherapy groups: cumulative cisplatin dose ≤850 mg (n = 375) and >850 mg (cis>850, n = 89). Patients with cardiovascular disease, diabetes or SCORE ≥5% constituted a high-risk group, and those with SCORE >1% an intermediate/high risk group.
Age-adjusted mean SCORE was 0.93% for the surgery group. In comparison, chemotherapy treated patients had significantly higher SCORE (1.07%, p = 0.01). Only 15% of patients were scored to be at high-risk, while 53% qualified for the intermediate/high risk group. Patients in the cis>850 group had increased odds for having intermediate/high risk, compared with the surgery group (OR 3.4, 95% CI 1.3–8.7). Only 23 cardiovascular events had occurred since the testicular cancer diagnosis.
The SCORE model indicates that patients treated with cisplatin-based chemotherapy have a significantly increased future risk of a fatal cardiovascular event.
Implications for cancer survivors
TC survivors should be followed regularly with respect to cardiovascular risk profile beyond the routine 10-year clinical follow-up.
KeywordsTesticular cancer Cisplatin Cardiovascular Mortality Morbidity SCORE
- 1.Bray F, Dahl T, van Dijk T, et al. Cancer in Norway 2006. Available at www.kreftregisteret.no/forekomst_og_overlevelse_2006/CIN2006_web.pdf (2007).
- 16.De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J, et al. European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in clinical practice. Eur Heart J. 2003;24:1601–10.PubMedCrossRefGoogle Scholar
- 17.Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and other Societies on Cardiovascular Disease Prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil. 2007;14(Suppl 2):E1–40.PubMedCrossRefGoogle Scholar
- 23.Klepp O, Olsson AM, Henrikson H, Aass N, Dahl O, Stenwig AE, et al. Prognostic factors in clinical stage I nonseminomatous germ cell tumors of the testis: multivariate analysis of a prospective multicenter study. Swedish–Norwegian testicular cancer group. J Clin Oncol. 1990;8:509–18.PubMedGoogle Scholar
- 26.Horwich A, Oliver RT, Wilkinson PM, Mead GM, Harland SJ, Cullen MH, et al. A medical research council randomized trial of single agent carboplatin versus etoposide and cisplatin for advanced metastatic seminoma. MRC Testicular Tumour Working Party. Br J Cancer 2000;83:1623–9.PubMedCrossRefGoogle Scholar
- 27.Horwich A, Sleijfer DT, Fossa SD, Kaye SB, Oliver RT, Cullen MH, et al. Randomized trial of bleomycin, etoposide, and cisplatin compared with bleomycin, etoposide, and carboplatin in good-prognosis metastatic nonseminomatous germ cell cancer: a multiinstitutional medical research council/European organization for research and treatment of cancer trial. J Clin Oncol. 1997;15:1844–52.PubMedGoogle Scholar
- 43.Khaw KT, Dowsett M, Folkerd E, Bingham S, Wareham N, Luben R, et al. Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men. European prospective investigation into cancer in Norfolk (EPIC-Norfolk) prospective population study. Circulation 2007;116:2694–701.PubMedCrossRefGoogle Scholar