Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
J Natl Compr Canc Netw. 2012 Apr;10(4):537-44. doi: 10.6004/jnccn.2012.0051.
The introduction of cisplatin-based chemotherapy has transformed germ cell tumors (GCTs), the most common malignancy to affect young adult men, into a highly curable cancer, even in the setting of advanced disease. However, over the past decade, the success of these chemotherapy regimens in curing GCTs has been temporized by an increasing recognition of their important late toxicities, such as cardiovascular disease. The relative risk of coronary artery disease in this population is particularly elevated within the first 10 years of follow-up, when patients are still in their 30s and 40s, which are age groups often considered too young to experience cardiovascular events. Two hypotheses have been proposed to explain the association between chemotherapy and cardiovascular disease in this population. The direct hypothesis asserts that chemotherapy causes diffuse endothelial damage, including in the coronary arteries, gradually leading to cardiovascular disease. In contrast, the indirect hypothesis proposes that chemotherapy leads to an increased incidence of cardiovascular disease risk factors, such as hypertension, hyperlipidemia, and the metabolic syndrome, which in turn enhance the risk of cardiovascular disease. This article summarizes the data on the association between chemotherapy (predominantly cisplatin-based) and the development of cardiovascular disease among GCT survivors, and reviews the evidence supporting both mechanistic hypotheses. In addition, recommendations are provided for the management of GCT survivors who received cisplatin-based chemotherapy and are therefore at risk for cardiovascular toxicity.
顺铂为基础的化疗的引入改变了生殖细胞肿瘤（GCTs），这是最常见的影响年轻成年男性的恶性肿瘤，成为一种高度可治愈的癌症，即使在晚期疾病的情况下也是如此。然而，在过去的十年中，这些化疗方案在治愈 GCTs 方面的成功受到了越来越多的关注，因为它们存在重要的晚期毒性，如心血管疾病。在随访的前 10 年，即患者仍处于 30 多岁和 40 多岁的年龄段时，这群人的冠心病相对风险特别高，而这些年龄段通常被认为太年轻，不会发生心血管事件。有两种假说被提出来解释这一人群中化疗与心血管疾病之间的关联。直接假说认为，化疗导致弥漫性内皮损伤，包括冠状动脉，逐渐导致心血管疾病。相比之下，间接假说提出，化疗导致心血管疾病的风险因素（如高血压、高血脂和代谢综合征）的发生率增加，从而增加了心血管疾病的风险。本文总结了关于化疗（主要是顺铂为基础）与 GCT 幸存者心血管疾病发展之间的关联的数据，并回顾了支持这两种机制假说的证据。此外，还为接受过顺铂为基础化疗的 GCT 幸存者提供了管理建议，因为他们存在心血管毒性的风险。
