Fung Chunkit, Sesso Howard D, Williams Annalynn M, Kerns Sarah L, Monahan Patrick, Abu Zaid Mohammad, Feldman Darren R, Hamilton Robert J, Vaughn David J, Beard Clair J, Kollmannsberger Christian K, Cook Ryan, Althouse Sandra, Ardeshir-Rouhani-Fard Shirin, Lipshultz Steve E, Einhorn Lawrence H, Fossa Sophie D, Travis Lois B
Chunkit Fung, Annalynn M. Williams, and Sarah L. Kerns, University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester; Darren R. Feldman, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick Monahan, Mohammad Abu Zaid, Ryan Cook, Sandra Althouse, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert J. Hamilton, Princess Margaret Cancer Center, Toronto, Ontario; Christian K. Kollmannsberger, University of British Columbia, Vancouver, British Columbia, Canada; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; Steve E. Lipshultz, Wayne State University School of Medicine; Steve E. Lipshultz, Children's Hospital of Michigan; Steve E. Lipshultz, Karmanos Cancer Institute, Detroit, MI; and Sophie D. Fossa, Oslo University Hospital, Radium Hospital, Oslo, Norway.
J Clin Oncol. 2017 Apr 10;35(11):1211-1222. doi: 10.1200/JCO.2016.70.3108. Epub 2017 Feb 27.
Purpose To provide new information on adverse health outcomes (AHOs) in testicular cancer survivors (TCSs) after four cycles of etoposide and cisplatin (EPX4) or three or four cycles of bleomycin, etoposide, cisplatin (BEPX3/BEPX4). Methods Nine hundred fifty-two TCSs > 1 year postchemotherapy underwent physical examination and completed a questionnaire. Multinomial logistic regression estimated AHOs odds ratios (ORs) in relation to age, cumulative cisplatin and/or bleomycin dose, time since chemotherapy, sociodemographic factors, and health behaviors. Results Median age at evaluation was 37 years; median time since chemotherapy was 4.3 years. Chemotherapy consisted largely of BEPX3 (38.2%), EPX4 (30.9%), and BEPX4 (17.9%). None, one to two, three to four, or five or more AHOs were reported by 20.4%, 42.0%, 25.1%, and 12.5% of TCSs, respectively. Median number after EPX4 or BEPX3 was two (range, zero to nine and zero to 11, respectively; P > .05) and two (range, zero to 10) after BEPX4. When comparing individual AHOs for EPX4 versus BEPX3, Raynaud phenomenon (11.6% v 21.4%; P < .01), peripheral neuropathy (29.2% v 21.4%; P = .02), and obesity (25.5% v 33.0%; P = .04) differed. Larger cumulative bleomycin doses (OR, 1.44 per 90,000 IU) were significantly associated with five or more AHOs. Increasing age was a significant risk factor for one to two, three to four, or five or more AHOs versus zero AHOs (OR, 1.22, 1.50, and 1.87 per 5 years, respectively; P < .01); vigorous physical activity was protective (OR, 0.62, 0.51, and 0.41, respectively; P < .05). Significant risk factors for three to four and five or more AHOs included current (OR, 3.05 and 3.73) or former (OR, 1.61 and 1.76) smoking ( P < .05). Self-reported health was excellent/very good in 59.9% of TCSs but decreased as AHOs increased ( P < .001). Conclusion Numbers of AHOs after EPX4 or BEPX3 appear similar, with median follow-up of 4.3 years. A healthy lifestyle was associated with reduced number of AHOs.
提供有关接受四个周期依托泊苷和顺铂（EPX4）或三个或四个周期博来霉素、依托泊苷、顺铂（BEPX3/BEPX4）治疗后的睾丸癌幸存者（TCSs）不良健康结局（AHOs）的新信息。方法：952例化疗后1年以上的TCSs接受了体格检查并完成了一份问卷。多项逻辑回归分析估计了与年龄、顺铂和/或博来霉素累积剂量、化疗后时间、社会人口学因素及健康行为相关的AHOs比值比（ORs）。结果：评估时的中位年龄为37岁；化疗后的中位时间为4.3年。化疗主要包括BEPX3（38.2%）、EPX4（30.9%）和BEPX4（17.9%）。分别有20.4%、42.0%、25.1%和12.5%的TCSs报告无、一至两个、三至四个或五个及以上AHOs。EPX4或BEPX3后的中位AHOs数量为两个（范围分别为零至九个和零至11个；P>.05），BEPX4后为两个（范围为零至10个）。比较EPX4与BEPX3的个体AHOs时，雷诺现象（11.6%对21.4%；P<.01）、周围神经病变（29.2%对21.4%；P=.02）和肥胖（25.5%对33.0%；P=.04）存在差异。较大的博来霉素累积剂量（每90,000 IU的OR为1.44）与五个及以上AHOs显著相关。与零个AHOs相比，年龄增加是一至两个、三至四个或五个及以上AHOs的显著危险因素（每5年的OR分别为1.22、1.50和1.87；P<.01）；剧烈体育活动具有保护作用（OR分别为0.62、0.51和0.41；P<.05）。三至四个及五个及以上AHOs的显著危险因素包括当前（OR分别为3.05和3.73）或既往（OR分别为1.61和1.76）吸烟（P<.05）。59.9%的TCSs自我报告健康状况为优秀/非常好，但随着AHOs增加而下降（P<.001）。结论：在中位随访4.3年时，EPX4或BEPX3后的AHOs数量似乎相似。健康的生活方式与AHOs数量减少相关。
